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."

Sunday, February 28, 2010

Draft Personal Submission to the Senate on the HI Legislation.

As reported a day or so ago the Senate is conducting a short enquiry into the Health Identifiers Bill. The deadline for response is very tight indeed.

Tight deadline for e-health identifier bill inquiry

  • Karen Dearne
  • From: Australian IT
  • February 25, 2010 2:13PM

THE controversial Healthcare Identifiers Bill has been referred to a Senate inquiry, but interested parties will need to meet a very tight deadline for comment, with a report due back before federal parliament by March 15.

The Senate Scrutiny of Bills committee said the HI bill "seeks to introduce a significant change by implementing a national system to assign healthcare identifiers for consumers and providers".

Under the proposed law, introduced by federal Health Minister Nicola Roxon, unique identifiers will be mandatorily issued to all Australians by Medicare Australia, which will operate the HI regime.

If the bill is passed, from July 1 all Australians will be issued with a 16-digit unique number linked to existing Medicare numbers, while all medical providers and healthcare organisations will also be given a unique 16-digit identifier.

Unique identifiers provide a key foundation for more widespread information-sharing of patient records across the health sector, and are intended to ensure correct assignment of personal data in electronic health record systems, and secure exchange of communications between doctors.

But health consumer and privacy advocates have warned of the dangers of abuse or exposure of personal medical information, as well as the potential for government-issued numbers to morph into a broader national identity scheme.

The Senate Community Affairs committee will have to consider whether the bill contains sufficient privacy safeguards, the operation of the HI service, including access to identifiers, and its relationship to the wider national e-health agenda and future electronic health records.

Written submissions should be lodged by March 5, and public hearings are expected to be held in Canberra on March 9-10.

More here:


The story was also picked up here

More input sought for e-health Bill

By Suzanne Tindal, ZDNet.com.au
26 February 2010 03:27 PM

Health Minister Nicola Roxon has referred the e-health Bill for the introduction of a universal identifying health number — the Healthcare Identifiers Bill — to a Senate Committee.

According to the minister's office, the Bill was introduced to the Senate Standing Committee on Community Affairs to satisfy "ongoing community and stakeholder interest".

"Whenever there are high levels of community interest in [a] bill it's very common practice for a bill to be referred to the committee," Roxon's spokesperson Katie Hall told ZDNet.com.au.

The committee is expected to look into privacy safeguards in the Bill, which involves the issue of a unique 16-digit unique number to Medicare members, medical providers and healthcare organisations. The committee will also look at the operation of the services required to utilise the numbers, and the Bill's expected role in the national e-health agenda.

More here:


Here are the full details of the enquiry.

Healthcare Identifiers Bill 2010 and Healthcare Identifiers (Consequential Amendments) Bill 2010

Information about the Inquiry

On 24 February 2010 the Senate referred the Healthcare Identifiers Bill 2010; for inquiry and report.

The Healthcare Identifiers Bill 2010 establishes the national e-health Healthcare Identifiers Service to provide that patients, healthcare providers and provider organisations can be consistently identified.

The Healthcare Identifiers (Consequential Amendments) Bill 2010 (introduced with the Healthcare Identifiers Bill 2010) amends the Health Insurance Act 1973 to authorise the Chief Executive Officer of Medicare to delegate functions to support the Healthcare Identifiers Service (HIS); and Privacy Act 1988 to: provide that the HIS comes under the jurisdiction of the Privacy Commissioner; and make amendments consequential on the Personal Property Securities (Consequential Amendments) Act 2009.

The following issues were outlined for the Committee to consider during the inquiry:

• privacy safeguards in the Bill

• operation of the Healthcare Identifier Service, including access to the Identifier

• relationship to national e-health agenda and electronic health records.

Submissions should be received by 05 March 2010. The reporting date is 15 March 2010.

The Committee is seeking written submissions from interested individuals and organisations preferably in electronic form submitted online or sent by email to community.affairs.sen@aph.gov.au as an attached Adobe PDF or MS Word format document. The email must include full postal address and contact details.

Alternatively, written submissions may be sent to:

Department of the Senate
PO Box 6100
Parliament House
Canberra ACT 2600

Notes to help you prepare your submission are available from the website at http://www.aph.gov.au/senate/committee/wit_sub/index.htm. Alternatively, the Committee Secretariat will be able to help you with your inquiries and can be contacted on telephone +61 2 6277 3515 or facsimile +61 2 6277 5829 or by email to community.affairs.sen@aph.gov.au.

Inquiries from hearing and speech impaired people should be directed to Parliament House TTY number 02 6277 7799. Adobe also provides tools at http://access.adobe.com/ for the blind and visually impaired to access PDF documents. If you require any special arrangements to enable you to participate in the Committee's inquiry, please contact the Committee Secretariat.

Once the Committee accepts your submission, it becomes a confidential Committee document and is protected by Parliamentary Privilege. You must not release your submission without the Committee's permission. If you do, it will not be protected by Parliamentary Privilege. At some stage during the inquiry, the Committee normally makes submissions public and places them on its website. Please indicate if you want your submission to be kept confidential.

For further information, contact:

Department of the Senate
PO Box 6100
Parliament House
Canberra ACT 2600

Phone: +61 2 6277 3515

Fax: +61 2 6277 5829

Email: community.affairs.sen@aph.gov.au

This information is found here:


My Draft Submission is as follows and I would welcome comments and suggestions.

----- Begin Submission.

Submission to the Senate Standing Committee on Community Affairs.

Topic: Enquiry into the Healthcare Identifiers Bill 2010 and Healthcare Identifiers (Consequential Amendments) Bill 2010

Submission Author:


Author’s Background. The author of this submission is an experienced specialist clinician who has been working in the field of e-Health for over 20 years.

General Points on the Bills.

First without seeing the associated regulations it is impossible for the Senate committee to know what we are actually going to wind up with as a final implemented system. As the Late US President Ronald Regan put it "Trust but Verify" The Senate should insist in seeing at least the proposed draft regulations.

Second the Bills are being treated in isolation from the larger e-Health agenda for which there is at present no effective leadership, organisation or governance as recommended in the 2008 National E- Health Strategy which was developed for the Australian Health Ministers Council (AHMC) by Deloittes and subsequently agreed. To be undertaking legislation and implementation with this gap not addressed is as Sir Humphrey would say ‘exceptionally courageous’.

Third to not be undertaking small and large scale pilot implementations before a nationwide rollout is, in my view just foolhardy and just nonsensical. No responsible organisation just switches on a national system of this scale without a lot of operational testing etc. The whole project poses massive risk from an organisation that has been found wanting in other much less complex implementations. (e.g. Medicare Easyclaims). Internationally and at a State level in Australia there have been very many difficulties with many such projects and very few obvious successes.

Fourth it would seem to be quite strange to be passing legislation for the HI Service without being clear what comes next. A COAG proposal is being developed by Department of Health Ageing for a fuller E-Health approach at the time of this submission but is still secret. The time for legislation is when that fuller agenda is public and has been debated by stakeholders.

Fifth there is no evidence there will be wide-spread use of the HI Service until there are some arrangements put in place to ensure they have their reasonable time and costs rebated in some form. I am informed NEHTA has approached their Board on this matter – but in absence of this approval the entire Health Identifier Service risks being an expensive white elephant

Last, while there is no doubt there would be major benefit from a smooth running efficient National Identifier System the costs of ongoing delivery and maintenance (recording births, deaths, address changes and so on for some 22 million souls) are not addressed and may be very considerable. Other options exist for addressing Health Identification but these have never been explored and there has never been a business case developed .

All the above points ignore the various risks to privacy and identity protection which I am sure others will provide detailed submissions upon.

In summary it is my professional opinion that the community is entitled to be presented with legislation that takes a far more holistic view of the way e-Health systems and services are to be delivered to Australians and addresses clearly and systematically all the possible risks that are associated with the implementation of large complex systems as well as providing an optimal framework for governance, leadership, privacy protection and engagement with the caring professions and consumers who are going to be required to use these systems.

The present proposed legislation is deeply inadequate and there are major implementation risks with the project overall which I do not believe have been treated frankly by the enthusiasts for this Bill in its present form.

Dr David G More.

----- End Submission

I would be keen to have comments that can improve this draft.


Saturday, February 27, 2010

Another Chance to Read the NEHTA Health Identifiers Spin Manual.

About 4 weeks ago I posted the two documents I had been sent.

See here:


After a request from NEHTA I took the – claimed to be draft - documents down, on the understanding NEHTA would release the finalised documents in reasonable period.

See here:


Well it now appears that the strategy is being actioned. We have the new web-site (www.ehealthinfo.gov.au) and we have banner ads appearing a on the RACGP web site.

A check on the NEHTA website and my e-mail inbox finds no such documents.

With all that in mind it seems the time has come to allow readers to know what to expect next!

The files can again be downloaded here:


and here:


Enjoy reading and as they say forewarned is forearmed!

I will note in passing – as free advice to NEHTA – their case for fostering provider adoption looks flimsy at best.

This time the files come down when NEHTA releases the finals – if any later versions actually exist.



Friday, February 26, 2010

Weekly Overseas Health IT Links 24-02-2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.



Healthy return for the two GPs who computerised patient records

Catherine Boyle

Two former GPs have discovered the equivalent of a happiness pill — start a business, float it on the stock exchange and pick up millions of pounds. That is the prognosis for Peter Sowerby and David Stables when Egton Medical Information Systems (EMIS) goes public next month.

They were working in a rural Yorkshire practice in the 1980s when Dr Sowerby realised how important technology could be in keeping patient records. He and Dr Stables wrote the software for an IT package and when GPs started computerising their records, the pair were ready to take advantage of the new market.

EMIS now holds about 34 million patient records on its platform, representing 52 per cent of all GP practices. Last year, the debt-free company made an operating profit of £15.8 million on turnover of £58 million.



‘Core measures' at center of health IT debate

By Joseph Conn / HITS staff writer

Posted: February 19, 2010 - 11:00 am ET

The Health IT Policy Committee has asked the CMS to drop three so-called “core measures” from its proposed rule on “meaningful use,” but that's not to say the committee has a problem with another group of core measures used by the Joint Commission, the CMS and the Hospital Quality Alliance quality measures reporting programs.

The two groups of measures are different, and the recent use of the phrase “core measures” by CMS rulemakers was an unfortunate choice of words that could lead to some confusion between the two, according to a Health IT Policy Committee leader.



Surescripts lowers e-prescribing costs

February 17, 2010 | Molly Merrill, Associate Editor

ALEXANDRIA, VA – Officials at Alexandria, Va.-based Surescripts say it is reducing what pharmacies, pharmacy vendors and pharmacy benefit managers pay for e-prescribing.

According to company officials, it has been six years since Surescripts, which operates the nation's largest e-prescription network, has had a price increase.

"Our decision to lower prices fulfills a public promise made when legacy SureScripts and RxHub were founded," said Harry Totonis, pre



CDC to monitor adverse blood transfusions

ATLANTA, Feb. 18 (UPI) -- A new national surveillance system will monitor adverse events in patients who receive blood transfusions, U.S. health officials said Thursday.

By having a coordinated national network, health officials at the Centers for Disease Control and Prevention in Atlanta can summarize national data to understand better how to prevent adverse transfusion events such as reactions to blood products, medical errors, and process problems.

The system, called the Hemovigilance Module, is part of CDC's National Healthcare Safety Network -- an Internet-based surveillance system that allows healthcare-associated infection data to be tracked and analyzed to allow CDC and healthcare facilities to maximize prevention efforts.



Docs using mobile apps at the point of care

February 18, 2010 | Kyle Hardy, Community Editor

The introduction of a medical check list for the iPhone could be a benefit to providers as mobile technology is quickly being integrated into the care process.

Peter Waegemann, vice president of development for the mHealth Initiative, Inc. says so many health professionals have started using smartphones to help administer better care that some say they "don’t know how colleagues manage without them."

Official statistics aren't published, "but anecdotal reports confirm that many doctors are using the iPhone at the point of care,” says Waegemann. "There are several hospitals where all doctors are using the iPhone."



Friday, February 19, 2010

Developing Countries See Promise in E-Health; Challenges Remain

by Kate Ackerman, iHealthBeat Editor

When you think of developing countries, health IT might not be the first thing that comes to mind. In some developing countries, per person spending on health care is as low as $10 annually so it wouldn't be surprising if high-tech health tools weren't a priority.

But in fact, many developing countries worldwide are investing in e-health to help increase access, improve affordability and boost care quality.

From telemedicine in Mongolia to e-pharmacy projects in Malaysia to low-cost electronic health records for HIV/AIDS patients in Kenya to Web-based communication tools to address maternal and child mortality in Peru, e-health applications are being used in many developing countries.

The February issue of the journal Health Affairs focuses on how e-health -- the use of information and communications technology to manage patient care -- is transforming health care in poor and low-income countries. The Rockefeller Foundation provided the journal with financial support for this month's issue, and many of the articles grew out of a 2008 Rockefeller Foundation conference on e-health at the foundation's Bellagio center in Italy.



Perspective: California to build out HIE with nearly $40 million

Channel: NHINWatch.com

Source: Patty Enrado,

Date: February 17, 2010

Of the more than $100 million for the healthcare industry that California will receive from the American Recovery and Reinvestment Act, the California Health and Human Services Agency will get $38.8 million to build a statewide health information exchange (HIE).

The grant for HIE comes out to be approximately $1 per resident for the populous state, an amount many local industry leaders felt is insufficient to get the job done. “We’re going to need significant funding to have ubiquitous health information exchange, to fulfill the vision of having information safely and securely reach all corners of the healthcare delivery system and individuals,” said Jonah Frohlich, deputy secretary of Health Information Technology for CHHSA.



Fed Advisors Ask: Are HIT Systems Safe?

HDM Breaking News, February 18, 2010

A workgroup of the HIT Policy Committee, a federal advisory body, will hear testimony on the safety of health information technology during a public hearing on Feb. 25 in Washington.

Witnesses before the committee's Adoption/Certification Workgroup include Ross Koppel, PhD, principal investigator at the Center for Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine in Philadelphia. Koppel co-wrote a commentary published last March in the Journal of the American Medical Association that contended software vendors place provisions in contracts that protect themselves from harm resulting from faulty software while prohibiting customers from publicly disclosing the problems.


For more information on the hearing, accessible via the Web, click here.

--Joseph Goedert



HHS appoints Joy Pritts chief privacy officer

By Mary Mosquera
Wednesday, February 17, 2010

The Health and Human Services Department named Joy Pritts, an assistant research professor at Georgetown University's Health Policy Institute, as chief privacy officer in the Office of the National Coordinator for Health IT.

The chief privacy officer is a new role at ONC, part of a re-organization now underway to help the office meet its responsibilities under the American Recovery and Reinvestment Act.

As chief privacy officer, Pritts will advise Dr. David Blumenthal, the national coordinator for health IT, on forming policies on privacy, security and data stewardship of electronic health information, ONC said in an announcement Feb. 17.



Wound care teleassistance: unique in Canada

February 17, 2010 (Sherbrooke, QC) – A new service is being launched today: wound care teleassistance, also known as tĂ©lĂ©assistance en soins de plaies (TASP). With this service a nurse can use a camera to film her patient’s wound, while at the same time an expert nurse in another institution can receive the images. They can then hold an online discussion to evaluate the patient’s wound and plan treatment. TASP increases access to care, allows treatment of patients in their own communities, reduces visits to emergency centres and can prevent chronic wound complications. Because it is based both on a clinical network of specially trained nurses and standardized methods, TASP is unique in Canada.



CQC raises discharge concerns

16 Feb 2010

Almost 50% of GPs are not receiving discharge summaries from acute trusts in time for them to be useful, according to the Care Quality Commission’s report on the state of care in England.

In its first annual report, the care regulator found that only 53% of GPs reported receiving discharge summaries in a timely fashion, while 81% said that the details they contain about patients’ medication were incomplete or inaccurate “all” or “most” of the time.



ISoft wins GP order comms contract

16 Feb 2010

NHS Connecting for Health has awarded iSoft a contract to develop a solution to enable GPs to order pathology tests and view the results online.

The deal will see iSoft provide a new module that will enable GPs to request tests from within a electronic patient record and then access the results directly from the EPR when they are ready.

Isoft will also deliver a pilot project to prove the technology. This will begin at a major acute trust that is already using the pathology system, but which has yet to be named.



Panel proposes reducing meaningful use measures

By Mary Mosquera

Monday, February 15, 2010

Members of a federal health IT advisory group last week proposed to relax the number of measures that will be required for healthcare providers to demonstrate “meaningful use” of electronic health record systems.

The Health & Human Service Department’s meaningful use workgroup crafted an approach they said strikes a “middle ground” between too few and too onerous a set of measures of meaningful use necessary to qualify providers for financial incentives under HHS’s health IT adoption plan.



Fed Advisors: Change MU Criteria

HDM Breaking News, February 17, 2010

The HIT Policy Committee, which advises federal officials, has approved recommendations from a workgroup to scale back some proposed criteria to demonstrate meaningful use of electronic health records to receive Medicare and Medicaid incentive payments.

The action is important because the committee of industry stakeholders advises federal officials who now are receiving comment on the proposed meaningful use rule as they consider changes for a final rule expected during the first half of 2010.



Nearly $1 billion released for healthcare IT

By Jennifer Lubell / HITS staff writer

Posted: February 16, 2010 - 11:00 am ET

The White House has released nearly $1 billion in stimulus money to make health information technology available to thousands of hospitals and primary-care physicians and to train thousands of people in healthcare and information technology careers.

During a teleconference announcing the funds, HHS Secretary Kathleen Sebelius said $750 million would be earmarked to help hospitals and physicians adopt electronic health records. “We're at a point in the United States where only 20% of doctors and 10% of hospitals have even basic electronic heath records,” Sebelius said. Many obstacles exist to adopting this technology: small practices often lack their own health IT staff, and incompatible systems make it difficult for doctors to share patient information with pharmacies.



Health IT's Three Big Issues: Money, Money, and Money

Gienna Shaw, for HealthLeaders Media, February 16, 2010

This year's HealthLeaders Media Industry Survey presents a snapshot of the healthcare industry at a time of excitement, uncertainty, and tumult. And healthcare IT is in the center of so many of the big changes that are coming, especially because of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

From budgets to staffing to investment in new technologies that will help organizations achieve meaningful use, healthcare IT leaders spoke out on how the changes will affect their organizations—and their organization's budget.



Keys and obstacles to e-health in low income countries

INDIANAPOLIS – In an essay in the February 2010 issue of Health Affairs, a special issue of the journal devoted to global e-health, William Tierney, M.D., of Indiana University School of Medicine and the Regenstrief Institute, and colleagues, who like Dr. Tierney have significant experience in the development of workable health information technology systems in low-income countries, identify critical steps toward allowing developing countries to cross the "digital divide" to realize the full potential of e-health to improve the quality and efficiency of their health care systems.

"Although business enterprises in developed nations have begun to use electronic information systems to collect, manage and communicate information, low-income nations generally lack advanced e-health tools that can help them achieve better health outcomes. In countries where per capita spending on health care barely reaches US $10 per year, it is key that they get the most out of whatever they can spend," said Dr. Tierney, an Indiana University-Purdue University Indianapolis Chancellor's Professor of Medicine, Joseph J. Mamlin Professor of Medicine at the IU School of Medicine and executive director of the Regenstrief Center for Healthcare Improvement and Research at the Regenstrief Institute.



Friday, February 12, 2010

Federal Officials Tout Importance of Health IT Adoption

by Kate Ackerman, iHealthBeat Editor

Last week, three high-level federal officials tasked with overseeing different areas of the Obama administration's agenda walked into the same conference room, stood at the same podium and touted the same thing -- health IT.

Chief Technology Officer Aneesh Chopra, National Coordinator for Health IT David Blumenthal and Agency for Healthcare Research and Quality Director Carolyn Clancy spoke at a joint plenary session of the National Health Information Exchange Summit, the Health IT Summit for Government Leaders and the Eighteenth National HIPAA Summit.

Chopra, Blumenthal and Clancy offered insight into how health IT fits into the Obama's administration's larger health care and innovation goals.


Health IT Jobs Outlook Bright

The health IT sector will spawn 50,000 to 200,000 jobs between now and 2015, survey says.

By Antone Gonsalves, InformationWeek

Feb. 12, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=222900186

Most new health IT jobs over the next five years will be filled by consultants and application trainers, a survey of IT professionals showed.

In addition, the survey conducted by the American Society of Health Informatics Managers found that 90% of the respondents believed that employers were looking for people with both IT and healthcare experience and knowledge.

Participants in the jobs survey released this week included beginners, intermediate workers and experts. Workers at the expert level, which comprised half of the respondents, were described as decision makers and senior management. The ASHIM interviewed 135 people.



Breach Prevention is Critical as HIPAA Compliance Worlds Collide

Dom Nicastro, for HealthLeaders Media, February 12, 2010

Privacy and security officers have to comply with more rules than ever. The Federal Trade Commission's Red Flags rule, existing HIPAA laws, and the new Health Information Technology for Economic and Clinical Health (HITECH) Act require that covered entities:

  • Protect patient information with technical, administrative, and physical safeguards (HIPAA)
  • Lessen the negative effect of unauthorized disclosure (HIPAA)
  • Notify patients within 60 days of breaches that involve unsecure personal health information (PHI) and pose a significant risk of financial, reputational, or other harm (HITECH; enforcement effective February 17)
  • Inform HHS of breaches (HITECH; enforcement effective February 17)
  • Establish an identity theft prevention program with policies and procedures to detect, prevent, and mitigate identity theft (Red Flags Rule; enforcement effective June 1)



ISoft creates UK LIS development team

16 Feb 2010

ISoft is creating a development team to advance the capabilities of its pathology systems. It is also planning to release a series of new functions for its i.Laboratory and i.Laboratory TP range.

The new modules will include GP test results requesting and reporting, business intelligence, digital solutions for lab-lab connectivity, configurable dashboards and a dedicated laboratory manager.

The modules will be demonstrated at a user group forum at the International Convention Centre in Birmingham on 10-11 June 2010, where users will be able to provide feedback to inform future developments.



[FOCUS] Hurdles confront e-health across Europe


15.02.2010 @ 12:26 CET

EUOBSERVER/ HEALTH FOCUS– Information technology applied to healthcare – broadly termed e-health – is set to revolutionise patient care and how healthcare systems can be structured and managed. However, different obstacles are standing in the way for Europe to truly embrace the digital reform of its healthcare systems.

Europe's aging population and increase in chronic lifestyle illnesses pose serious challenges and strains to the sustainability of governments' national health and social care systems, which are mostly based on public financing.

Health expenditure in the European Union is therefore expected to increase from nine percent of the EU gross domestic product at present to around 16 percent by 2020, according to Healthcast 2020.

"The health sector is, however, very information intensive, so advanced information and communication technologies can make healthcare systems more cost-effective, allowing more funds to be spent on healthcare, and less on administering it," states the European Commission.



Mass. health IT attracts $26M in federal funds

By Mass High Tech staff

Massachusetts has pulled in $25.6 million in federal funding for work in health information technology, according to an announcement by Gov. Deval Patrick and the Massachusetts Congressional Delegation.

The funding will be divided so that $15 million supports electronic health records implementation and $10.6 million will be used for a secure health information network to be built in Massachusetts.




Thursday, February 25, 2010

British Columbia - A Manifest Warning for Australia and NEHTA.

A few days ago the Auditor General in British Columbia released two reports on e-Health in that province.

Here is the initial reporting I saw.

Auditor general says B.C. e-health system progressing slowly, has long way to go

By Camille Bains (CP)

VANCOUVER, B.C. — British Columbia lacked a strategic plan as it embarked on a multimillion-dollar electronic health records project six years ago, says the province's auditor general.

John Doyle said the government was slow to get going on the system because there was no co-ordination involved.

"Key stakeholders such as health professionals were not effectively engaged to ensure the proposed EHR (electronic health records) system would meet the needs of its users," he said in an audit report released Wednesday.

He said that while the government has initiated some ways to involve doctors in planning the project, they have not succeeded.

"Among the reasons for the failure of this effort: unclear goals for doctor involvement, possibly too little compensation offered, and the competing priority of health authorities planning regional (electronic health records)."

The Health Ministry has made some progress after changing tactics two years ago, Doyle said of the project that has also been linked to an ongoing RCMP investigation.

"The new strategy has not been widely communicated and it is too early to assess the effectiveness."

"The work still to be done to complete (the project) is extensive."

Doyle said the ministry's new 2008 strategy included establishing a simpler governance structure that brought together a group of 20 people including doctors, nurses, pharmacists and First Nations.

Lots more here:


This has been followed up by a series of reports – which have probably not really been noticed because of the Winter Olympics that are going on there.

Scathing report details botched e-health plans

Poor planning, a budget that is soaring out of control and delivery that is five years behind schedule plague electronic records program

By Vaughn Palmer, Vancouver Sun February 18, 2010

The B.C. Liberal drive for electronic records-keeping in the health care system is behind schedule, over budget, poorly planned and still a long way from realizing any benefits to patients, according to auditor general John Doyle.

Doyle released a report Wednesday that chronicled a list of failings so comprehensive as to raise doubts about whether the Electronic Health Records project could be said to be "managed" in any proper sense whatsoever.

By way of accountability, the almost 60-page report contained a passing mention of one likely blame line for the Liberals: "Turnover in senior management" at the health services ministry and "a sudden change in the assistant deputy minister."

Both references to the ouster, in mid-2007, of the senior official in charge of e-health, over a series of allegations that are still being examined by a special prosecutor.

But it would be a mistake to attribute the EHR failings to a single official, however highly placed.

More than two years after the supposed housecleaning in the health ministry, there remain considerable problems with the Liberal plan to establish a single, province-wide system to allow authorized health care providers to access a patient's complete medical records wherever the individual seeks medical attention.

"There is still a long way to go before British Columbians fully realize the benefits of having an electronic health record," Doyle cautioned in his report.

The auditor-general agreed the project has potential benefits for patients and medical professionals alike. But given the inherent complexities, his report conveys a sense of astonishment at the inadequacies of the planning process and absence of follow-through.

More here:


Next day.

Planning came late to the initiative for electronic health records

The Liberals fumbled the e-health file so badly that regional systems being developed aren't compatible across the province

By Vaughn Palmer, Vancouver Sun February 19, 2010

One doesn't need to read too far into the latest report from auditor-general John Doyle to discover why electronic health records should be a good thing for patients and medical professionals alike.

"Why should a lack of comprehensive EHR be a concern for British Columbians?" asks Doyle, in the opening pages of his damning investigation of the provincial government's way-behind-schedule, grossly over-budget and ineptly planned records-keeping initiative.

He then proceeds to answer his own question, using a series of fictional scenarios to illustrate the potential benefits of a thorough system of electronic record-keeping in the health care sector.

Fictional scenario one: "Eric is a senior citizen who has lived in six different parts of B.C. in the last 10 years. He has had X-rays and blood tests and received various prescriptions in several different towns."

Then one day, while our senior is on vacation in the Okanagan, he experiences shortness of breath and is taken to a walk-in medical clinic in Kelowna.

"Currently, Eric's health records exist all over the province, on paper and film. This makes the job of the treating physician in Kelowna especially challenging because she will have difficulty accessing all the details about Eric's medical history quickly and efficiently."

One can readily expand on Doyle's scenario by adding a few more telling details.

What medication has Eric been taking? Has he experienced shortness of breath before, when and to what extent? He might be able to answer himself, were he not stressed and increasingly muddled. His doctor would know, but she's on vacation and her practice is being handled by a stand-in who has never treated Eric.

Point made. Electronic health records could be a positive boon. But that only underscores the significance of Doyle's report, summarized by his discouraging observation that "there is still a long way to go before British Columbians will enjoy the benefits of an EHR system."

The system, which was supposed to be fully operational two years ago, won't be up and running for three years at the earliest. "Once built," adds Doyle, "it will still need to be fully integrated across the health sector and regularly used by health professionals in treating their patients."

Nor can one have much confidence that the Liberals will be able to stick to their current, much-revised schedule, given their ineptitude to date.

For instance, take the matter of the government's relations with the medical professionals who will be generating the electronic records and accessing them on a daily, hourly and perhaps minute-by-minute basis.


Four years into the program for electronic health records, $150 million already spent, and the B.C. Liberals (under prodding from the auditor-general) have finally got around to producing a credible strategic plan.

Monumentally embarrassing for a party that claims to know how to run the proverbial peanut stand.


More here:


And next day

E-health security so lax report was withheld

Publication of auditor-general's findings delayed half a year while Vancouver Coastal tried to plug holes in medical records database

By Vaughn Palmer, Vancouver Sun February 20, 2010

When Auditor-General John Doyle and his staff investigated the security of electronic record-keeping at the Vancouver Coastal Health Authority, they found trouble everywhere they looked.

"In every key area we examined, we found serious weaknesses," wrote Doyle. "Security controls throughout the network and over the database were so inadequate that there was a high risk of external and internal attackers being able to access or extract information without the authority even being aware of it."

This for a database containing the sensitive medical records of some 620,000 people receiving residential and home care, mental health, addiction and other services, in 75 community locations across Vancouver and Richmond.

The system is known as PARIS, a cutesy-pie acronym derived from Primary Access Regional Information System. But nothing about it suggested any point of comparison with the fabled city of light.

Some sample findings from Doyle's 30-page report, one of two issued recently on the government's mismanaged electronic health initiatives.

"No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time."

More than 4,000 users were found to have access to the records in the database, many of them at a far higher level than necessary.


More here:


The link to the first report can be found here:


The second report is here:


An equally awful report from Ontario – the biggest province is here (Oct 2009)


The key lessons from all of this is that you need high quality program planning, project controls, risk management, leadership and stakeholder engagement to undertake complex projects of this type.

It all looks awfully like something rather closer to home to me.

I leave it as an exercise for the reader to work out what an AG report on NEHTA might reveal now. If they were to worry about that maybe they could make a bit off a positive difference in the next few months.


Another Ridiculous Deadline For Comment on the HI Service Legislation.

The following appeared in the last hour or two.

Tight deadline for e-health identifier bill inquiry

  • Karen Dearne
  • From: Australian IT
  • February 25, 2010 2:13PM

THE controversial Healthcare Identifiers Bill has been referred to a Senate inquiry, but interested parties will need to meet a very tight deadline for comment, with a report due back before federal parliament by March 15.

The Senate Scrutiny of Bills committee said the HI bill "seeks to introduce a significant change by implementing a national system to assign healthcare identifiers for consumers and providers".

Under the proposed law, introduced by federal Health Minister Nicola Roxon, unique identifiers will be mandatorily issued to all Australians by Medicare Australia, which will operate the HI regime.

If the bill is passed, from July 1 all Australians will be issued with a 16-digit unique number linked to existing Medicare numbers, while all medical providers and healthcare organisations will also be given a unique 16-digit identifier.


The Senate Community Affairs committee will have to consider whether the bill contains sufficient privacy safeguards, the operation of the HI service, including access to identifiers, and its relationship to the wider national e-health agenda and future electronic health records.

Written submissions should be lodged by March 5, and public hearings are expected to be held in Canberra on March 9-10.

In referring the matter, the Bills committee queries the compulsory nature of identifiers, noting that the service operator "is not required to consider" whether providers or patients agree to participate in the new regime.


More here:


So it is time to get weaving if you want your say!

It seems the first contact can be here:


Senate Standing Committee for the Scrutiny of Bills

For further information, contact:

Toni Dawes

Committee Secretary

Senate Scrutiny of Bills Committee

PO Box 6100

Parliament House

Canberra ACT 2600


Phone:+61 2 6277 3050

Fax: +61 2 6277 5881



The main issue in my mind in all this is the lack of apparent capacity and understanding from Medicare / NEHTA about how major change programs are implemented in the Health Sector.

To date my view is that their performance has been abysmal with lack of consultation with the software industry, care providers and consumers, absent implementation plans and demonstration foilware offered as working demonstration systems.

Get going if you share this or any other concerns.


Wednesday, February 24, 2010

This Government is Seems to be Very Keen on Numbering People.

The following has received a bit of publicity today.

Gillard flags national ID scheme for schoolchildren

February 24, 2010

The Federal Government plans to assign every schoolchild an individual identity number to track their academic progress.

Education Minister Julia Gillard is expected to unveil the plan in a speech at the National Press Club today.

Ms Gillard says the program will allow parents to monitor their children's development, even if they move schools.

She says the Government will ensure privacy is protected.

"If we have a way of tracking we can obviously have better measures of how schools are going in developing student performance," she said.

"And then for individual parents it obviously would be of assistance to be able to track the records of a child's schooling."

Opposition Leader Tony Abbott says he has doubts about the plan.

More here:


So it seems all those lucky students will now have a both Health Identifier and a Student Identifier. I wonder which other sort of person they will think of next to number – people who are unemployed to see who gets work, people who are blond to see whether they are actually dumb or have more fun and so on.

One really wonders whether the cost of introduction and maintenance of such a system will actually return some real community benefits. Has anyone seen the business case and privacy impact statements?

That the Leader of the Opposition seems unkeen on this makes one wonder how the Opposition – with their Senate control – will approach the HI Service Legislation.


Weekly Australian Health IT Links - 23-02-2010

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

General Comment:

It looks like the impact of the rather messy Senate Estimates hearing reported last week is continuing to reverberate.

If there has been a theme this week it has been about implementation competence in Government. On the basis of what we see in the e-Health space, one really wonders about all these programs that have been pushed out by the Federal Government.

The issue may very well be that Ministers simply do not understand, in detail, just what capabilities exist in the public service. On the evidence to date there do seem to be some substantial gaps in program management and delivery.

Heaven help us if DoHA attempts to take over and manage the Hospital Sector. They are simply not up to it in my view.



Govt laughs at commercial NEHTA fears

By Renai LeMay, Delimiter.com.au
15 February 2010 10:52 AM

The Federal Department of Health and Ageing has rejected "laughable" questions on whether the National E-Health Transition Authority (NEHTA) would ever compete against e-health companies as a commercial entity.

The authority was established back in mid-2005 by state health ministers as a non-profit company. With funding running into the hundreds of millions of dollars over the years, its mission is to develop electronic health standards to better tie together the IT systems of Australia's health institutions to better outcomes for patients.

Yet according to Liberal Senator Sue Boyce in Senate Estimates last week, firms in the health IT industry were feeling uncertain about whether NEHTA might ultimately use the information it has been gathering for a national e-health system to compete against them. She asked whether there were any intention for NEHTA to be a commercial entity.



Hospital pharmacists want e-script integration

15 February 2010 | by Mark Gertskis

Electronic prescription systems used in hospitals should be linked to systems used by GPs and community pharmacists, according to hospital pharmacists.

The Society of Hospital Pharmacists of Australia (SHPA) has called on the Federal Government to link the electronic prescription systems across the entire health system.

"When a patient moves between the community health and hospital sectors, one of the most fundamental things doctors need to know is what medicines are being taken," SHPA chief executive Yvonne Allinson said.



iSOFT: Australia playing follow the e-health leader

Australian e-health giant iSOFT has noted what it says are “early signs” of action on e-health by Australia’s Federal Government but today said its major growth driver would be the Unites States’ US$34 billion stimulus investment in health IT systems and that Australia would likely follow other countries in the area.

Federal Health Minister Nicola Roxon last week introduced legislation into Federal Parliament that would introduce a National Health Identifier to be implemented by the middle of 2010.

“In Australia … we have seen the early signs of the Government preparing the foundations for e-health, with the legislation for patient unique identifiers,” said iSOFT chief executive Gary Cohen in a briefing after the release of the company’s half-yearly financial results. Cohen also noted encouraging signs in Europe, China and Latin America for the company.



An uphill battle for online privacy


February 17, 2010

The furore sparked by Google's new online social network, Buzz, proves people don't want their candour taken for granted. Buzz plans to overtake Twitter and Facebook, and has the inside running, because it uses the information Google already has about you from your Gmail account, Picasa photos, and maybe your search history.

But it misstepped badly by creating an instant circle of followers from email address books. In other words, it used information collected for one purpose for another. Privacy advocates call that function creep.

Reusing information is not new. Advertisers try to guess your interests from your search history. Retailers promote their products direct to your smart phone when you are near to the store. The whole world can tell what football team I follow, because the bumper sticker on my car is visible on Google Street View.



iSOFT Announces Lorenzo for the iPhone

Wednesday, 17 February 2010

Australia's largest listed health information technology company, announced that it is bringing its Lorenzo strategic healthcare solution to Apple's iPhone for medical professionals to access scans, x-rays and patients records via a prototype application due for release later this year.

With the iPhone application, nurses can also directly register basic patient information like pulse and temperature with Lorenzo, reducing the time spend on administrative actions and making information available with a click of the 'enter' button.



Relevance of health libraries in the digital age

Read the full text

PDF Relevance of health libraries in the digital age

15 February 2010This article discusses the future of health libraries and how they need to meet the needs of the parent organisation and its staff to maintain relevance in the digital age. Nicole Jovicic is a trainee librarian at the East Arnhem Health Library in Nhulunbuy. Health Libraries Australia is a group of health librarians and is part of the Australian Library and Information Association.



Computer test catches children with ADHD


February 18, 2010

RESEARCHERS have developed a computer test that can diagnose children and adolescents with attention deficit hyperactivity disorder (ADHD) with 96 per cent accuracy.

ADHD is the most common mental health condition in adolescents and children, said psychologist and lead researcher Leanne Williams of the University of Sydney.

''Six per cent of children in Australia have been diagnosed with ADHD, which equates to about one child in every classroom,'' she said.

To be diagnosed with the disorder, children have to have difficulty paying attention as well as display hyperactive and impulsive behaviour at home and at school.



February 16, 2010 07:37 AM Eastern Time

iMDsoft and iSOFT Announce Distribution Agreement

Software supplier to distribute MetaVision clinical information systems in Germany

LEIDEN, The Netherlands--(BUSINESS WIRE)--iMDsoft®, a leading provider of clinical information systems for perioperative, critical, and acute care, and iSOFT Health, a leading supplier of software applications for the healthcare sector, have announced that iSOFT will begin distributing the MetaVision® Suite in Germany. iSOFT currently serves customers in 40 countries and is one of the world’s largest healthcare information technology companies.

“I believe that iSOFT has the reach and expertise to enable a wider network of customers in Germany to enjoy the proven benefits that MetaVision brings to users worldwide.”



National e-med management plan

A national project could see aged care facilities across the country benefiting from electronic prescribing and medication management by 2013.

The Aged Care Industry IT Council is currently developing a strategy for implementing a secure repository GPs, pharmacists and aged care facilities would be able to access.

If further funding is forthcoming, the implementation of the new system would occur over a relatively short timeframe throughout 2012 and early 2013.

ACIITC spokesperson and Aged Care Association Australia (ACAA) CEO, Rod Young said the project would deliver a market ready solution.



iSOFT Group Limited (ASX:ISF) Announces H1 FY10 Results

Sydney, Feb 16, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) Australia's largest listed health information technology company today announced its half-year result for the six months ended 31 December 2009.



Strong Aussie dollar hits iSoft results

GFC spurs slowdown in public sector health spending

Despite a strong global health IT market, iSOFT has recorded declines across its revenues, after tax profits and EBITDA for the half year to 31 December 2009.

The company recorded revenue of $237.3 million; down 1 per cent year on year. EBITDA of $40.8m; down 27 per cent over the same period and net profit after tax of $4.8m, down 27 per cent.

According to CEO Gary Cohen, the global health IT industry remained strong, however the high Australian dollar had had a large impact on the first half results.

“Notwithstanding the currency effect, we are seeing growth in our core businesses, we are meeting important milestones in the rollout of our Lorenzo solution in the UK and we are continuing to invest in world class solutions as significant opportunities emerge in markets such as the US, Europe and Latin America,” he said in an ASX statement.



GPs call for $31m in e-health funding

IT Policy - Government Tech Policy

A network of general practitioner doctors has called for $31 million in funding into electronic health projects to be allocated in the next Federal Government budget.

The Australian General Practice Network (AGPN) represents 110 general practice networks, in addition to eight state-based networks. It claims that more than 90 percent of general practitioner doctors are members of their local general practice network.

In a broader submission to the next Federal Budget released this month, AGPN said e-health initiatives such as the E-Health Support Office Program (EHSOP) — which was initiated in 2005 and has been funded until June 2010 — had aided the network in increasing the uptake of e-health infrastructure across the health care sector.



Primary Health Care shares fall despite surge in first-half profit

PRIMARY Health Care stock tumbled today after a surge in its first-half net profit came in below analyst expectations.

Australia's largest pathology services company said net profit in the half ended December 31, 2009 surged to $76.6 million, from $11.5m a year before as borrowing costs fell. But this was still well short of the $91m median forecast of five analysts polled earlier by Dow Jones Newswires. Broker estimates had ranged from $83.4m to $93.8m.

Primary stock tumbled after the result. Its shares today were down 12 per cent at $4.87, after earlier hitting a low of $4.77 amid an overall market that was up 0.8 per cent.

Note: Primary are the owners of Health Communications Network that provides Medical Director.



Hospital promises doctors a bedside data delivery

A BEDSIDE communications cockpit will deliver doctor and patient access to a wide range of smart systems being built into the $180 million hi-tech Macquarie University Hospital, opening soon in Sydney.

Chief operating officer Evan Rawstron said Seimens' HiPath HiMed units would interface with back-end systems to create a totally digital environment for the teaching and research facility.

The 150-unit project is the first local installation for Siemens Enterprise Communications.



Weight loss that isn't all workout, no play

February 16, 2010

It's games versus gyms as Louisa Hearn sweats it out with virtual trainers.

Farewell to gym classes forever. There is a fitness revolution and its happening in my lounge room.

Armed with a small, hand-held motion-sensitive baton and a "Balance Board" under my feet, I am joining a parade of celebrities, sports stars and senior citizens who have been spotted flailing and gyrating on Nintendo's Wii game console in the pursuit of fitness.

With more and more exercise games crowding the market and a New Year's resolution to get back in shape, I am undertaking a one-month challenge to see if I really can get fit doing nothing but working out with my Wii.

I have set an ambitious target of losing two kilograms in that time as I try to dodge calories and cram in at least four workouts a week.



Failure of authority phone line puts patients’ care on hold

Andrew Bracey - Monday, 15 February 2010

GPs were last week hamstrung in their efforts to care for patients, after the Medicare authority prescription line shut down for nearly three days.

Doctors attempting to access the line say they were met with delays of up to five minutes only to be advised the service was down and to call back later.

Sydney GP and Doctors Action president Dr Adrian Sheen, who tried repeatedly to access the hotline, said he was forced to ask a patient to return the next day to collect a prescription.

“I had to tell the patient it will either cost $400 or come back tomorrow,” Dr Sheen told MO.



Performance-based hospital funding: a reform tool or an incentive for fraud?

Antony Nocera

MJA 2010; 192 (4): 222-224


· Hospital funding based on achieving targets for numerical key performance indicators was implicated in Queensland’s Bundaberg Base Hospital scandal and has driven hospital data fraud in Victoria and New South Wales.

· Nationally uniform legislation is required to make health service reporting standards consistent and to criminalise public sector data fraud.

· Urgent action is needed to develop realistic outcome measures that base hospital funding more on the quality and safety of patient care and less on patient throughput numbers.



Doctoring hospital patient data should be criminal offence, says physician


February 15, 2010

Manipulating hospital performance data should be made a criminal offence in the same way corporate directors are prosecuted for cooking the books, according to an article in The Medical Journal of Australia.

National uniform legislation must also be introduced to make the reporting of hospital data comparable between states because it is now meaningless due to differing standards, said Antony Nocera, an emergency physician at Dubbo Base Hospital. The article, published today, says deliberate manipulation of emergency data has occurred in h NSW and Victoria since performance-based funding was introduced in the 1990s.

The fraud includes hospital managers admitting patients to ''virtual wards'' on a hospital's computer system, or discharging and readmitting the same patient, to meet benchmarks in order to generate additional funding or qualify for performance bonuses.



Make faking data a crime: expert


February 15, 2010

HOSPITAL staff should face criminal charges if they manipulate performance data sent to governments and reported to the community, an expert says.

Dr Antony Nocera, based at Dubbo Base Hospital in NSW, yesterday said that current systems of data reporting in Australian hospitals were inadequate and could not be trusted.

In a Medical Journal of Australia article, Dr Nocera said the manipulation of data in Victorian hospitals, evidence of data fraud in NSW hospitals and variable interpretations of reporting requirements generally had made comparisons of performance between states and territories meaningless.




Computerised prescribing: assessing the impact on prescription repeats and on generic substitution of some commonly used antibiotics

David A Newby and Jane Robertson

MJA 2010; 192 (4): 192-195



To assess the impact of two interventions on computer-generated prescriptions for antibiotics — (i) an educational intervention to reduce automatic computerised ordering of repeat antibiotic prescriptions, and (ii) a legislative change prohibiting the “no brand substitution” box being checked as a default setting in prescribing software — and to compare these findings with those of a similar survey we conducted in 2000.



GP software linked to overprescribing

Shannon Mackenzie - Monday, 15 February 2010

Default settings embedded in GP prescribing software are contributing to unnecessary repeat prescriptions of antibiotics, two academics have claimed.

In a study of prescriptions for four antibiotics most commonly prescribed for URTIs, the academics found that 69% of computer-generated scripts permitted repeats, compared to just 40% of hand-written scripts.

According to Dr David Newby (PhD), senior lecturer in clinical pharmacology at the University of Newcastle, the higher rate suggested some doctors were not making conscious decisions to add a repeat script.

Many prescribing software programs have a default setting that automatically adds a maximum number of repeats to a prescription. However, Dr Newby said while this was entirely appropriate for many medications for chronic illnesses, it was a problem when it came to antibiotics.



OpenOffice 3.2 fixes several vulnerabilities

Users should upgrade to the latest version of the open-source office suite to avoid trouble

The latest version of OpenOffice fixes several vulnerabilities that could cause a computer to become compromised by a remote attacker.

OpenOffice.org has issued version 3.2, which adds a lengthy list of new features and improves the suite's overall performance while also fixing six vulnerabilities.

Three of those problems could allow a remote attacker to execute code. In one of those cases, a malicious XPM file -- a type of image format supported by ODF (OpenDocument Format) -- could be maliciously crafted and allow remote user to execute other code on the computer with the same privileges as the local user.