Quote Of The Year

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

Sunday, July 26, 2009

Useful and Interesting Health IT News from the Last Week – 26/07/2009.

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

First we have:

E-prescribing a ‘freaking mess’

23-Jul-2009

A race to sign up GPs to electronic prescribing systems is undermining the public good, independent observers say.

E-script software brands Medisecure and eRx are both calling on GPs to register with their software for free, and start using scripts with barcodes to reduce transcription errors at the pharmacy.

They say that once the Federal Government rolls out patient and provider health identifier numbers from next year, the e-scripts may start to replace paper scripts altogether.

But because the two systems are not interoperable, an e-script will only function if the pharmacist uses the same software as the GP.

Health IT specialist Dr David More said the situation was "a complete freaking mess".

.....

A spokeswoman for the Federal Health Department would not comment on whether GPs should start using either system.

Dr Mukesh Haikerwal, an advisor to NEHTA, said prescriptions needed to be readable one system to another, and not dependent on the supply of software.

"The problem is these two companies have beaten the standards setters to the post," he said. "They are not helping anyone."

More here (subscription required):

http://www.australiandoctor.com.au/articles/71/0c062a71.asp

Three points:

First your blogger is going to be a bit more reserved in chatting with journalists (but the quote is accurate)!

Second obviously NEHTA and DoHA are not all that impressed either with what is going on.

Third – does anyone remember this tender?

RFT 272/0809

REQUEST FOR TENDER

EPRESCRIBING AND DISPENSING OF MEDICINES BENEFITS REALISATION AND IMPLEMENTATION PLAN

LODGEMENT OF TENDERS (Refer Part A, Section 3.1)

Tenders must be lodged by “Tender Closing Date” (2.00pm local Canberra time on Thursday 23 April 2009).

I am told that it will still be a week or two before the contract to do this work is awarded – at the earliest – and given the work is to take 34 weeks we are looking at close to the middle of 2010 before DoHA will even have a plan of what to do. Just amazingly pathetic in my view!

Invaluable background is found here:

Canberra fails to follow the online script

Karen Dearne | July 18, 2009

Article from: The Australian

DOCTORS and pharmacists have lined up behind rival electronic prescribing systems that will eventually spell an end to paper scripts, despite an e-prescribing policy vacuum in Canberra.

Two main players have emerged to claim the new market, with the Pharmacy Guild's 50 per cent owned eRx Script Exchange first out of the blocks. MediSecure, endorsed by the Royal Australian College of General Practitioners, is not far behind.

At stake is a potential $60 million annually, with both players set to charge a 25cent fee for each transaction out of 240million prescriptions issued each year.

They are forcing the pace as federal Health Minister Nicola Roxon has yet to provide clear direction. As well, the Department of Health and Ageing is scrambling to complete internal investigations of key management and operational concerns.

A spokeswoman says the department is ``still considering'' the outcome of a tender earlier this year calling for consultants to draw up an e-prescribing business and implementation plan in response to a previous critical report from financial advisory firm KPMG last year.

But the spokeswoman indicates the department may play ball on transaction fees, an item certain to be on the agenda as the Pharmacy Guild sits down to thrash out the fifth community pharmacy agreement. Negotiations are gearing up now.

``The issue of payment arrangements will be considered if it arises, taking into account the business efficiencies that e-prescribing and dispensing provides,'' the spokeswoman tells Weekend Health.

Much more detail here:

http://www.theaustralian.news.com.au/story/0,25197,25796849-23289,00.html

Second we have:

Essential e-health is watertight

Article from The Advertiser

July 20, 2009 12:01am

THE implementation of a national e-health system may well save money and probably lives.

Eight in 10 Australians believe it is a good idea. But, as with any genuine reform, the Federal Government must be sure it gets the process right. Doctors and their patients must be satisfied that the system is secure and reliable.

In 2004, a national body was set up by the country's health ministers to drive e-health forward. In 2006, then-opposition health spokeswoman Julia Gillard attacked the Howard government for lagging on the issue. She said it was "dangerously close" to being an "expensive failure".

It was then spruiked at Prime Minister Kevin Rudd's 2020 Summit, and the details released in today's Advertiser are another important step forward.

Shared electronic records will give patients more control over their medical care by allowing them to easily access their own information, such as vaccination, prescription, and chronic disease information.

It will give doctors more control by helping to stamp out "doctor shopping" and allowing better continuity of care.

More here:

http://www.news.com.au/adelaidenow/story/0,22606,25807068-5006336,00.html

It is good to see we are now even seeing editorials on how useful e-Health could be. They do also not it has to be done right – that is where the risk lies right now!

Third we have:

AMA criticises plans for 'e-health' medical records reform

Plans to give Australians access to their health records online are being criticised by the nation's peak medical body.

The proposal has reportedly been put forward by the National Health and Hospitals Reform Commission (NHHRC).

Under the plan doctors would have to link patient records to a national database, with those who don't comply to miss out on lucrative medicare payments.

But AMA President Andrew Pesce says threats won't result in a quality system.

"It would be much better to provide adequate incentives to recognise there will be an initial financial outlay and cost to developing properly working medical records."

The NHHRC says an e-health system would save the government up to $8 billion over 10 years, making it easier to track the progress of chronic disease sufferers and store test results, scans and x-rays.

More here:

http://livenews.com.au/news/ama-criticises-plans-for-ehealth-medical-records-reform/2009/7/20/213407

Dr Pesce is dead right to point out that imposing penalties without some prior incentives is just crazy!

More AMA commentary is here:

http://www.news-medical.net/news/20090720/e-Health-revolution-will-give-Australian-patients-access-to-their-health-records.aspx

e-Health revolution will give Australian patients access to their health records

20. July 2009 01:01

The Australian Medical Association (AMA) which represents than 27,000 doctors across Australia has criticised the government's plans for 'e-health' medical records reform.

And here:

http://www.australianit.news.com.au/story/0,25197,25819833-15306,00.html

E-health vital to rural areas: AMA

Karen Dearne | July 22, 2009

E-HEALTH infrastructure in rural Australia must be a priority for federal and state governments, the new president of the Australian Medical Association, Andrew Pesce, has warned.

Fourth we have:

Experts warn of e-health privacy threat

22-Jul-2009

By Sarah Colyer

PRIVACY experts are warning of mayhem -- including greater identity theft and dubious secondary use of patient information -- when Medicare begins its rollout of electronic health identifiers next year.

The proposed system is designed to allow health professionals to send data to each other without the risk of the information being intercepted or corrupted by third parties.

In a discussion paper released last week, the Australian Health Ministers' Advisory Council said Medicare would introduce operational identifiers for patients and health providers from mid-next year -- before national privacy legislation had been finalised.

Existing federal, state and territory privacy laws would apply in the interim, it said, despite noting that the laws were inconsistent and confusing.

Chairwoman of the Australian Privacy Foundation's health sub-committee Dr Juanita Fernando (PhD) said, "in any kind of project management situation this would be laughed at".

Full article here:

http://www.australiandoctor.com.au/articles/c4/0c0629c4.asp

This debate has a while to run yet I believe.

Fifth we have:

Doctors issue deadly warning

IT seems incredible that a patient record system that aims to improve treatment could kill people, but that is a claim being made about a new system that is almost certainly going to be introduced into the Grafton Base Hospital next week.

Earlier this month, leading health officials from the Lismore Base Hospital wrote to the North Coast Area Health Service (NCAHS) claiming a new Surginet electronic medical record system that had been operating in the hospital for several months would 'inevitably' lead to the death of patients.

But the health service said changes had been made to the Surginet electronic medical record (EMR) system since the concerns were raised by the four senior clinicians on July 2, and the system had been operating 'satisfactorily' in Sydney without patient concerns being raised.

In their letter to NCAHS chief executive officer Chris Crawford, which was copied to the Minister for Health John Della Bosca, the four medical specialists said there had been recurring problems over several months and 'these have not improved'.

“This has resulted in unnecessary compromise of patient safety,” they wrote.

“There have been repeated well demonstrated cases of near miss disasters due to these problems.

“We believe that negative patient outcomes, including death, will inevitably result from the continuing use of this system.

“Surginet is fundamentally flawed.

“New technology should: improve the quality of our work; help us to be more efficient, and; make routine tasks easier.

“EMR Surginet does none of these; in fact it has had the opposite effect.

More here:

http://www.dailyexaminer.com.au/story/2009/07/23/doctors-issue-a-deadly-warning/

It seems there are some ongoing issues with these implementations in the rural areas. I will be interested to hear comments from those involved.

Sixth we have:

Crikey July 23, 2009

3 . Aboriginal patients may end up the real losers in ACC victory

Paul Smith, political editor of Australian Doctor, writes:

After a long-running legal tussle, a remote Aboriginal health clinic has lost its battle against the Australian Crime Commission (ACC) to safeguard the privacy of its patient records. Subject to another appeal, the clinic will have to hand over the records of eight Indigenous children to the ACC.

Whether those records contain information which is of sufficient importance to justify the protracted efforts of the country's most powerful crime-fighting organisation to seize them is one of many unanswered questions about this case. But I doubt the ACC bosses will have been celebrating its legal victory with much enthusiasm.

Firstly the court case itself has lifted the lid on activities it was desperate to keep secret. It used a series of gagging orders to stop anyone approached for medical records revealing to either patients or the wider public what was happening. The penalties were fines and jail sentences.

Secondly when you read the Federal Court ruling, you get a picture of an organisation that seemed to pay little regard to the implications of its actions -- for the clinic, the Indigenous community or the patients treated at the clinic.

The Federal Court found the ACC had a legal obligation to consider "the interests of the children" when forcing the clinics to hand over the records. It seems the commission managed to do this -- just. The Federal Court ruled that by acknowledging the clinic's concerns that the children and others may not seek medical attention if they discovered their files were being secretly handed over to crime investigators, the ACC had met its obligation.

But it is important to stress the court did not consider whether the commission had, for instance, carefully weighed the pros and cons and come to a well-informed, reasoned decision to issue its legal orders. The court never looked at that issue (it was not part of the appeal) even though it described ACC's attempts to document in the paperwork its reasons for seizing the records as "laconic, formulaic and often unhelpful", suggesting it may have been a "tick-box" exercise.

Much more here (subscription required):

http://www.crikey.com.au/2009/07/23/aboriginal-patients-may-end-up-the-real-losers-in-acc-victory/

This is an issue that still has a way to run. I don’t feel what was done here was in any way appropriate. The way the ACC went about this is repressive in the extreme I believe. As a commentator points out all sorts of similar records are likely to vanish unexpectedly at the first sign of a request for information of this kind!

Seventh we have:

HCL Axon bags Ramsay SAP deal

Fran Foo | July 21, 2009

HCL Axon has scored a gig worth almost $1.5 million with Ramsay Health Care for its multi-million-dollar SAP project.

Despite the economic crunch, Australia's largest private hospital operator in January began the selection process for a partner to undertake its ambitious SAP plan.

Ramsay is in the midst of deploying SAP ERP 6 for financials, purchasing and inventory management, as it moves to consolidate legacy systems gained through acquisitions.

Half of Ramsay's sites run on an older SAP platform, while Pronto Software, a Melbourne-based ERP player, powers the other half.

According to Brian Pereira, HCL Axon's head of Asia-Pacific, Japan and Middle East, Ramsay will be able to standardise business processes and information currently not possible, as the two systems are structured and configured differently.

"Key benefits will be the elimination of duplication in data, reporting and processes," Mr Pereira said. "Ramsay went through a selection process in January and the actual project commenced in March 2009. Our consulting services component is worth nearly $1.5m."

In Australia, SAP will be deployed in three stages -- until March next year -- covering about 70 Ramsay sites.

More here:

http://www.australianit.news.com.au/story/0,24897,25810041-15306,00.html

Here we have a large hospital chain doing the other important aspect of e-Health, improving efficiency and information flows in the administration of their hospitals.

Eighth we have:

Medical mix-ups add to patient's misery

Laurann Yen | July 25, 2009

Article from: The Australian

WHEN Doris Lessing, the 2007 Nobel Prize winner for literature, was asked whether she was still writing, she said she didn't have the time at her age.

She was either at the doctor, chemist, physiotherapist or taking someone else to see them.

People living with chronic illnesses need to manage the logistics of their many appointments and the complex nature of their treatment. It can be a full-time job. Patients who live at home might take more than 30 medicines a day. They struggle to balance their health with the demands of everyday life.

The health round table, an industry benchmarking collaborative, has shown that regardless of the reason for admission, people with multiple illnesses have longer stays in hospital.

Governments have attempted to improve the clinical quality of care through guidelines and incentives, but patients are burdened with services that are delivered by myriad players with different agendas and rules.

Making life manageable for people with chronic illnesses requires reform in the organisation and delivery of health care. There needs to be better co-ordination between all involved, from patients to senior specialists.

A focus on inter-professional learning and practice in a system that is patient-focused may offer our best hope of achieving change.

Patients need comprehensive and co-ordinated care across all jurisdictions, but they don't get it. The Pharmaceutical Benefits Scheme, for example, may list a medication but not include appliances needed to administer and monitor the drug. States and territories have different rules about what a resident is ``entitled'' to and funding depends on different definitions of comparative need and risk.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,25829258-23289,00.html

Another recognition of the importance of e-Health in improving patient safety.

Ninth we have:

Stephen Conroy is confronting a tangled web

Jennifer Hewett | July 25, 2009

Article from: The Australian

STEPHEN Conroy is not a man to concede too many problems. So the fact that Kevin Rudd has given his Communications Minister a seemingly impossible task doesn't appear to have dinted Conroy's confidence that he can deliver high-speed broadband to every home in Australia.

The era of POTS -- Plain Old Telephone Service -- has long been relegated to the dinosaur era. But the official message is that Australia's move to high-speed broadband will transform the way society and the economy work. It is a popular line with the public and it will be repeated by the government from now until the next election. The Prime Minister already likes to refer to it as his legacy to the country. What lies beneath the rhetoric is considerably more messy.

The government is about to announce the chairman of the national broadband network company, as well as the lead adviser for the six-month implementation study on how to pull off the "nation-building" project. Melbourne, Sydney and Brisbane are jostling to host the headquarters. A chastened Telstra is being extremely polite about its determination to engage with Canberra and to become involved with the grand vision for the country's telecommunications. No more aggressive talk of protecting shareholders from the depredations of oppressive government regulation. The new Telstra would rather wash its ducts out with soap and water than even hint at criticism of government.

Even the voters don't appear to have been blinked at the theoretical price tag massaged into shape via the Department of Finance and then finessed into a $43billion headline figure by Conroy and his department. And an army of lawyers and financial and technical advisers on the project have their own version of government stimulus spending to keep them busy while private sector opportunities remains so dismal.

Much more here:

http://www.theaustralian.news.com.au/business/story/0,28124,25830445-5013565,00.html

This is an excellent article that highlights just how difficult this may be to move forward.

Lastly the slightly more technical article for the week:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

Microsoft wraps up Windows 7, declares RTM

Freezes code, signs off on build, hands over to OEMs

Gregg Keizer 23 July, 2009 07:59

As anticipated, Microsoft this afternoon announced that it had finished work on Windows 7, declaring that the new operating system had met the "release to manufacturing" (RTM) milestone.

"Today, after all the validation checks were met, we signed off and declared build 7600.16385 as RTM," said Microsoft spokesman Brandon LeBlanc in a message that will be added later today to the company's Windows 7 blog.

Microsoft also announced that Windows Server 2008 R2, the server software companion to Windows 7, reached RTM today. Both Windows 7 and Server 2008 R2 are slated to launch Oct. 22.

"The RTM code will be delivered to our partners within the next few days who will then start preparing to deliver some amazing new products timed to hit at General Availability (GA) of Windows 7," said LeBlanc today, referring to the Oct 22 public debut.

Much more here:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

I have to say this seems to be going very smoothly. The following article makes the point that if you are an Win XP user the upgrade is a major pain – so find out details before leaping.

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

For Some, Move To Windows 7 Will Be Tough

By WALTER S. MOSSBERG

On October 22, Microsoft will finally release a new version of Windows that will be as good as the deeply disappointing Windows Vista should have been when it came out in January 2007. The new edition, called Windows 7, is a big improvement over both Vista and the sturdy, 2001-vintage Windows XP still widely in use. It will give Apple’s long-superior Mac OS X operating system a run for its money (though Apple might maintain its edge with a new version, called Snow Leopard, due in September).

Full article here (subscription required):

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

More next week.

David.

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