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."

Thursday, September 30, 2010

Weekly Overseas Health IT Links - 30 September, 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 subscription payment.



A Google Health update

9/15/2010 06:00:00 AM

Google Health launched a bit over two years ago, and since then we’ve been listening to our users, analyzing feedback and conducting research. We’ve learned a lot from you! You’ve confirmed that having a central place online to store and share medical data with whomever you want is important and a step in the right direction. And we’ve added a number of features based on what you’ve asked for so far. But you’ve also told us that it’s not enough; that you’re also looking for tools that will help you act on all your health and wellness concerns. We’ve heard you ask for easier data tracking, more personalization and the ability to set and track progress toward your health goals. We’ve listened, and today we’re announcing a new design and new features for Google Health.



Stud Health Technol Inform. 2010;160:889-93.

Implementation of a Secure and Interoperable Generic e-Health Infrastructure for Shared Electronic Health Records based on IHE Integration Profiles.

Schabetsberger T, Wozak F, Katt B, Mair R, Hirsch B, Hörbst A.

ITH icoserve technology for health care GmbH, Innsbruck, Austria.


Introduction: The ubiquitous availability of medical or care data for authorized clinicians and nurses is expected to increase quality while reducing costs in the health care sector. The standardized, distributed provision of medical or care data is capable to support the vision of patient centered shared electronic health records (SEHRs). A main contribution to cross-institutional data exchange is provided by Integrating the Healthcare Enterprise (IHE). However, holistic implementations of IHE based eHealth infrastructures for SEHRs are currently rare and security and privacy regulations are not fully covered by existing IHE Integration Profiles. This work aims to point out our experiences and lessons learned from five years of development and the implementation of IHE compliant products. Methods: Cross-Enterprise Document Sharing (XDS) describes the base components for exchanging medical or care data. A unique patient Identification is described by the Patient Identifier Cross-referencing (PIX) and the Patient Demographics Query (PDQ) Integration Profile. All interactions are logged in an "Audit Record Repository" deployed once per Affinity Domain and defined in the Audit Trail and Node Authentication (ATNA) Integration Profile. Results: Based on the IHE Integration Profile XDS and other Integration Profiles high-level components for eHealth infrastructures and applications, supporting a holistic, secure concept and, based on these concepts, software products for a technical cooperative care infrastructure, has been developed. The products are practically evaluated in a project for setting up an IHE XDS Affinity Domain in the Austrian district of Tyrol and a number of lessons have been learned.



Doctors call for stricter rules to protect patient confidentiality

September 21, 2010 by Jennifer Trueland

The BMA has called for tougher safeguards for electronic records to protect patient confidentiality – partly because doctors themselves might share user names passwords with each other.

Speaking ahead of a parliamentary debate on e-health, doctors’ leaders warned that current measures to protect patient information might not be enough.

Specifically, the doctors say that the Clinical Portal Technology project – which allows patient information to be viewed electronically by a wide variety of clinicians and, in some cases, by others as well – requires tighter controls.



Blumenthal: 2013 meaningful use to ramp up HIE, decision support

By Mary Mosquera

Tuesday, September 21, 2010

Dr. David Blumenthal, the national health IT coordinator, sent a strong signal to healthcare providers and vendors to expect that more complex requirements for health information exchange and clinical decision support tools will be among forthcoming requirements for the next stage of meaningful use.

The Office of the National Coordinator for Health IT is now beginning to do “early reconnaissance” around development of stage 2 meaningful use requirements, according to Blumenthal.

“We know there were a set of unfinished tasks, things we passed over in the effort to get the first stage of meaningful use out the door,” he said at an industry event Sept. 21 about states which are leading in electronic prescribing and where he took the opportunity to communicate some future plans.



CMS to publish meaningful use clarifications

By Mary Mosquera

Thursday, September 23, 2010

The Centers for Medicare and Medicaid Services plans to correct a few inconsistencies in the meaningful use final rule it published in July and will post on its Web site more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

The minor revisions, including more detailed descriptions of each of the meaningful use objectives and measures, “should help clarify issues and help the (Health IT Policy Committee) plan for recommendations for future stages,” said Tony Trenkle, director of CMS’ Office of e-Health Standards and Services.

Trenkle, who spoke at a Sept. 22 meeting of the policy committee’s meaningful use workgroup, did not offer further information on the clarifications. They would be released, “shortly,” he said.



Practice Fusion touts growth of 'free' EMR

You've no doubt heard of Practice Fusion by now. That's the San Francisco vendor that provides a free, advertising-supported EMR to a roster of physicians that the company says numbers 43,000.

But does that model represent the future of EMRs, and is "free" really free? Practice Fusion's business partner sure thinks so.

"Advertising is a natural fit in the healthcare sector," Bill Jennings, CEO of Good Health Media, which serves up targeted, mostly pharmaceutical advertising to Practice Fusion users, says in a press release. "Doctors get it; they're comfortable with discreet advertising inside their medical practice. The advertising programs give a small medical practice the chance to add a time-saving, life-saving technology solution for free. It's a benefit for the advertiser, the doctor and the patient."



Stick with the programme?

23 Sep 2010

It’s been two weeks since health minister Simon Burns announced the outcome of the review of the National Programme for IT in the NHS. His statement has left trusts in the North, Midlands and East needing clarity on exactly what comes next. Equally, it has given many the final push to go it alone. Sarah Bruce reports.

Six months ago, trusts were understandably cautious when they were asked where they stood in relation to implementing the long awaited Lorenzo electronic patient record system under the National Programme for IT in the NHS.

Now, something has changed. Trusts in the North Midlands and East that traditionally said they remained committed to the programme are openly saying they are fed up of waiting and will follow their own destiny.

And who can blame them. Last year, Christine Connelly, the Department of Health’s director general for informatics, said that if local service provider CSC failed to get Lorenzo working smoothly across an acute care setting by the end of March 2010 the DH would look for a “new plan for delivering informatics in healthcare.”

Following University Hospitals of Morecambe Bay NHS Trust’s failure to go live with the latest version of the system on schedule, the ‘new plan’ announced by health minister Simon Burns seemed to amount to more local ownership.

In a ministerial statement, Burns said there would be more locally-led procurement and more modular implementations. However, trusts that go outside the programme will not get central funding. And the DH is being very clear that existing LSP contracts will be honoured.



Extormity 'breach' highlights fine line between fiction, reality

September 23, 2010 — 2:48pm ET | By Neil Versel

Extormity struck again this week. The fictional, satirical EMR vendor emailed a "press release" with the headline, "Extormity Proudly Announces Breach." (If the people behind Extormity were as diligent with updating their website as they are with needling the major EMR vendors, I'd have a link for you, but I guess they'd charge me a consulting fee for that.)

According to the phony announcement: Electronic health record vendor Extormity today announced a data breach that compromised the demographic and health information of more than 80,000 patients.



NME trusts look to portals

23 Sep 2010

The effective end of the National Programme for IT in the NHS at a time of economic constraint is likely to mean fewer big EPR deployments and more focus on integration.

An E-Health Insider telephone poll of trusts in the North, Midlands and East of England, suggests that many will focus on enhancing existing clinical functionality and business cost reduction.

EHI conducted the poll to gauge reaction to the Department of Health's announcement that a 'national' approach to IT is no longer required and that the future lies in more local procurement and module deployment.



FCC Approves Spectrum for 'Super Wi-Fi'

John Commins, for HealthLeaders Media , September 24, 2010

The Federal Communications Commission has unanimously endorsed a proposal to free up for unlicensed use the so-called TV white spaces—vacant airwaves between TV channels—that supporters predict will improve the availability of new technologies such as "super Wi-Fi" for underserved areas, including rural healthcare providers.

It's the first significant block of spectrum made available for unlicensed use in more than 20 years.

"This new unlicensed spectrum will be a powerful platform for innovation. And as we've seen time and again, when we unleash American ingenuity, great things happen," said FCC Chairman Julius Genachowski, after Thursday's 5-0 vote.



Survey: Docs show little concern for meaningful use penalties

September 23, 2010 | Molly Merrill, Associate Editor

ROSLYN, NY – A recent survey finds physicians are not well-informed about financial penalties for complying with meaningful use – and that they may have little effect on the decision to implement an EMR.

Physicians' Reciprocal Insurers (PRI), headquartered in Long Island, NY, released the results of the survey, which polled more than 500 physicians regarding the implementation of EMR systems.

One significant finding of the study revealed physciains' awareness of financial incentives and penalties for implementing EMR systems. While 85 percent of physicians were aware of the financial incentives for implementing the systems, more than 35 percent did not know that they face government-assessed financial penalties for not complying beginning in January 2015. The penalties are equal to a one percent reduction of the physician's annual Medicare payments per year up to five percent. The survey found that more than 65 percent of physicians who were unaware of the financial penalties said this would not cause them to implement EMR.



Scotland plans Key Information Summary

23 Sep 2010

NHS National Services Scotland has announced it will develop a Key Information Summary that will be fully integrated with its Emergency Palliative Care Summary record.

Speaking at the BCS Health Scotland conference, Jonathan Cameron, programme manager of the National Information Systems Group for NHS NSS, told E-Health Insider that the new summary would build on the success of the EPCS but would add considerably more information to the record.



23 September 2010

Keep Track of Information Technology with HIMSS State HIT Dashboard

This online, free, publicly-available resource makes it easy to find information on state-centric information technology resources, health information exchanges, and state-based health information technology policy.

The HIMSS State HIT Dashboard gives healthcare professionals, policy makers and stakeholders a snapshot of major health information technology initiatives underway across the Nation. HIMSS designed the dashboard as an easy and comprehensive online tool for timely access to credible and comprehensive information about relevant health IT programs and initiatives across the United States and its territories.



Thursday, September 23, 2010

Mobile Health Forecasts Are Promising, but Who Will Buy?

By asserting that 40% of U.S. adults would be "willing to pay" for mobile health applications, valuing the market at $7.7 billion, PricewaterhouseCoopers has opened up a dialogue on Twitter, in blogs and even in the mainstream press on whether consumers would really open up their wallets and spend money on personal health information technology.

A growing array of other influential industry analysts are offering promising mobile health forecasts. For example:

  • Deloitte Center for Health Solutions' survey found that 50% of consumers want a "personal monitoring device" to alert and guide them to make improvements in their health or treat a condition;
  • McKinsey's 2009 survey on mobile health asserted that "willingness to pay is high" for mobile health services such as a "phone doctor" and medication reminder. They estimate the mobile health market at $50 billion to $60 billion worldwide and $20 billion in the U.S.;
  • Remote patient monitoring via mobile networks will be a $2 billion market by 2014, according to Juniper Research; and
  • Parks Associates projects the wireless home health monitoring market will reach $4.4 billion in 2013.



Hospital EMR sales almost doubled from 2008 to 2009

September 21, 2010 | Bernie Monegain, Editor

OREM, UT – The sale of hospital EHR systems nearly doubled in 2009 over 2008, driven by the American Recovery and Reinvestment Act (ARRA), according to a new report by research firm KLAS. Epic and Cerner captured nearly 70 percent of the new large hospital sales.

KLAS' eighth annual clinical market share report details the wins and losses of acute care electronic medical record (EMR) vendors at large hospitals with more than 200 beds.

CIS Purchase Decisions: Riding the ARRA Wave, reflects data collected from more than 1,600 hospitals with more than 200 beds in the United States and Canada. During the economic downturn in 2008 EMR sales reached a seven-year low.



At UN summit, calls to use IT as global health tool

By Shawn Rhea / HITS staff writer

Posted: September 22, 2010 - 12:00 pm ET

Global health officials attending a healthcare information technology roundtable in New York on Tuesday called on information technology providers to create "scalable, cost-effective" mobile-health solutions for low-resource countries.

"I think what everybody has discovered is that mobile technology is a cheap and effective way to provide everything from a reminder letting a woman know that she is due for a checkup to identifying stock-outs on drugs and condoms so they can be replenished in a timely fashion," said Kathy Calvin, CEO of the United Nations Foundation, a founder the global mHealth Alliance. "What we haven’t gotten is a scaled-up market place that will help us understand what is needed and how to do it," added Calvin.



Expert view: Nigel Strang

22 Sep 2010

In healthcare, the use of ICT to increase patient safety has so far been remarkably limited. The European Commission is encouraging the development of meaningful ICT solutions geared towards increasing patient safety by offering funding to safety-relevant ICT projects.

No human life is without risk; and there is certainly no healthcare without risk. Modern healthcare has contributed enormously to increased life expectancy and more so to the fall in the number of lasting disabilities that we have witnessed in recent decades.

Nevertheless, healthcare brings with it new risks that need to be addressed by healthcare providers, particularly the risk of medical errors. These include adverse drug reactions or drug interactions, surgical complications, faulty diagnoses or the accidental transmission of a nosocomial infection.



Expert view: Colin Jervis

22 Sep 2010

There are many explanations for the failure of healthcare information systems to deliver the benefits expected of them. To succeed, they must change practice – and that means challenging the status quo, argues Colin Jervis, one of the speakers at eHealth Insider Live 2010.

I joined the NHS full of enthusiasm for the integration of human and technical systems; but I was soon deflated. It seemed everyone knew all about it and was “getting the clinicians on board” or had a chief executive who has told staff IT was “not optional” and that it was definitely coming.

I was influenced by Professor Enid Mumford, who worked at Manchester Business School investigating the human and organisational effects of computer systems. Rare among academics, she had gained practical experience working in personnel for an aircraft manufacturer and as a production manager for a clock manufacturer.

She noticed that the implementation of large computer systems often failed to produce the expected outcomes, even when the technology was sound. Other researchers reached similar conclusions, and the phenomenon eventually became known as the ‘IT Productivity Paradox’. Decades later, this is still being rediscovered by healthcare academics.



Privacy hindering EHR progress, say researchers

September 21, 2010 | Molly Merrill, Associate Editor

RALEIGH, NC – Privacy concerns remain the key obstacle in the widespread adoption of electronic health records in the U.S., according to researchers from the North Carolina State University.

The paper, "Privacy and Security in the Implementation of Health Information Technology (Electronic Health Records): U.S. and EU Compared," outlines steps that could be taken to boost privacy and promote the use of EHRs.

"Electronic health records could reduce costs in the U.S. by an estimated $80 to 100 billion each year," says David Baumer, head of the business management department at NC State and co-author of the paper. "Using electronic records allows the healthcare system to operate more efficiently, minimizes duplicative testing, et cetera. But you can only get those cost reductions if everyone, or nearly everyone, makes use of the records, from healthcare providers to pharmacies to insurance companies."



E-Health Intelligence Report

21 September 2010

Scientific Articles

Studies in Health Technology and Informatics - Volume 160

- A New Approach for Goal-oriented Analysis of Healthcare Processes

The development of efficient e-services for patient-centered healthcare requires insight into concrete problems in administrative and clinical work processes as well as an understanding of the strategic goals that should guide these healthcare processes. However, considering both concrete processrelated problems and high-level strategic goals during process analysis and solution design can be problematic. To address this, we propose a structured approach for analyzing both high- and low-level goals in a healthcare process and relating these to identified problems.



More U.S. doctors moving to e-prescriptions: report

CHICAGO | Tue Sep 21, 2010 12:24am EDT

CHICAGO (Reuters) - U.S. doctors increasingly are ditching pen and paper and sending prescriptions to pharmacies electronically, lured by up to $27 billion in government funds aimed at speeding the switch to electronic medical records.

There are now 200,000 doctors who use e-prescribing, or roughly one in three office-based doctors.

That compares with 156,000 at the end of last year, and 74,000 at the end of 2008, according to new data released on Tuesday by Surescripts, which operates the largest U.S. electronic prescribing network.



QResearch to predict patient cancer risk

20 Sep 2010

A score to predict the risk of patients developing common cancers is to be developed by the QResearch database.

Prof Julia Hippisley-Cox, professor clinical epidemiology and clinical practice in Nottingham University and a co-director of QResearch, told the EMIS National User Group annual conference that QCancer scores were being developed from the database which has already led to the creation of risk scores for cardiovascular disease, diabetes, kidney disease and fracture risk.

More than 600 EMIS practices covering more than 12 million patients contribute to the QResearch database, a not-for-profit partnership between Nottingham University and healthcare IT supplier EMIS.



Vision 360 brought to Isle of Wight

17 Sep 2010

NHS Isle of Wight is to use INPS’s Vision 360 to share summary information from GP records with its walk-in centre, out-of-hours service and A&E department from the beginning of November.

The primary care trust this week wrote to all 149,000 patients registered with a GP on the island to inform them of the information sharing plans and their right to opt out.

The letter, which includes an opt-out form, says information sharing will help clinical decision making, reduce duplication of tests and requests for information and reduce the risk of errors.



5 Ways to Avoid CPOE Pitfalls

Gienna Shaw, for HealthLeaders Media, September 21, 2010

An increasing number of organizations are implementing computerized provider order entry (CPOE) systems in order to help physicians make decisions based on evidenced-based best practices. There are a number of benefits to such systems, from streamlined ordering of clinical tests, labs, and medications, allergy and drug interaction alerts, and, of course, an end to the errors caused by physicians' notoriously poor handwriting.

But there are a number of pitfalls, as well. Improperly deployed systems are at risk to cause more harm than good. Here are five common pitfalls of CPOE and how to avoid them.

1. Make it easy to use

Look for graphic displays that are easy to read and understand says Ron Short, vice president of operations at Good Shepherd Medical Center in Longview, TX. Physicians like "touch, enter, and go" software, he says.



College ends medical transcription program

By Ryan Boetel The Daily Times

Posted: 09/19/2010 11:09:27 PM MDT

FARMINGTON — Fearing it may be preparing students for a diminishing profession, San Juan College will shut down its medical transcription program at the end of the school year.

Many health care professionals anticipate computer programs will soon replace medical transcriptionists.

The School of Health Sciences will focus on modernizing the coding and health information technologies degrees instead. Students with those degrees are qualified for better paying jobs, said Oliver Borden, the dean of the health sciences school.



CCHIT to begin taking vendor applications

By Joseph Conn / HITS staff writer

Posted: September 20, 2010 - 11:45 am ET

The not-for-profit Chicago-based Certification Commission for Health Information Techology will begin taking vendor applications today for testing electronic health-record systems against federal standards for "meaningful use" under the federal EHR subsidy program of the American Recovery and Reinvestment Act of 2009, a CCHIT spokeswoman said.



Social networks can help in predicting epidemics

September 20, 2010 — 10:09am ET | By Neil Versel

Facebook and Twitter aren't just idle distractions. In fact, those sites and other social networks--even ones not based in cyberspace--can help epidemiologists predict flu outbreaks and other epidemics, researchers from Harvard University and the University of California, San Diego, report in the journal PLoS One.

By asking more than 300 randomly chosen Harvard students to name some of their friends and then tracking the two groups independently, the researchers were able to speed up detection of influenza in the group of friends by two weeks with one method. Another method helped them detect an outbreak 46 days before the epidemic peaked, according to HealthDay News. The success is likely due to the fact that those at the center of a social network often are more likely than the average person to contract a contagious illness. "Hence, the careful collection of information from a sample of central individuals within human social networks could be used to detect contagious outbreaks before they happen in the population-at-large," the report reads.



New HIPAA rules need more clarification

September 20, 2010 — 11:06am ET | By Neil Versel

When it comes to the new HIPAA privacy and security standards, it seems like everybody has an opinion. Quite a few organizations are spreading the word about the comments they've filed in response to the changes HHS proposed in July.

The American Health Information Management Association wants the HHS Office for Civil Rights to add some detail to the stewardship role providers must play in determining the "minimum necessary" use and disclosure of patient-specific protected health information, Health Data Management reports. Specifically, AHIMA wonders whether one alternative in a forthcoming final rule on HIPAA attachment standards would effectively force providers to violate the "minimum necessary" standard.


Commerce Department Funds Telehealth Networks

Projects in California and Georgia are among recipients of $482.4 million in grants to boost economic growth, create jobs, and improve healthcare through broadband infrastructure.

By Nicole Lewis, InformationWeek

Sept. 16, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227500045

Telehealth networks in California and Georgia have received funding to improve and expand their broadband infrastructure, which will help these states bridge the technological divide in healthcare delivery.

Announced on Monday by U.S. commerce secretary Gary Locke, investments totaling $482.4 million in grants will go toward 35 projects across the country that will help boost economic growth, create jobs, and improve education and healthcare.



ONC names InfoGard as third EHR certifier

Friday, September 17, 2010

By Mary Mosquera

The Office of the National Coordinator for Health IT has named InfoGard Laboratories, Inc., of San Luis Obispo, Calif., as the third organization to test and approve electronic health records under ONC’s temporary certification program.

InfoGard Labs tests and validates the security of IT products and networks for approval and use by the federal government and large financial institutions, including Visa International and MasterCard International. The company also offers independent third-party security testing services.



Deloitte: IT essential investment for medical home

September 16, 2010 | Molly Merrill, Associate Editor

CHICAGO – Healthcare IT is the essential front-end investment for organizations participating in the patient-centered medical home (PCMH) initiative, according to a new report released by the Deloitte Center for Health Solutions.

The report, "Medical Home 2.0: The Present, The Future," reviews several PCMH pilots and provides insights on the future evolution of the medical home. It highlights the expansion of medical home pilots as part of the Patient Protection and Affordable Care Act of 2010 (PPACA) to help reduce costs and improve population-based health by leveraging clinical information technologies, care teams and evidence-based medical guidelines.

The report concludes that the medical home will likely be a permanent, near-term fixture on the U.S. healthcare landscape due to rising health costs, an aging and less healthy population, payment reforms that are shifting volume to performance, and increased access to clinical information technologies.



VA beefs up data security of network devices

Friday, September 17, 2010

By Mary Mosquera

By the end of September, information security managers at the Department of Veterans Affairs will have the electronic tools in place that will let them see how vulnerable the one million computers and other devices connected to the VA network are.

For the last six months, VA has been deploying multiple software applications and data scanning tools “to get visibility on every device on our network,” said Roger Baker, VA CIO.

The tools will enable the department to do a better job of protecting its network and veterans’ sensitive data, reducing the potential for data breaches.



Healthcare workforce training receives $130M boost

September 17, 2010 | Bernie Monegain, Editor

WASHINGTON – The federal government will give the healthcare workforce $130.8 million in grants, Department of Health and Human Services Secretary Kathleen Sebelius announced Friday. The awards include $50.5 million for state-of-the-art training equipment and technology, such as e-learning tools, video, audio and interactive learning systems and simulators.

Six areas are targeted: primary care workforce training, oral health workforce training, equipment to enhance training across the health professions, loan repayments for health professionals, health careers opportunity programs for disadvantaged students, and patient navigator outreach and chronic disease prevention in health disparity populations.

The grants include $88.7 million in funding from the American Recovery and Reinvestment Act of 2009.



Web group to screen bogus drug sellers

By Joseph Menn

Published: September 19 2010 20:31 | Last updated: September 19 2010 20:31

In a victory for the fight against criminal networks distributing counterfeit and adulterated drugs over the internet, the world’s second-biggest seller of website addresses is to begin screening customers for unapproved drug sales.

Under pressure from security professionals, the internet governance group Icann and the White House, the domain-name seller eNom last week quietly retained LegitScript, a company that vets internet pharmaceutical concerns to make sure they are licensed to do business in the US.




Wednesday, September 29, 2010

The View From The E-Health Front Line. One Man’s View.

This is what I found to be a wonderful note from someone on the ground. Posted with his permission. (It is in note form - but the intent is clear!)

---- Begin E-Mail.


Thanks for your article in the AUSTRALIAN this weekend.

Have visited http://www.aushealthit.blogspot.com/

Could not see where/how to add to the blog discussion.

As a medico about to retire [at 65] and having spent some 36 years in anaesthetics, may I comment:

Commenced a Health Informatics course with UTAS ... which disappointed me as the curriculum ran out of steam.

Prof did not even answer my letter.

The core prescribed reading texts for that course informed us of the billions of dollars euros and pounds wasted on ehealth.

Why don't we all learn?

Why don't "stakeholders" and "significant persons" building ehealth read the established facts/history?

I support ehealth ...

Some thoughts:

I vehemently and steadfastly support the:

"Girl in the short black skirt" interfacing ...

It is inappropriate and an ergonomic interruption to the work habits and practices of health carers/professionals to assume that they sit at a desk and use a keyboard.

The "Girl in the short black skirt" at a restaurant whips out her card on a slip string, swipes, hits the touch screen and goes.

That fast.

I witnessed Epworth Hospital Box Hill attempt to introduce a paperless system, driven essentially by pharmacy, in Melbourne.

Try as we did, and we did speak to the CEO, the Medical Director, the medico from ACT who contributed to the [hopeless] software, the full time trouble shooter from pharmacy, and others at the coal faces.

Having witnessed the CEO wishing to personally rip the wires from the walls, and the medical staff planning to jump [private] ship, I did give the IT guys a loan of my Health Informatics course texts, and suggested they read the basics.

Now, as an imminent retiree I assist the Tasmanian Medical Retrieval Service, and RFDS with medical retrievals:

Having offered my services in public as a rural locum since Oct 07 I found a Mac Air + Telstra dongle ergonomically "perfect".

Now, I have an iPad ...

{And iMac and Mac Book Pro},

Ergonomically convenient pad which does not interrupt my work flow and is a window to the net world.

On my ICU rounds I can access any net and wifi data within seconds bedside.

{And offer to ventilated patients to tap out their messages to us}

When called out on an urgent retrieval I can record the case details, communicate, look up medical conditions, refresh details of procedures such as inserting an intercostal drain, check out details of medications etc etc all on my lap in the King Air 200 RFDS aircraft, or in the back of an ambulance, en route to the patient.

All I need is my databases and a Telstra signal.

Any person involved in setting up "work stations" with keyboards in hospitals just does not understand work habits/ergonomics of healthcare workers .... especially proceduralists in theatres ...

I recall comments by midwives at Griffith Hospital in NSW in 2008:

"It takes only x time to deliver the baby and clean up and then we spend an hour and a half at the [ping] computer entering the details"

The NSWHEALTH system I witnessed being introduced at Broken Hill GWAHS in 2009 will not fly in an operating theatre suite.

Admittedly my GP does use her terminal well.

In fact, in the Western District of Victoria I set up a Peri Operative Unit and in my office we had a blisteringly fast connection courtesy of a smart CEO.

Utilising that in pre and post anaesthetic consultations, in an office actually did work very well.

{I had a duplicate screen for the patient to watch, and deleted any hospital email}

The privacy hurdle is real.

However, I do assume that the world knows who I am, where I am and what I am about to buy, already.

So .... ???

My concepts of ehealth include:

Blisteringly fast convenient "at the bedside" access to:

Patient's known clinical "Problems" list {"History"}

Significant other "History" data ... such as ...

· Trend data of past numbers

· True "allergies"

· Prescribed Rx Hx.

· and non time critical access to details of Hx events PRN

Inpatient current-admission numbers imaging and other data.

Carers' instant access to academic/journals/other quality data, in the office, at coffee, on the tram, at home, at bedside, and during a boring Keynote.



One patient One system ....

Same data retrievable at GP, in DEM, in private, in public ...

Dr George Waters

----- E-Mail Ends.

Thanks George. I especially like your emphasis on speed, ease of use and ubiquity of information access.


I Am Not Sure There Is Really A Serious Problem Here.

The following appeared last week


EMR development debate focuses on standards, competition

September 20, 2010 — 9:05am ET | By Neil Versel
Lest anyone think the issue has been settled, national health IT coordinator Dr. David Blumenthal says there is a "raging debate" in scientific and policy circles about whether standards or competition should drive EMR development, MassDevice reports.

"There is a raging debate in the computer science world, which I have only lifted the lid on because I'm not a computer scientist, but it goes basically like this: Do we want a world where somebody sets very detailed standards for what computers have to do in order to create interoperability? Or do we want a world that's a little bit more like the Internet, where a minimal set of standards was created and an enormous, vibrant competition and spontaneous growth occurred?" Blumenthal reportedly said at a gala for the Lucian Leape Institute of the National Patient Safety Foundation.

"I hear both sides of that argument, constantly, and even those people who believe in the minimal set of standards aren't really sure what that minimal set is, but we're working on precisely that," Blumenthal added.

He was responding to a question from former U.S. Treasury Secretary Paul O'Neill about EMR standardization.

"Why is it that we're reluctant to declare that we are going to design the best prototype that we can with an idea that we will have [iterative versions] as we learn more and we identify more needs?" wondered O'Neill, himself now a patient-safety advocate. "Why is it that we can't call to question and get on with what's a clear and apparent need for a national standard that's a work in progress?"


To learn more:
- take a look at this MassDevice

More here:


I have to say I am a little surprised that this has become a hot topic.

It seems to me what you do is Standardise the basic infrastructure and then let innovation flourish in matters of user interface, usability, workflow, functionality etc.

As long as the underlying data models and structures, communications protocols and coding systems being used are properly managed a more than adequate level of interoperability should be possible.

I am told that, at the very least, openEHR, has a very good place to start on all this actually developed. If it can be properly proven up at scale - or alternatives with the appropriate clinical richness and integrity developed then there seems to me to be a line that can be drawn between what is standardised and what is level to developer / vendor choice.

Working out just where the line should be might be a trifle exciting - but I reckon it is doable.

Comments welcome.


Tuesday, September 28, 2010

Sometimes Politicians Really Comes Out With Rubbish. This Is One of the Worst.

The following appeared today.

Roxon demands Coalition admits it was wrong on e-health

HEALTH Minister Nicola Roxon will seek an admission from the Coalition that it was wrong on e-health.

She will also seek Coalition support for health IT measures in the new parliament.

"The Coalition does not believe in e-health," she told The Australian.

"Despite all the experts uniting to support the Gillard government's $467 million e-health investment, the Coalition wanted to cut the funding.

"A key question during this parliament will be whether the Coalition is prepared to accept they were wrong, and support our work."

Ms Roxon said the introduction of a patient controlled e-health system had the potential to save lives and money.

"It is one part of the government's plan to build a health system for the future, through investing and building up services," she said.

Opposition response follows:


In summary they say because of previous examples of “waste and mismanagement” they are sceptical.

Can I say I just despair about the quality of this debate. We have Labor pushing a totally ill-defined plan that is supported by virtually no evidence base I have seen (if Anon knows where this evidence is hiding I would love a link!) and we have the Opposition coming up with oppositionistic platitudes!

How can the Opposition admit they were wrong when they have not been provided with any real information about just what is being proposed in any credible detail.

As we have this drivel emitting from our politicians we have this from Canada:

Canada invests $500 million in electronic health record (EHR) systems with a focus on physicians and nurse practitioners across Canada

September 27, 2010 (Toronto, ON) - Canadian physicians and nurse practitioners will benefit from a $500 million investment made by the Government of Canada in Budget 2010, announced Richard Alvarez, President and CEO of Canada Health Infoway (Infoway).

Of the total amount allocated to Infoway, $380 million of the new money will be directed to speed up the implementation of electronic medical record systems.

EMR systems are the gateway that will enable physicians and nurse practitioners to securely access vital patient information including diagnostic images, blood test results, drug histories and clinical reports.

"A number of provinces and territories are making solid progress developing systems to electronically store the patient information that is far too often unavailable when health providers need it," said Alvarez. "The time has come to shift our attention to the front-lines, where the lion's share of care is delivered, so more physicians and nurse practitioners can access and retrieve the information stored in these systems."

EMRs will provide physicians and nurse practitioners with a better picture of their patients' overall health so better informed care decisions can be made. They also allow health care professionals to record their clinical notes electronically, eliminating the need for inefficient paper-based systems.

"Electronic medical records will allow health professionals to access the vital patient information that is too often lacking in a paper-based environment," added Alvarez. "Currently, 37 per cent of community-based physicians have adopted EMR systems across Canada. The new funding is intended to significantly increase their use in clinics, clinician offices and ambulatory care clinics."

In addition, funding from the $500 million invested by the Government of Canada will be used to support consumer health, diagnostic imaging and telehealth solutions.

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada.

The release is found here:


At least Canada is smart enough to direct resources where the focus is needed in my view. And before everyone comments I do know most GPs are using some form of EHR but that is by no means the case in other forms of practice.

We would do much better to get all clinicians properly supported by quality EMR systems (with integrated clinical decision support) and get those systems properly networked and sharing information appropriately before heading down what I suspect will be a wasteful ‘wild goose chase’ of the PCEHR.

I believe we have taken a very bad strategic step to plan to move down this path. Time will doubtless tell!