Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, October 31, 2009

NEHTA Invent a Paper Based Electronic Prescribing System.

Just a quick heads up that NEHTA have released their first attempt at ETP (Electronic Transfer of Prescriptions) documentation.

These can be found here:


The key document is the Concept of Operations document. Amazingly it seems to assume just paper and no electronic transfer for now! They are also assuming there will be multiple providers of prescription repositories as best I can tell!

Comments due by 10 December 2009 – So get reading.

Read and be amused.

I may comment in detail next week as there are some great lines to be quoted.


Friday, October 30, 2009

This is an Issue We Are Going to Hear Much More About.

The following was posted a day a few days ago.

Senator Grassley: You’re on Track About EMR Problems, But Here Are Some More Questions to Ask

Posted by Vince Kuraitis on October 25, 2009

Filed in EHRs/PHRs, Health Policy/Reform, Information & Communication Technologies (ICT) · Comments

An article in today’s Washington Post links to a letter written by Senator Charles E. Grassley.

The letter is directed at 10 EMR (electronic medical record) vendors, and asks very pointed questions about whether the vendors have been negligent in not addressing patient safety issues in their technologies.

Senator Grassley, you have the scent and you’re on the trail. There are several other questions you should be asking these vendors:

  • Prior to the HITECH Act, why did EMR vendors promote and government policy tolerate non-interoperable EMRs? Health care isn’t like computer operating systems — where competing, non-interoperable tech is fine. Lives are at stake.

More points here:


I am planning to do some more work over the next few weeks on this.

Comments are more than welcome.


Thursday, October 29, 2009

Weekly Overseas Health IT Links 26-10-2009

What I have spotted this week.


Fuzzy Math? Rising Costs in Government's Digital Health Stimulus

Spending Could Be Double The Obama Administration's Public Estimate of $19 Billion

By Fred Schulte
Huffington Post Investigative Fund

1:01 pm | 15 Oct 2009

Creating digital medical records for every American within the next five years – a key provision of President Obama’s stimulus package -- could cost more than twice the $19.5 billion figure that has been cited by federal officials.



Private medical records offered for sale

20 Oct 2009

Medical records of patients treated at a private British hospital, The London Clinic, have been illegally sold to undercover investigators.



Wednesday, October 21, 2009

Massive Gene Database Planned in California

The data will be compared against electronic health records and patients' personal information.

By David Talbot



Kansas to begin work on statewide system for electronic sharing of patient records

By Associated Press

4:01 AM CDT, October 22, 2009

TOPEKA, Kan. (AP) — The Kansas Department of Health and Environment has applied for $9 million in federal grants to encourage physicians to switch patient records to computers.



HIT sector outperforms others in third quarter: report

By Jean DerGurahian / HITS staff writer

Posted: October 23, 2009 - 11:00 am EDT

The health information technology sector continued to improve in the third quarter, but the market is still waiting to see when federal funding will have an impact on profitability, analysts say.



IT programs can help improve outcomes: AHRQ

By Jean DerGurahian / HITS staff writer

Posted: October 23, 2009 - 11:00 am EDT

Health information applications can help engage patients in their care and improve outcomes, according to research released by the Agency for Healthcare Research and Quality.



CIOs: CPOE Provision Won't be Easy to Achieve

Implementing order systems involves significant work if benefits are to be achieved, CIOs say.

By Fred Bazzoli

The use of computerized provider order entry (CPOE) is growing among U.S. health care organizations, according to results from a recent survey of members of the College of Healthcare Information Management Executives (CHIME).



Getting Connected

Health information exchange links physician EMR systems with hospital labs.

By Charles Halfpenny

Integration of clinical systems has always been challenging. As the number of physician practices deploying electronic medical record (EMR) systems increases, so does the demand for electronically exchanging orders and results between the hospital system and the practice EMR. Without an interface, practices must manually enter results into the EMR, which is both labor-intensive and error-prone.



Standards panel explores patient access to EHRs

By Mary Mosquera

Thursday, October 22, 2009

A federal advisory panel has begun to explore how patients might access health information from their physicians and what data should be included in their personal health record. To probe the issue, participants in an Oct. 14 Health IT Standards Committee meeting examined the experience of providers who already share clinical information with their patients.



Physicians have doubled their time online since 2004

October 22, 2009 | Bernie Monegain, Editor

BOSTON – The head of a New York-based healthcare market research firm says physicians who might have spent four hours a week online in 2004 are now spending at least eight hours in front of a computer.


Web 2.0 Summit: Fed CTO Talks Healthcare IT

Federal CTO Aneesh Chopra says government spending on IT can help cut healthcare costs and improve care quality.

By J. Nicholas Hoover, InformationWeek

Oct. 22, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=220900162

The federal government can use IT to help lower the cost and improve the quality of healthcare in the United States, federal CTO Aneesh Chopra said Wednesday.



Friday, October 23, 2009

Health 2.0: Beneath the Hype, There's Cause for Real Hope

Health 2.0 is a trend accompanied by both buzz and buzzwords. That worries some advocates for the poor, underserved and just plain old and sick. Will those groups be left behind in the latest information revolution?




It’s almost a decade since the Audit Commission called for e-prescribing in secondary care. Progress has been slow, but that may be about to change. Daloni Carlisle reports.

There are some people who don’t follow fashion, at least not in the conventional sense. Steve Reggione, senior project manager for e-prescribing software specialist JAC is one of them.



Clinic's medical files vanish

Privacy commission launches probe

By Ryan Cormier, Edmonton Journal

October 21, 2009

The Information and Privacy Commissioner is raising a red flag for doctors after a Fairview clinic lost two years worth of electronic patient records.



Four out of five healthcare IT pros had at least one data breach last year

October 22, 2009 — 12:28pm ET | By Neil Versel

Even IT professionals in hospitals are concerned that their organizations aren't doing enough to safeguard electronic patient information, according to a newly released survey. The Traverse City, Mich.-based Ponemon Institute, with the support of security management firm LogLogic, reports that 61 percent of health IT practitioners doubt that their organizations have the resources to meet privacy and security requirements, while 70 percent say senior management isn't making data protection a priority.



Wealth of information online could threaten privacy of de-identified EMRs

October 22, 2009 — 10:01am ET | By Neil Versel

Back in 1997, it took an MIT statistician to find ways to re-identify electronic patient data that had been stripped of identifiers--using then-Massachusetts Gov. William Weld as the unsuspecting guinea pig to make a point about privacy. Nowadays, there's so much personal information widely available on the Internet that the task has become much easier, the New York Times reports.




eHealth inquiry is required

By John O'Toole/The Scugog Standard

Ontario’s eHealth scandal has grown to the point where only a public inquiry can do justice to the concerns raised by opposition MPPs and indeed by virtually all taxpayers.



The other side of the eHealth story

Posted Oct 22 2009, 11:07 AM by Dave Webb

Amid the flood of coverage of Auditor General Jim McCarter'sreport on out-of-control spending at eHealth Ontario -- much of it of increasingly hysterical tenor -- I received an e-mail from Aaron Blair. Blair's a former employee of Smart Systems for Health Agency, eHealth Ontario's predecessor in the initiative to bring Ontario's health-care community online, and he's troubled by the suggestion that Ontario taxpayers have nothing to show for the seven years and $1 billion invested in the effort.



Growth in teleradiology market appears to lag

By Shawn Rhea / HITS staff writer

Posted: October 21, 2009 - 11:00 am EDT

Expansion of the teleradiology market appears to be slowing, according to a study to be published in the November issue of the American Journal of Roentgenology.



A murky crystal ball?

Critics say too many systems are collecting data on disease outbreaks with little coordination among them

  • Oct 21, 2009

About 300 systems at federal, state and local agencies monitor disease outbreaks and chemical exposure. Some critics say that multiplicity is a problem.



Report: Acquisition Activity Down

HDM Breaking News, October 20, 2009

Health care information technology company stock prices have risen significantly during 2009 but acquisition activity has yet to catch up, according to a quarterly summary of vendor activity by Healthcare Growth Partners LLC, a Chicago-based strategic and financial advisory firm.


Why Your Next IT Job Will Be In Healthcare

Federal stimulus billions are fueling demand for up to 50,000 new information technology positions. Most sought after are tech pros with real-world implementation experience, Windows experts, and network admins.

By Marianne Kolbasuk McGee, InformationWeek

Oct. 20, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=220700404

Hospitals and medical practices are scrambling to deploy e-medical record and other clinical information systems to meet federal requirements for the more than $20 billion in stimulus incentives included in the American Recovery and Reinvestment Act. And that means many of them are expanding their IT teams to bring in the skills and expertise they need to implement these systems.



Wednesday, October 21, 2009

Comparative Effectiveness Research About To Hit Prime Time

An obscure acronym edged a little closer to the mainstream earlier this year as part of the federal stimulus debate. Now, with Congress about to dive into health reform legislation in a big way, CER may move firmly into the cultural crosshairs.



Vermont Docs to Get Free E-Prescribing

HDM Breaking News, October 19, 2009

A $1 million federal grant to Vermont Information Technology Leaders Inc. will enable physicians in the state to access free electronic prescribing software.



Five Lessons on How to Get Physicians to Adopt CPOE

Carrie Vaughan, for HealthLeaders Media, October 20, 2009

I often read or hear about "physician buy-in"—as I'm sure most of you do too—as the key component to successfully implementing many IT projects, including computerized physician order entry. While I agree that physicians need to join the effort for CPOE to be successful, I also think there is a lot more behind the successful implementations—like dogged persistence.



Prescription: Networking

A new urban network suggests how technology could remake health care.

By David Talbot

A crow flying from Vera Sinue's apartment in Boston's Roxbury neighborhood to her job as an insurance representative near the Charles River in Brighton would skirt the edge of the Longwood Medical Area, a district of medical institutions including Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Children's Hospital, the Dana-Farber Cancer Institute, and Harvard Medical School. These institutions are among the nation's most respected. They supplied some of the experts now leading the Obama administration's effort to reform the nation's health-care system.



The crisis in e-health standards III – solutions

Stakeholder Aspirations and Needs

Before going so far as to offer a solution to the e-health standards problem, I want to have a look at what we consider to be the requirements that such standards, and indeed health informatics in general is meant to address.



October 18, 2009


When 2+2 Equals a Privacy Question


TIME to revisit the always compelling — and often disconcerting — debate over digital privacy. So, what might your movie picks and your medical records have in common?




Wednesday, October 28, 2009

NEHTA Releases an Annual Report for 2008-9. What Fun!

Oh dear. Spin Central from NEHTA rolls on.

Here is page 5 of the report. You find the spin (Italics are a clue)!

Introduction to e-health

E-health is the electronic collection, management, use, storage and sharing of healthcare information. This information can include individual items such as test results, discharge summaries, vaccination history, medication history and diagnoses, to comprehensive medical records which keep all of this information about a person in one place.

The governments of Australia recognise that e-health and an Individual Electronic Health Record (IEHR) are vital to the achievement of major health reform in the next decade.

E-health systems that can securely and efficiently exchange data can significantly improve how important clinical and administrative information is communicated between healthcare professionals.

As a result, e-health systems have the potential to unlock substantially greater quality, safety and efficiency benefits.

E-health has the capacity to benefit all Australians – individual consumers, healthcare providers and healthcare funders.

The National E-Health Transition Authority Limited (NEHTA) is a company established by the Australian, State and Territory governments in 2005 to develop better ways of electronically collecting and securely exchanging health information.

As a collaborative vehicle, NEHTA has been assigned responsibility for a number of related projects aimed at establishing the foundations for the widespread and rapid adoption of electronic health (e-health).

----- End Extract.

Has anyone noticed Australian Government commitment to this. Given the Health Department Secretary’s most recent comment I do not think so.

The most amazing figures are here:

Employee benefits expense and contractors

2008/9 $30,212,229 – Last Year $27,041,497


2008/9 $26,148,157 – Last Year $2,293,259

The consultant budget rose by 1000% in a time of un-employment – why not just employ the people? What a money trough for those involved!

Why no detailed explanation of this amazing rise?

Read the full report here:



Promised Response to Some Anonymous Questions.

This was left as a comment a few days ago:

Anonymous has left a new comment on your post "I Guess This is a Good Time to Stop All This, and Say Goodbye and Good Luck!”:

Thank you David.

Your closing remarks on the following issues would be interesting.

Firstly, how would the accurate and secure transmission of health information between general practice and other providers be achieved when the GP/primary care provider does not receive the end benefit, does not want bear the cost of the capability and the funder of those health providers does not want to fund the capability?

Secondly, how would state (eastern seaboard?) clinical system implementations move to more integrated health records when the two major suppliers have no interest in integration (particularly for medications), such changes are capital funded and severely constrained (eg. http://www.treasury.nsw.gov.au/__data/assets/pdf_file/0005/10778/tpp06-10.pdf, with 250k limits), Treasury's are not inclined to fund IT integration over tunnels and rail, the GITC framework is too constrictive, the needs of Australia must compete with international demands that pay more and re-tendering and system replacement is not an option?

Thirdly, integrated health records require the co-operation of all health sectors, yet in the public sector, (presumably) most of the decision makers have performance contracts that focus on tertiary care and the priorities within. Therefore, state investment in cross-setting IT initiatives is not a priority, nor a KPI.

No, you are right. it's easy and everyone involved is incompetent.


Q1 Response:

My consistent view on this has always been is that those who are benefiting should pay the costs for a service. In each case it is then a matter of working out who are the winners and losers across each information flow and making sure there is an equitable and reasonable flow of funds in the appropriate direction.

In some situations there will also be intermediaries, such as messaging providers, and they need fair cost recovery and a reasonable profit for their services – ideally in a competitive market.

It has been clear for a long time that clinicians are frequently not beneficiaries while payers (Government and Health Funds) are. Sorting this out is vital to achieve Health IT adoption.

This is an area where appropriate national governance could make a real difference as an impartial arbitrator of who pays for what.

Q2 Response:

I believe that within organisations (e.g. an area health service, hospital or region) it is an internal issue to get internal system integration in place. Where information needs to flow across the boundaries (e.g. Hospital to GP via say a discharge summary) we need pragmatic workable standards in place to facilitate this. This is a job that NEHTA and IT-14 should do and then some funds be made available nationally to have all legacy providers comply with import / export requirements and all new procurements ensure standards are part of the mandatory requirements for future purchases. This will take time due to the long time there has been no real e-Health governance (again).

Q3 Response:

This is really a pure governance and leadership issue –as identified in the Deloittes Strategy. The failure to look at and plan for a whole health system properly is a key NEHTA failing in my view – but what do you expect when you have a board that predominantly only represents State health systems and not the rest of the sector.

It is not easy to solve issues like this. Needs leadership, working national governance structures and some funds. At present we have zero out of three!


Tuesday, October 27, 2009

Weekly Australian Health IT Links - 25-10-2009

What I have spotted this week.


Plan for accreditation to rely on e-health

Elizabeth McIntosh - Friday, 23 October 2009

THE Federal Government is considering a proposal to make e-health capabilities a requirement of practice accreditation, which would leave GPs little choice in whether to sign up to the national e-health agenda.



Costly data-exchanging IT system fails to connect with doctors

Adam Cresswell, Health editor | October 24, 2009

Article from: The Australian

A FEDERAL scheme to provide thousands of GPs with communications encryption technology so they can send sensitive health information securely over the internet risks turning into an expensive white elephant because hardly any other health workers can decode the messages.



Impotence fears over robotic surgery


October 24, 2009

NEW evidence suggests that robotic prostate cancer surgery, far from being the saviour of men, is leaving them with more incontinence and impotence than traditional techniques.



NHMRC IT systems not up to scratch: ANAO

Auditor finds NHMRC's systems not adequate for reporting on the awarding of grants

Trevor Clarke 23 October, 2009 07:52

The National Health and Medical Research Council's (NHMRC) IT systems do not adequately support its core focus of granting millions of dollars in research funds, according to the Australian National Audit Office (ANAO).



iSoft signs up BI alliance

Australian healthcare systems developer iSoft has entered an agreement with US company Rocket Software (www.rocketsoftware.com) that will enable it to include business intelligence and strategic management applications in its products.



Private specialists shun e-health

by Michael Woodhead

Specialist physicians are e-health luddites, with as few as one in ten using computers in their private practice, a new survey suggests.

And comment


Private specialists shun e-health

...read original article

First, it is unwise to generalise as the 27% of specialists who have actually invested in IT often have very elaborate IT setups. Second, apart from the HealthConnect program in SA there has never been an incentive program directed at specialists (or allied health providers for that matter), whereas GPs have benefited from multiple targeted incentive programs over the years.



NEHTA misquoted

...read original article

Is it not surprising to anyone that the public are less than enthusiastic about e-health when the so called experts can’t agree amongst themselves about what is or isn't an electronic health record. Someone or something needs to show leadership if this is ever going to get off the ground.



College gets cosy with chemists

by Jared Reed

The RACGP has formed a strategic alliance with the Pharmaceutical Society of Australia, in a bid to get more clout on e-health issues such as electronic prescribing.



'Unbreakable' Windows 7 may lock out the law


October 22, 2009 - 9:38AM

Queensland police fear criminals will use high-tech encryption software on Microsoft's new Windows 7 to bury pornographic images and files deep within computer networks.



Privacy changes put data at mercy of scams

Karen Dearne | October 20, 2009

BUSINESSES will be able to send customer information to "dangerous" countries such as Russia and Nigeria under proposals to update the federal Privacy Act for the digital age.




Monday, October 26, 2009

Looks Like Any Major e-Health Investment in Australia is Off the Table.

The following great summary of the e-Health Section of Senate Estimates Hearings from last week appeared this morning. What we learn certainly requires being highlighted!

NEHTA on target, says Health secretary

Karen Dearne | October 26, 2009

THE nation's top health bureaucrat Jane Halton has ruled out major investment from government in e-health systems "to have everything happen instantly".

Pressure has been growing within the e-health community as a growing pile of reports warn of the cost of inaction, following the Council of Australian Government’s acceptance of a National E-Health Strategy last December.

The strategy put the cost of establishing a nationwide electronic health record system at around $1.6 billion over four years.

Queensland Liberal Senator Sue Boyce was seeking information on progress of various National e-Health Transition Authority outcomes previously promised for delivery by December this year, including specifications for secure messaging, clinical terminologies, electronic referrals and e-prescribing.

Earlier this month, NEHTA released its own strategic plan, positioning itself as an implementation agency as adoption of e-health accelerates.

"The e-health community is feeling a little irritated by what they see as a lack of progress in this area," Senator Boyce said. "The view has been put to me that NEHTA was established in 2004 and their budget has been more than $200 million."

Responding to questions at an estimates hearing this week, the federal Health Department secretary said the bottom line was that "we are trying to build a national system that will enable private investment and private engagement".

Ms Halton said all of the work on NEHTA's delivery schedule was on target "and is as good as you will get around the globe. Genuinely I think that. Okay, they might want several billion dollars more. That is fine as an ambition. But in terms of taking relevant, logical, ordered steps towards this e-world, I think actually we are not doing too badly".

Ms Halton said NEHTA's job was to ensure that there were not six or eight railway gauges in this country in respect of e-health.

"None of us wants a world where what we have stored in terms of our medical records is controlled by a proprietary product in a doctor's surgery or something else," she said. "We want interoperability and the ability to say, 'Are you Senator Boyce?' such that no-one can steal your identity or misconnect a record about you.

"This is not just about security, and security is absolutely fundamental. It is also about ensuring that there are not islands of information over here that somebody owns and islands over here that somebody owns, and any notion of basically connecting those two up - which would be in your interests medically - is either controlled and charged for privately by somebody or is just not able to happen."

Lots more here:


This is a must read summary. For the full transcript of the hearing my earlier post provides a direct link.

See here:


All one can now think is that we have the situation where NEHTA is building one of those ‘highways to nowhere’ so beloved of the US and Japanese porkbarrelers.

Looks like the target NEHTA was aiming for has just been taken down and carted away!

If there is no plan to invest in the systems that will use what NEHTA is building in the relatively near-term future then why bother? There is a real risk it will all be an outdated white elephant by the time anyone get round to adoption at this rate!

It is good Ms Halton thinks we are doing ‘not too badly’. She is actually ‘not doing too badly’ at doing essentially nothing and attempting to pass it off as activity.

We are hardly likely to see much investment from the private sector with this being what Government is planning, so I think her strategy to attract funds is doomed from the start!

Just hopeless!



There is more commentary that I have just found here:

NEHTA unsure of own success

By Suzanne Tindal, ZDNet.com.au
26 October 2009 12:34 PM

The National E-health Transition Authority (NEHTA) was unable to measure how many organisations were using the products it was creating, according to a secretary for the Department of Health and Aging.

Much, much more here:


I find what Ms Halton said here just plainly offensive. To quote:

“When Boyce raised community concerns that e-health was not progressing, Halton said that people needed to "calm down a bit about this".”

She clearly does not care about the lives e-Health, when implemented, can save.


Sunday, October 25, 2009

Apparent Australian Censorship of Adverse Academic Commentary on EHR Provider and NSW Health.

The following appeared a little while ago in the US.

Academic Freedom Curtailed: Censorship Down Under On EHR's for the Emergency Department?

In a stunning development:

The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney, that I referenced in my posts "The Story of the Deployment of an ED Clinical Information System Systemic Failure or Bad Luck" and "NSW Nightmare and Overuse of Computers" has been censored. This apparently occurred at the level of the Ministry of Health.

The essay was available as item 6 at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 . Attempts to download now provide a message "This document is not currently available." I do not know if the vendor was involved.

(A copy of vers. 3 of Professor Patrick's report is still available here in PDF; it was a work in progress when it was pulled.)

Complete blog here:


I can’t say I disagree with the poster (Thanks Scot for letting me know about the post)!

It would be nice to have honest academic criticism to be able to be freely discussed and reviewed. Indeed such a freedom is vital in any decent democracy – but this is happening in NSW! Enough said.



As of 10am Sunday 25 Oct Professor Patrick has said he is happy with the way Sydney University is handling a complaint they have received. He also says 'time will tell' if that continues to be the case.


Postscript 2:

File is no longer available from the US - as Prof Patrick has asked it be taken off-line for now.


Friday, October 23, 2009

Spin Alert!

The Senate Estimates Transcript with DoHA and NEHTA being questioned about their progress is now available here:


A good read from about page 102 on!

Lots of things being taken on notice as DoHA seems to be an answer free zone.

Main impression is that the answers just muddy any understanding of what is planned in the EHR/EMR/IEHR/SEHR/PHR domain. We really need a clear statement of just what is planned.

See the Australian IT News Page for more details.




Thursday, October 22, 2009

Believe It If You Want – But This is a Really Bad Plan!

The following is part of the lead item in the www.chik.com.au newsletter (Free version)

Health ICT Headlines - 21/2009

Amid the flurry of Australian e-health activity reported in this edition, an observer could believe that Australia's e-health record strategy is adrift and close to foundering on dangerous shores. CHIK does not believe that this is the case. In particular, there has been concern in relation to an apparent renewed government focus on commercially developed, person controlled e-health records as a ‘quick fix' to Australia's e-health needs. CHIK agrees with Peter Fleming, CEO of the National E-Health Transition Authority, that it is likely that several e-health records will be available in the market. That scenario makes NEHTA's role in ensuring standards, privacy rules plus infrastructure (including indexing) all the more critical.

--- End Extract

This observer thinks the bolded sentence is true (i.e. we are drifting in a hopeless strategic vacuum) and that what will happen, if the this multi-vendor commercial outcome, as is apparently being supported by Peter Fleming and NEHTA, actually occurs it will be very sub-optimal. I believe that this commercial strategy is very poorly conceived and will fail to provide the benefits we all hope for from a quality implementation of appropriate e-Health.

I also believe CHIK is quite wrong in supporting this, but that’s up to them!

That’s my 5 minutes of blogging for the day. Back to Handel.


Wednesday, October 21, 2009

I Am Really Trying to Give This Up!

Posted to encourage some professionals to respond.

Should every Australian have their own, portable e-health record?

5:02pm, 20 Oct 2009 by Ross - yourHealth Team

The idea of having personal electronic health records, controlled by each individual, has been recommended by the National Health and Hospitals Reform Commission.

In its report A Healthier Future for All Australians , the Commission said, “Much like the state and private railways of the 19th century, Australia runs the risk of un-linked electronic health infrastructure.

“From remote communities to metropolitan hospitals, governments, private companies and clinicians have implemented dozens of innovative e-health projects.

“But much more can be gained by taking advantage of synergies and committing to a truly national effort to optimise the system.”

Each individual’s e-health record would be designed to give them better access to and more control over their own health information.

With an individual’s approval, health care providers and carers could instantly access the same, up-to-date patient information - avoiding asking them the same questions and manually re-entering patient data.

The Commission believes this approach would help reduce waste and inefficiency in the creation and use of health information and lead to better, safer care and improved health outcomes.


What do you think?

More here:


My view is that they are asking the wrong question and that there is a Government agreed strategy about what is needed that they should be implementing!

Go for it - comments I mean!.


Tuesday, October 20, 2009

Form Your Own View on This!

This link to a blog post is passed on without major comment.


The associated report (link in the post) makes interesting reading.

I am not sure lawyers are the ideal people to form e-Health policy.

Back in my box!


Sunday, October 18, 2009

I Guess This is a Good Time to Stop All This, and Say Goodbye and Good Luck!

Well, as they say, the time to leave is on a high.

That is where the blog is and that is why I am stopping it.

The statistics from yesterday tell the story.

Australian Health Information Technology

VISITS Total 113,744

Average Per Day 206

Average Visit Length 3:15

Last Hour 6

Today 90

This Week 1,442

PAGE VIEWS Total 187,474

Average Per Day 375

Average Per Visit 1.8

Last Hour 7

Today 170

This Week 2,626

From here we also see:

FeedBurner Reader Count

1165 readers:

Pretty cool! I never imagined Health IT was so interesting.

The blog has been online since March 2006 and it seems to me 3.5 years is long enough to cause me stop giving myself a headache by repeated banging of my head on a hard object!

It seems to me the failure of the Australian National Government to have to capacity to get its act sufficiently together to even enunciate a policy for the deployment of Health Information Technology in Australia is a total failure of governance and leadership. The case for action is totally clear, they (the Government) are just incompetent and worse, they are killing patients through inaction.

NEHTA is an absurd money-wasting joke, the reasonable and the not too expensive National E-Health Strategy (which pays for itself in the medium term and which would make a major difference) has been ignored and instead we see wacky ideas from the likes of Peter Fleming about how important a commercial focus is, and what a wonderful thing it would be to have Google and Microsoft help. (Even thought Google at least wants no part of it at present)

The investment in NEHTA now well exceeds $200M and nothing has been returned that anyone can see.

After 1000 posts it is time for some-one else to carry this forward and for me to get on with listening to music (Handel especially) and spending time working out how to spend the rest of my life disengaged from the incompetent and the stupid who, for unfathomable reasons, seem to be determined to have nothing good happen.

To those who have read and commented – thanks heaps! There has been wisdom and honesty found here which is certainly not found in the public domain.

To those who have something to say. Send me your text and if it is reasonable I will publish it under your name on the blog. Otherwise this is all over and the ‘forces of darkness’ can celebrate as they slip into the inevitable abyss.

To those who enjoyed what I have written, it was a pleasure. To those who were made to feel I was less than impressed with them – well tough – you earned it!

I will leave the blog up as a searchable resource for those who want reference etc.

I have the comfort of having tried, and failed, rather than never having tried. I am content if a little disappointed.

A friend, probably wisely, pointed out that the Government and NEHTA have got what they want. Minimal cost, minimal public upset and a story to tell about how they are trying if anyone asks. A Machiavellian trifecta if ever there was one.

Once I post this I will have my life back. Live long and prosper!


ps. There just might be a post every few weeks just to highlight some especially pathetic bit of nonsense. I may not be able to help myself .


The NEHTA Spin Cycle Tangles Itself Up!

The following note appeared on the 6minutes.com.au web site a few days ago.

NEHTA misquoted

Person-controlled records (link)

The 6minutes adaptation of the story included a misquote from Peter Fleming ‘NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records . He did not say this nor was he quoted as saying this in The Australian article.

This has lead to an assumption that ‘person-controlled records’ is the same as the commonly known personal health records – records that are initiated and maintained by individuals.

Peter’s comment in The Australian article pertained to a design change of the proposed ‘person-controlled records’ system also technically known as the Individual Electronic Health Record (IEHR).

Previously, the design of the ‘person controlled records’ / IEHR focused on an e-health record for all Australians held on a centralised database. NEHTA is now working towards a system whereby, given medical information is currently stored in a number of different repositories and locations (private and public), information would be drawn from these existing sources through a single interface. This approach is preferred as it is able to be adopted more quickly to meet the needs of the Australian healthcare sector.

The work NEHTA is doing on healthcare identifiers, secure messaging and other technical standards would support a rollout of ‘person controlled records’ / IEHR by 2012, pending the decision by COAG on the business case put to it by NEHTA.

‘Person controlled records’ / IEHR records will be healthcare provider generated with healthcare providers owning and populating the records, and individuals controlling providers’ access to the information the records contain.

More here:


15 October 2009

This was published in response to a short news item published a day or do earlier.

13 October 2009

“NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records that can be adopted more quickly, writes The Australian.”

This is a very important statement from NEHTA, but not necessarily a good one.

What they are saying is that their IEHR will, using the IHI as a key, pull together a collection of patient information, format it, and with patient / consumer authorisation make what they can find available to a treating clinician.

Why may this not be a good idea?

Firstly experience overseas shows that such ‘assembled from source systems’ display approaches tend not to be sufficiently complete for clinicians to rely on them.

Second as we now know that the implementation of the IHI will be both phased in, and optional in actual use, the likelihood of safely and reliably assembling a reasonably comprehensive record for use by a new treating clinician can’t be very high anytime soon.

Third it will only take a few errors in allocation of IHI’s to individuals or clinical documents to have the wrong information retrieved. This will cause all sorts of issues regarding ongoing use of such a system.

Fourth the entire concept relies on healthcare providers making information available when requested but then being in the position of needing to seek consent from the patient to view other details on that same patient that may be held elsewhere. Once a patient says no the clinician will just go back to basic Q&A to obtain information in the old way – and all the potential benefits of a shared system are lost.

Fifth, of course no provider can be expected to open their systems for external lookup without both compensation and warranties as to security, now and in the future, of the requesting system.

Last all the issues of currency, which document is the most current and reliable etc will quickly emerge – as will all the issues about the information quality and format of the data that is being shared.

Take it from me to get all this right is, at best, a 5-10 year journey despite what NEHTA says about it being ‘adaptable quickly’.

I will watch with interest as all these issues are recognised and then, possibly, addressed.

Does anyone reading this believe NEHTA actually knows what it is doing? I certainly don’t.


Useful and Interesting Health IT News from the Last Week – 18/10/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

Healthcare Identifiers Service

The Healthcare Identifiers Service (HI Service) is being developed as a foundation service for e-health initiatives in Australia.

What is e-health?

Governments across Australia have committed to a national approach to e-health that will enable a safer, higher quality, more equitable and sustainable health system for all Australians.

E-health is set to improve the way healthcare is delivered by transforming the way information is used to plan, manage and deliver health services. It will achieve this through better use of information technology to facilitate electronic access, transmission and recording of health information.

Foundations, standards and solutions are being established to enable the secure electronic transfer of information such as referrals, test orders and results and prescriptions quickly and safely between healthcare providers.

In the future e-health will enable you to:

    • Have electronic access to your own information helping you to better manage and control your personal health outcomes
    • Support healthcare providers in their decision making by making your health information electronically available at the right place and right time
    • Feel assured that your personal health information is being managed in a secure, confidential and tightly controlled manner.

Developing the foundations for e-health

A key element in progressing e-health is to establish strong foundations – including a national identifiers scheme for individuals and providers and a robust privacy regime. The integration of security protections and privacy policies will continue to underpin how your health information is handled. The way in which this information is collected, used or disclosed is already regulated by privacy laws that are set out in legislation, including health records legislation and confidentiality obligations.

In 2006, the Council of Australian Governments (COAG) agreed to a national approach to developing and implementing individual and healthcare provider identifiers as part of accelerating work on an electronic health records system to improve the safety of patients and improve efficiency for healthcare providers.

It is the foundations for e-health – healthcare identifiers and privacy protection - that will allow the healthcare system and consumers to realise the full benefits of using information technology to share health information more reliably and securely.

The Healthcare Identifiers Service (HI Service)

A healthcare identifier is a unique number that will be assigned to each healthcare consumer, and to healthcare providers and organisations that provide health services.

The identifiers will be assigned and administered through the HI Service that is being established to undertake this task.

A key aim of healthcare identifiers is to ensure that individuals and providers can have confidence that the right health information is associated with the right individual at the point of care.

For further information on the HI Service see: Frequently Asked Questions

Lots more here:


We now have the 93 submissions regarding the proposed legislation available on web site.

They are found here:


It will be interesting to see what comes of all this.

A FAQ on the service is found here:


Here we have some commentary:

Timing ‘unrealistic’ for rollout of e-health patient ID scheme

Elizabeth McIntosh - Friday, 16 October 2009

GPs face a long wait to see the promised rollout of an electronic patient identification system, an e-health expert claims, despite the National E-Health Transition Authority (NEHTA) saying that it will be in place by mid-2010.

Unique healthcare identification (UHI) numbers are a key plank of the e-health program, and are expected to improve patient safety by reliably identifying patients, providers and care facilities.

According to the recently released NEHTA strategic plan, UHI numbers will be rolled out to all stakeholders by July 2010.

However, health IT consultant Dr David More was sceptical of the 10-month time frame listed in the 46-page document, arguing it was unclear and unrealistic.

“Look at all the other [e-health initiatives] that they’ve attempted to introduce to help – even the ones that have been successful have taken years to be adopted,” Dr More said.

“2012 – that is reasonable – but pretending that 2009/10 is the year of delivery is not going to happen. They’re not going to have the majority of GPs signed up.”

More here (registration required):


Reading the FAQ – where all the talk is of phased approaches from mid 2010 – it seems they agree.

Second we have:

How do they do IT? Mater Hospital

A look at Queensland's largest independent hospital group's IT strategy

Kathryn Edwards 13 October, 2009 13:21

Tags: Mater Hospital, e-health, Cisco

Seven hospitals, 1000 beds, 7000 staff, 9000 babies, 35,000 theatre cases and 90,000 emergency attendances is all in a year’s work at Queensland’s largest independent hospital group.

The Mater Hospital has embraced the role of IT in enabling healthcare through the development of a ‘Smart Hospital Strategy’. And it does this with funding of just two per cent of the hospital’s $750 million yearly budget.

The mammoth task of making it all work and migrating the hospital to a paperless environment with a fully-functioning electronic health records system falls to CIO Malcolm Thatcher, and Chief Medical Information Officer (CMIO) Dr Paul Devenish-Meares.

Thatcher, who has been with the hospital since 2004, explained the healthcare industry is episodic and careful consideration has to be given to any form of integration due to the complex division between wards.

“Because we have so many different services, we have over 240 enterprise systems hosted in our data centres, so we have to look at how we integrate those services – there’s no ERP for healthcare,” Thatcher said.

With up to 100,000 messages sent across the hospital’s system daily, an agile IT infrastructure with high availability is required to respond quickly to physicians' needs and provision services and systems in an efficient manner.

According to Thatcher, it’s literally the difference between life and death.

More here:


This is good news to see how one Australian hospital group is making some considerable progress in their progress towards really effective use of Health IT.

Third we have:

$3b p.a. windfall for online fraudsters


October 12, 2009

Identity fraud is costing the Australian economy up to $3 billion a year, police experts will tell a national crime conference on the Gold Coast this morning.

And much of the rich pickings can be attributed to online's social networking in which internet users unwittingly provide information profiles the identity fraudsters dip into.

The 2009 National Identity Crime Symposium is being held at the Royal Pines Resort on the Gold Coast for the next three days, attended by Australian and world experts.

According to Queensland fraud and corporate crime squad police, criminals gather the information and new identities are built up over time.

"Criminals are now harvesting identity data and building profiles. The more information that can be obtained, the greater the criminal value," the corporate crime squad police report.

"Identity data stolen today may not manifest itself for years to come," they said.

"The 13-year-old child with today's online social networking is unwittingly providing the profile for exploitation in only five years time."

Detective Sergeant Steve Bignell of the Queensland Police Computer Crime Investigation Unit will tell the conference that 50 per cent of Australia's wireless internet networks are not safe from hackers.

"Incredibly, 50 per cent of our wireless internet networks are insecure, essentially giving the green light to criminals to access our computer and steal our identity and and financial data," Det Sgt Bignell said.

More here:


The implications of all this for e-Health are pretty obvious.

Fourth we have:

Government to re-write Privacy Act

Karen Dearne | October 14, 2009

THE Rudd Government will rewrite the 21-year-old Privacy Act for the technology age, ending the fragmentation of state laws and streamlining the rules to apply to both private and public sectors.

Special Minister of State, Senator Joe Ludwig, has released the government's response to the first stage of the Australian Law Reform Commission's report, For Your Information, at a meeting of privacy professionals in Melbourne today.

"The Government will create a single framework that is simple, clear and easy to understand," he said. "We will provide a single set of privacy principles for the handling of personal information by government agencies and relevant private sector organisations.

"The Privacy Act will be amended to streamline the 11 information privacy principles that apply to government agencies, and the 10 national principles that apply to businesses and private sector organisations."

Senator Ludwig said the federal Privacy Commissioner's powers of investigation and compliance will be enhanced, and enforcement functions strengthened.

More here:


All the details can be read about here:


There are some significant issues yet to be addressed in the areas of identifiers and shared electronic records – and it seems these will be dealt with by specific legislation, which we saw some consultation on a few months ago. Links for all this are found in item 1.

Fifth we have:

Worries over new health e-records


14/10/2009 3:49:00 PM

THE State Government's computerised health recording system Healthelink has some parents concerned about privacy.

The pilot program, underway in western Sydney since in 2006 for under-16s and over-65s, adds medical information to a patient's database after visit to a GP.

The aim is allow health professionals ready access to the patient's complete medical history. Patients can also see the file on the internet.

Benefits include keeping track of medicines, allergies, immunisation and appointments.

But one mother was mortified to find that her 10-year-old daughter's details had been added without her knowledge after an emergency visit to Nepean Hospital.

She questioned why she was not asked in the first place and was sent a letter saying she only had 30 days to opt out of the system.

She is afraid that confidentiality is at risk from market researchers, paedophiles and identity thieves and that the system has potential for ``social control''.

She said that as parents would have access to their children's files pregnant girls might seek a ``backyard'' abortion so their parents did not discover their condition.

More here:


Interesting concern has re-emerged. This trial is taking just an absurd amount of time. One really wonders just what the heavens is going on

Sixth we have:

Landmark patient safety study to track human cost of errors

Rosemarie Milsom - Friday, 16 October 2009

PATIENT safety will come under more scrutiny than ever before, with the launch of an $8.45 million study that will try to quantify the human and financial costs of inappropriate patient care across the health system.

The world-first CareTrack Australia study comes 15 years after the landmark Quality in Australian Health Care Study and is expected to help bridge the widely recognised gap in patient safety research.

Observers say there is no way of knowing if the safety of Australia’s health system has improved in the past 15 years.

Funded by the NHMRC, the study will draw on a random sample of 2500 Australians who will be interviewed about the care they received in the previous two years.

With the patients’ permission, researchers will also review medical records and interview healthcare practitioners, many of whom will be GPs.

More here:


This sounds like a very important study. I hope the sample size is big enough to provide really useful information on the slightly less common errors.

Seventh we have:

E-health benefits don’t justify costs

Elizabeth McIntosh - Friday, 16 October 2009

A REPORT commissioned by the Government has conceded that the cost of signing up to the e-health agenda currently outweighs the benefits for most doctors, and calls for the introduction of new financial incentives.

The National E-Health Strategy – drawn up by Deloitte and handed to the Federal Government in September last year – lists the recommendation as one of a series on how to drive e-health forward.

Priority areas listed in the strategy include building the technical and legislative foundations of an e-health system, accelerating delivery of e-health solutions and encouraging healthcare providers to sign on.

“The costs of implementing e-health solutions are typically higher than the direct benefits that care providers will initially receive,” the authors state.

“Awareness and education campaigns should therefore be supported by an appropriate time-limited incentive program.”

More here (registration required):


A bit of a cute headline. What the study says is that the costs for providers are higher than THEIR benefits. Overall e-Health offers total health system benefits which are very substantial indeed.

Eighth we have:


6:59 AM, 12 Oct 2009

Isabelle Oderberg

Our cloud-computing opportunity

Unless Australia gets to grips with the true meaning of cloud computing and starts to create and implement the technology to make genuine offerings available to the domestic market, we will to miss out on an industry expected to be worth $US100 billion worldwide by 2013. But if we can service our own domestic market, we will also open up opportunities internationally – especially in Asia, where latency issues creep in for European and US service providers.

A recent study by IT services group Longhaus showed that Australia doesn’t have a single local provider offering a true cloud computing service. True cloud computing occurs, traditionally, when software is delivered as a service, with the common theme of being web-hosted and able to be scaled as required. The client takes the capacity or service they need, and is offered the ability to scale up or down as their business requires on an almost immediate basis.

Dr Steve Hodgkinson, Ovum’s research director for the public service, was previously deputy chief information officer for the Victorian government, responsible for e-government and IT strategy. He points out that not a single enterprise-scale cloud computing data centre exists in this country.

“It’s a highly competitive global business and if Australia’s not in there as much as anyone else, then they’ll be a net loser,” says Dr Hodgkinson. “If Australia can get in there harder and faster and sharper than anyone else, it may be a net winner. But Australia will have to fight just to not lose, rather than saying it’s a huge global market and Australia can dominate it because we’re so smart and intelligent.”

Last month, Verizon unveiled its newest data centre in Amsterdam. Clients can order a physical server over the internet and it will be installed by a robot at their data centre in Amsterdam in 120 minutes, ready to go.

A centre of this type in Australia would be large, constructed in a modular fashion, with the latest technologies incorporating features like virtualisation, so that the different assets in the data centre can be sliced and diced and used very flexibly. It can also be built out incrementally, again very flexibly, preferably by robots.

More here:


I found this amazing – the robot part – and worrying that OZ is not involved as much as it should be.

Lastly for the week a more technical article:

The best free open source software for Mac OS X

If you live and work on a Mac, you'll want to try these 10 killer open source apps

Peter Wayner (InfoWorld) 14 October, 2009 21:04

Tags: open source, Mac OS X

Most Mac lovers love the Mac for the carefully wrought user interfaces and the crisp design, and never pay attention to the open source at the heart of the operating system. But underneath this beautiful facade is a heart built upon the rich - if often chaotic - world of open source software.

If you want to go through the pain and joy of building the OS yourself from scratch, you can even download the open source core of Mac OS X known as Darwin.

That's just the foundation. There are thousands of open source tools available for the Mac, some built for the Mac alone and others that are translations of software created for other operating systems. Some are aimed at a niche of programmers or scientists, but a good number are supremely useful tools for everyone.

This list includes just 10 of the most essential open source applications for a Mac, all precompiled, polished, and ready to run.

Downloading the software is just the beginning because many of them have yet another layer of openness hidden inside. Several of the applications have their own built-in environment for extending the software. Some accept plug-ins, some have pop-up windows for writing short extensions, and some have both - so you have even more options for customization.

In many cases, you're not just getting an open source tool; you're getting a range of options to add to that tool.

Fix your Mac with AppleJack Why is one of the simplest ways to mend a sluggish Mac is to "fix the permissions"? Who changes the permissions on my files? Shouldn't I know? Shouldn't I - what is that word? - give permission for the change? What good are permissions if some gremlin can just come in and change them without asking me?

One way to fix the permissions and perform a host of housekeeping chores is to run AppleJack, an open source tool that triggers many of the standard housekeeping scripts like disk repair and cache cleanup. The only limitation is that you need to run it in Single User mode (hit Command-S at startup).

AppleJack won't ask you how you want to set the permissions because, well, that would shatter the myth by letting you, the system owner, know what's going on. So don't worry your pretty little head. The permissions will all be fixed and your Mac will run faster and smoother. If you ask too many questions, you'll end up burning the time you've saved by making your Mac more efficient -- so don't.

More here:


There are a lot of Mac users out there and this seemed interesting for them at least.

And to end with a laugh..

Web creator apologises for his strokes

Murad Ahmed in London | October 14, 2009

A LIGHT has been shone on one of the great mysteries of the internet. What is the point of the two forward slashes that sit directly in front of the "www" in every internet website address?

The answer, according to the British scientist who created the world wide web, is that there isn’t one.

Sir Tim Berners-Lee, who wrote the code that transformed a private computer network into the web two decades ago, has finally come clean about the about the infuriating // that internet surfers have cursed so frequently.

The physicist admitted that if he had his time again, he might have made a change, or more specifically, two.

“Really, if you think about it, it doesn’t need the //. I could have designed it not to have the //”, he said, speaking at a symposium on the future of technology in Washington DC last week.

Sir Tim ruefully explained that when he started devising the network almost 30 years ago he could not have predicted the hassle that has been caused by his small error in thinking about the way a web address is written.

“Boy, now people on the radio are calling it ‘backslash backslash’,” Sir Tim told his audience, even though he knows they are, in fact, forward slashes.

More here:


Love it!