Quote Of The Year

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

Wednesday, October 31, 2012

Ministerial Speech To RACGP Last Week. It Will Be Interesting To See What Comes Of All This.

Here is the text of the speech. I have marked the e-Health Component in italics.
Speech - Royal Australian College of General Practitioners Conference GP12: Leading Primary Care - Gold Coast Convention and Exhibition Centre - Broadbeach, Queensland, 25 October 2012
Federal Health Minister - Tanya Plibersek.
Thank you for inviting me to be with you here today.
I’d like to begin by acknowledging the traditional custodians of the land on which we meet, the Kombumerri People, and pay my respects to their Elders past and present.
I would also like to recognise:
    • Dr Elizabeth Marles, the RACGP’s brand new President;
    • Professor Claire Jackson, immediate past President of the RACGP;
    • Dr Zena Burgess, the CEO of the RACGP; and
    • today’s keynote speaker, Professor Clare Gerada, Chair of the Royal College of General Practitioners in the United Kingdom.

Introduction

I’m delighted to be able to acknowledge international delegates from an impressive 16 countries. Welcome to Australia and the beautiful Gold Coast.
Your presence underscores the importance of the Royal College and the high esteem in which this conference is held.
Primary care and GPs: the heart of our health system
For most Australians, visiting a GP is their first, and often their main contact with our health system.
And you’re a popular bunch – with GPs always amongst the handful of professions at the top of our ‘most trusted professions’ lists.
But I know that trust is hard-earned.
Earned through the caring relationships you develop with your patients, and in your practices, each and every day.
And it’s those relationships that mean GPs are the ones best placed to make decisions with their patients, based on their unique circumstances and needs.
Today I’d like to talk about what I think are three key roles for government in the primary healthcare system.
Firstly, about how we can support local decision making, especially by GPs.
Secondly, about collecting, analysing and reporting honest, transparent information about our performance in primary healthcare.
And thirdly, about using that information to help guide investment and drive continuous improvement across the system.
Supporting local decision making in primary care
The international evidence tells us, loud and clear, that health systems with strong primary healthcare are more efficient, have lower rates of hospitalisation, fewer health inequalities and better health outcomes.
The World Health Report in 2008 found that where countries at the same level of economic development are compared, those that were organised around the tenets of primary healthcare produced better health outcomes for the same investment.
We have also seen how care coordination in the primary healthcare sector has been demonstrated to have a significant impact on reducing avoidable hospitalisations.
A randomised control trial conducted by GP Partners in north Brisbane provided clear evidence that a model including dedicated care coordinators, and GP-led care planning leads to lower service utilisation and better health outcomes for patients. The randomised control trial was carried out over three years and involved more than 3000 participants, 179 GPs from 108 practices, as well as 16 care coordinators. The evaluation showed that after 12 months the intervention participants had better general health, and enjoyed a higher quality of life compared to the control group. And after 18 months of care coordination, the intervention participants accounted for an incredible 25% less hospital admissions than the control group.
And another nationally representative study from the United States showed that patients who had a family GP, rather than a paediatrician or sub-specialist, as their regular doctor had:
    • a lower annual cost of care;
    • made fewer visits;
    • had 25% fewer prescriptions;
    • and reported less difficulty in accessing care…
...even after controlling for case-mix, and demographic characteristics.
As a Government we are taking this evidence seriously.
We are shifting the centre of gravity in the Australian system away from acute care in hospitals to primary care.
And as you’d all be aware that’s what we’ve be doing through the establishment of Medicare Locals...
...and more flexible funding and decision-making arrangements to allow GPs and their colleagues to better respond to local needs.
But now Medicare Locals have been established, what we are looking at is what other responsibilities we might sensibly think about devolving to a community level, including to GPs.
At the end of the day, our goal is to have more decisions made locally by GPs, rather than by bureaucrats in Canberra.
The potential of patient-centred medical homes, and better integrated team-care arrangements are some of things already on my list for further exploration.
But I’ll be talking to the RACGP about their vision for how that could look. And I’m very excited by potential of things like eHealth to help realise that vision.
I’ve been working closely with the RACGP on eHealth and I am confident it will help empower you, as GPs, to make even better decisions for your patients…
...decisions based on more comprehensive, more integrated information than ever before.
The statistics tell me that in any week, one in three Australian GPs see a patient for whom they have no current information. And more than one in five GPs face this situation every day.
That really serves to reinforce how central GPs will be to the system – which is why today I am pleased to announce the Government will invest around $2.55 million for the RACGP to lead some new work to assist general practice engage with the Personally Controlled Electronic Health Record.
The College will develop an eHealth syllabus and education modules for use by the Australian General Practice Training Program. And that will be done in collaboration with the Australian College of Rural and Remote Medicine – with the final program earning Continuing Professional Development points for GPs with either College.
This will help ensure GPs can access professional training in eHealth so care can be confidently delivered in a shared electronic environment.
As well, the College will manage a program of GP to GP support – again in collaboration with the College of Rural and Remote Medicine.
The program will employ around 30 GPs with expertise in the PCEHR to speak to their colleagues in around 200 locations across Australia.
The program will engage GPs on the clinical utility of the PCEHR and help prepare general practice for e-readiness and PCEHR compliance. Of course, this will complement the practical support offered to GPs by practice liaison officers under the Medicare Locals eHealth readiness program.
As the PCEHR rolls out, we will be keeping a close eye on the impact it has on the primary healthcare system, as well as the system as a whole.
But to help us better understand impacts like these we need honest and transparent information about our performance.
Honest and transparent information about our performance in primary healthcare
I’m sure everyone here is well acquainted with the health performance information agenda being progressed through the council of health ministers.
And you’d know we have established the National Health Performance Authority to help manage that work.
But today I wanted to touch on some of the things the Authority will be looking at across the primary care system.
Initially the focus will be on information about local health systems – so we can better understand the relationship between hospitals and primary care systems in local communities.
People often tell me they feel a little 'in the dark' about primary care, particularly in terms of understanding its success in keeping patients out of the acute system.
So what the Performance Authority will do is pull together comparable data to paint us a more accurate picture of how we’re doing – to help us explain variation in health outcomes across different communities by exploring the link between primary care and things like avoidable admissions, and length of stays in hospitals.
This is the kind of information that should be valuable for discussions between GPs, Medicare Locals and hospitals.
It will inform your work to ensure that patients get the right care in the right location.
In terms of nationally consistent information on local communities, the Authority will present information in such a way that communities can meaningfully compare experiences with healthcare. The Authority is already working with the Australian Bureau of Statistics to create ‘comparable communities’ so that Medicare Local regions can compare their results with other regions in Australia that face similar social, economic and geographic issues.
And most importantly for everyone here today, the Authority’s first report will include information on use and experiences with primary healthcare – and GPs in particular.
Using information to drive continuous improvement across the primary healthcare system
But all the information in the world is for nought if as a government you don’t look at it, analyse it, and act on it.
The examples I touched on earlier really highlight the power information has to describe how the primary care system is doing, and to identify the things that really work.
For Government, it helps to guide our investment towards what the evidence shows to work, and away from the things that don’t.
It will mean we can make even better use of every precious health dollar.
For instance, research has suggested that in Australian general practice only about half of patients with chronic diseases such as asthma, type 2 diabetes and hypertension received recommended care. And as well as that, there was variation across the country. In NSW for example, the rate of hospitalisation for medical conditions such as asthma and diabetes between local government areas varies by nearly three times.
What is needed is a better understanding of the extent and reasons for this variation in care. The Australian Commission on Safety and Quality in Healthcare is leading Australia’s involvement with the OECD in a project to consider clinical variation within a number of countries for a range of conditions. The Commission is also working to understand further the degree of clinical variation experienced by patients across the country and plans to describe such variation in clinical care.
The next important step will be to understand how best to reduce any unwarranted variation. We know that when patients are given clear and accurate information about treatment, their choices begin to change.
Collaborative work is also underway through the Australian Primary Care Collaboratives, with participation by some 1100 GP practices Australia-wide. The Collaboratives have worked closely with divisions and now with Medicare Locals to look at continuous improvement in practices. That work includes reducing variation in key areas such as diabetes prevention and treatment, chronic obstructive pulmonary disease, and coronary heart disease.
It is important that the medical profession, and in particular the College, is given a leadership role in the work to understand the reasons for this variation in care, and in taking action to reduce unnecessary variation.
This will help to ensure that more people get the right care, at the right time and in the right place.

Conclusion

In closing, I want to take this opportunity, here, amongst her colleagues, to thank Professor Claire Jackson for her fine work as President of the RACGP over the past two years.
On Claire’s watch, the College’s membership has grown to an impressive record of 21,500 practitioners.
Claire has displayed great leadership on issues from eHealth, to general practice funding streams, chronic disease management, and after-hours arrangements.
Her work has also set the stage for the College to continue to develop and support the next generation of GPs.
And on a personal note, Claire, I want to thank you for your wise and honest counsel to me as Minister. I know you will continue to make a significant contribution to your profession, and to the Australian health sector.
Just as I know your successor, Dr Elizabeth Marles, will continue to represent the RACGP admirably.
I look forward to working with you, Dr Marles, to better support GPs, and to use the evidence about our performance to drive continuous improvement in the Australian primary healthcare system.
Thank you.
The text of the speech is found here:
I really wonder just how most GPs will see all this.
Consider this statement:
“The statistics tell me that in any week, one in three Australian GPs see a patient for whom they have no current information. And more than one in five GPs face this situation every day.”
Surely this means that, for the vast majority of patients GPs see, they do have information?
What I see in all this is an expanding set of requirements and demands for measurement and performance assessment of GPs from the Commonwealth Government and what I am not seeing is the evidence that the profession has decided that this is the way they want to profession to proceed.
It is also not entirely clear just how much evidence there is that such an approach - without a lot of support, education and clinical leadership - actually works.
What I find quite interesting is that there has been recognition for a very, very long time (going back to the work done at Intermountain Healthcare by Brent James (going back to 1988) of the importance of limiting variation in practice
See here:
In this paper the authors specifically say that they “did not try to control physicians’ practice behaviour by top down command and control...Instead we relied on solid process and outcome data, professional values that focused on patients’ needs and a shared culture of high quality”.
Brent James is widely recognised as probably the world expert in the area of clinical quality improvement so I hope the Ministerial Advisors are making sure they are going about their attempts to obtain quality improvement the right way that we know works and not just measuring for the sake of measuring without relevant clinical buy in and understanding. The information that will make a difference needs to be relevant and solid as well a locally credible.
The Collaboratives program mentioned later in the speech certainly seem to be heading in a sensible direction and by being more locally driven and clinically led. This program is, of course, hard work and needs continuing support to reach the wider clinical community.
Canberra bureaucrats can be a long way from the GP clinical work face!
Of course the best source of information on which to base quality improvement is that from local live systems used daily by GPs. Hardly what the NEHRS is providing sadly.
David.

Tuesday, October 30, 2012

There Is Governance Management Chaos Loose With The NEHRS. What A Nonsensical Fiasco.

The following amazing diagram crossed my path the other day and I felt an urgent need to share.

This diagram is described as the PCEHR Governance Context and really makes alphabet soup sound like an understatement.

Click To Enlarge


The issue with all this is that it virtually guarantees decision making paralysis. Additionally it guarantees that absolutely no-one will ever be held accountable or responsible for anything.

There is a prize being offered - an opportunity to post a guest blog - for the person who can correctly say what each of these acronyms stand for. Many of them are clearly secret as no one seems to have heard of them except the members!

Imagine the hours that could be happily wasted and the frequent flyer points that could be accumulated attending all these!

Wanders off holding sore head in hands. What utter nonsense!

Last - while I have your attention - I hear rumours of all sorts of things happening at NEHTA. Stay tuned as they say.

David.

Monday, October 29, 2012

Weekly Australian Health IT Links – 29th October, 2012.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. 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.

General Comment

Quite a busy week with the Health Minister out talking up the PCEHR and then offering a trivial sum to have some clinicians talk it up while thinking that GPs are all going to be able to turn on  a technological dime and make it all work - supported by vendors who are still not entirely clear about how it will all hung together and how much disruption lies ahead.
The remarks made at Senate Estimates last week have finally been noticed and we have seen a lot of reporting - even internationally - on the cancellation of an IBM contract. Speculation that this will wind up in the courts is rife - but I suspect it will be sorted long before it gets to that. No one wins when the lawyers get involved!
Of course Windows 8 also hit the shelves this week. It is certainly a bit different so it will be interesting to see how it plays out in terms of adoption over time.  
It was good to see that all was well logging in to the NEHRS today. That’s twice in a row it has worked. The odd thing is that the Australia.gov.au login screen looks quite distorted - no idea why but has been the same for a couple of week. Go figure (using Firefox as browser).
This is a useful link if you want to keep an idea on outages and so on.
Can see how the NEHRS is going from there via a link.
Quote of the week from DoHA on the messed up graphic which had ovaries as kidneys etc:
“During a Senate estimates hearing on Friday, health department Assistant Secretary Adam Davey said the error occurred after the poster was sent back to the graphic designer with amendments and an old file version was accidentally used.
"The department does have processes in place to ensure the accuracy of our communications. On this occasion they were not followed," Mr Davey said.”
Oh really?
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Software ePIP update put practices behind

23rd Oct 2012
AN ePIP software update that crippled some practices using the most popular practice software has sparked concerns about looming disruption from the upcoming e-health record rollout.
Some practices using Medical Director were forced to return to paper records and cut consult times after the software’s latest update drastically slowed their IT systems.
Medical Director owner Health Communication Network (HCN), a Primary Health Care subsidiary, confirmed it issued a new version of the program, aimed at ensuring practices would qualify for the e-health Practice Incentives Program payment (ePIP), to its 17,000 users in September, with a follow-up patch to fix bugs earlier this month.
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State not sold on tracking

Date October 23, 2012

Josh Gordon

THE Baillieu government has not signed up to a new national ''real time'' prescription tracking system to prevent the growing abuse of painkillers, warning it is not a ''magic bullet''.
With mounting concern about the misuse of drugs such as fentanyl and oxycodone, the Royal Australian College of General Practitioners and the federal government are pushing for a nationwide electronic system that would allow pharmacists, doctors and state health authorities to monitor the prescribing and dispensing of addictive drugs.
The plan, which is being funded by the federal government and trialled in Tasmania, would allow health authorities and professionals to check up on people suspected of ''doctor-shopping'', forging prescriptions and trafficking painkillers using a national database.
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Online program to help GPs manage pain

26 October, 2012 Megan Reynolds
Access to the latest skills and research on acute and chronic pain management will be provided to GPs through an Australian-first online learning tool launched at the GP12 conference yesterday.
The innovative Active Learning Module (ALM) pain management program developed by the Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists (ANZCA), the RACGP, and the Bupa Health Foundation will give primary healthcare professionals immediate access to the latest evidence-based research and skills to help prevent transition from acute to chronic pain and improve their patients’ quality of life.
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GPs to play key role in e-health: minister

2:24pm October 25, 2012
General practitioners will play a vital role in the establishment of Australia's e-health system, according to federal Health Minister Tanya Plibersek.
Speaking at the opening of the Royal Australian College of General Practitioners (RACGP) annual conference on the Gold Coast, Ms Plibersek said the government was investing $2.55 million to develop training programs aimed at GPs.
The minister said the RACGP, in consultation with the Australian College of Rural and Remote Medicine, will use the funds to develop an e-health syllabus and education modules.
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Government increases focus on GP performance

26 October, 2012 Julie Robotham
The primary care sector can expect escalating government scrutiny of patients’ health outcomes, the federal health minister, Tanya Plibersek, foreshadowed yesterday.
Opening the GP12 conference on the Gold Coast, Ms Plibersek said the Health Performance Authority was working with the Australian Bureau of Statistics to find ways to compare geographically and socially similar regions.
This would identify regions with high rates of potentially avoidable admissions or prolonged hospital stays, and highlight “how to best reduce any unwarranted variation,” Ms Plibersek said.
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Government pledges ehealth funding for GPs

26 October, 2012 Nick O'Donoghue
GPs are set to get $2.55 million in Federal Government support to help them engage with the Personally Controlled eHealth Record (PCEHR) system.
Tanya Plibersek, Minister for Health and Ageing, announced the funding at the Royal College of General Practitioners (RACGP) Conference on the Gold Coast yesterday.
Recently, in a column in Pharmacy News, Kos Sclavos, Pharmacy Guild of Australia national president, expressed disappointment at the roll-out of the PCEHR.
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GPs gain PCEHR training and support boost

GPs will have access to peer support and online education tools under a new ehealth plan announced today by federal health minister Tanya Plibersek.
Under the $2.55 million funding agreement, The Royal Australian College of General Practitioners (RACGP) will train a cohort of 30 “GP advocates” to deliver peer-to-peer ehealth support and education via a seminar program delivered at up to 200 sites around Australia.
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IBM loses key e-health contract

Human Services steps in as provider.

The National E-Health Transition Authority (NEHTA) has sacked IBM as provider of the National Authentication Service for Health (NASH) after it failed to deliver the service on time.
The NASH service designed and built by IBM was intended to provide a secure means for clinicians to connect with the Federal Government’s $467 million Personally Controlled Electronic Healthcare Record (PCEHR) system.
IBM won the $23.6 million NASH contract in March 2011 and was due to deliver the system on 26 June 2012.
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IBM’s NASH deal gets terminated

news The National E-Health Transition Authority and IBM this afternoon confirmed Big Blue’s $23.6 million contract to build a key component of the Federal Government’s Personally Controlled Electronic Health Record project had been “terminated”, just 18 months after the contract was initially inked. However, it is unclear where culpability lies in the situation.
As part of a $466.7 million investment in the e-health records announced in September 2010 by the Federal Government, the nation’s peak e-health body NEHTA chose IBM in March 2011 to build and manage its new National Authentication Service for Health (NASH) system, which aims at establishing a nationwide secure and authenticated service for both healthcare organisations and personnel that have to exchange e-health information.
At the time, NEHTA chief executive Peter Fleming said NASH would improve healthcare for both professionals and patients. “Our agreement with IBM enables NEHTA to build a system that will give healthcare professionals timely and secure access to appropriate patient information,” he said in a statement. “In turn, the NASH program will take us one step closer to broader healthcare access for all Australians.”
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IBM loses $23 million contract for Australian EHR system

October 24, 2012 | Anthony Brino, Associate Editor
The Australian federal government has terminated a contract with IBM to build the National Authentication Service for Health (NASH), a key security component for the country's national health IT system.
The Australian National E-Health Transition Authority (NEHTA) has terminated the $23 million contract with IBM, citing missed deadlines and delays.
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Lawyers crawl over NASH debacle

The collapse of the $24 million contract to develop a National Authentication Service for Health (NASH) is now in the hands of lawyers following IBM being stripped of the project.
The National E-health Transition Authority, Nehta, awarded IBM the $23.6 million NASH contract in March 2011. IBM was charged with developing an access authentication framework using Public Key Infrastructure (PKI) and secure tokens to manage access to information stored in PCEHRs (Personally Controlled Electronic Health Records).
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Legal woes for IBM's e-health contract

Summary: The end of a key AU$24 million contract with the Australian government's e-health agency appears to be bound for the courts.
By Josh Taylor | October 25, 2012 -- 06:14 GMT (17:14 AEST)
IBM's AU$23.6 million contract with the National E-Health Transition Authority (NEHTA) is in tatters, and both sides have brought the lawyers in as the government implements an interim National Authentication Service for Health (NASH) system.
The deal was first signed in 2011 for delivery by June 30, 2012. IBM was tasked to develop a system that would use public key infrastructure and secure tokens, such as smart cards, in order to provide an authenticated service. This is so that healthcare personnel and providers can exchange e-health information, including referrals, prescriptions, and personally controlled electronic health records (PCEHRs).
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Patient sign-up to PCEHR steady

23 October, 2012 Kate Aubusson
Uptake of Australia’s new e-health system is gradually increasing, with more than 12,500 people signed up for a personally controlled electronic health record by mid-October.
However, the number is still a long way short of the 500,000 target the Federal Government has set for 1 July 2013.
There are also 68 individual health practitioners and 86 health organisations — including hospitals and practices — signed up to access the e-health system, launched on 1 July.
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Telehealth cut as PHI targeted in mid-year budget

22nd Oct 2012
GP telehealth rebates will be restricted to people in designated areas of need and after hours video conferencing restricted to people in aged care facilities as the federal government clings to its forecast budget surplus.
The private health insurance rebate, which was already means tested in the last budget, will now be reduced, Treasurer Wayne Swan said today as he blamed global economic conditions for across the board spending cuts in his Mid-Year Economic and Fiscal Outlook (MYEFO) statement.
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SA office to manage $485m ehealth spend

SA Health is establishing a body to oversee its $485 million investment into statewide ehealth transformation.
According to government documents released this week, the new eHealth Program Management Office’s (ePMO) primary role will be ensuring successful delivery of the $408 million Enterprise Patient Administration System (EPAS) and the associated statewide e-pathology ($30.4 million), imaging ($22 million) and financial and supply chain systems ($25 million).
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Medical agency blocks request for report's release

THE Department of Health and Ageing has refused to release details of a crucial risk-assessment study conducted by Ernst & Young on the personally controlled e-health record system.
The department's e-health division head, Matthew Corkhill, ruled that it was against the public interest to release the 21-page report, Assessment of PCEHR Information Security Threat and Risk Assessments, in response to a Freedom of Information request lodged by The Australian in July.
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No risk guarantee on e-health

THE Department of Health and Ageing has refused to guarantee that its much vaunted e-health record system is risk-free after more than 140 risks were identified before it went live on July 1.
The Gillard government's personally controlled e-health record system, developed by Accenture, contained a staggering 142 risks of which 32 were rated extreme, 77 high and 33 medium.
The detailed risk assessment study, obtained by The Australian, was prepared by the National E-Health Transition Authority (Nehta) and submitted to the Health Department and other relevant parties about two months before the July go-live date.
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IBM says it “successfully delivered” Qld Health payroll

news Global technology giant IBM has written to the new LNP Queensland Government claiming it “successfully delivered” against milestones agreed with the previous Labor administration with respect to the disastrous payroll systems overhaul at Queensland Health, which has already cost the state $417 million and will need another $837 million to fix over the next five years.
The project was first kicked off in late 2007, when Queensland Health determined there was a need to look at a new payroll platform to replace the previous platform, based on Lattice and ESP software, which had been progressively implemented from 1996. Partially as a result of the fact that the state had decided to standardise on SAP’s ECC5 and Infor’s Workbrain software across its whole of government operations, those same platforms were picked for the Queensland Health implementation.
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Date validation for exchanged data

Posted on October 21, 2012 by Grahame Grieve
A question arose in the PCEHR program: is the date 00010101 a valid date in CDA, and if not, what is the valid date range allowed?
Well, firstly, as far as the TS data type is concerned, 00010101 is a valid date – the 1/1/01, the nominal year of Jesus’ birth (only he wasn’t born that year). But just because it’s legal according to the type doesn’t mean that it makes sense – especially as the date of onset of a patient’s problem. This caused some discussion about what dates the national program should accept for clinical dates – what should be valid? When I looked around, I discovered remarkably little good information about the general subject of what dates are reasonable to accept in clinical records.
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Top health diagnosis apps

Date October 21, 2012
Jenneth Orantia reviews the best apps for helping - not replacing - your doctor's opinion.
iBGStar Diabetes Manager
iPhone
Free
The iBGStar Diabetes Manager helps monitor blood glucose levels for those with Type 1 or 2 diabetes. A small accessory for taking blood samples clips to your iPhone (the iPhone 5 isn't supported), alerting you when your blood sugar is out of range.
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Putting medical apps through their paces

APP NAME: SWAP It
PUBLISHER: Department of Health and Ageing.
COST: Free.
PLATFORM: iPhone.
PURPOSE: Gives tips on what food items and activities people can swap to achieve a healthier lifestyle.
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IT service found 'corrupt'

THE state-owned centre for information technology excellence in Victoria was undermined by corrupt behaviour, botched procurement systems and sham contracting, the acting Ombudsman has found.
Acting Victorian Ombudsman John Taylor said CenITex breached procurement policies and guidelines and accused it of nepotism and favouritism. He found some appointments were made on the basis of fabricated or false documentation and staff deeply compromised by conflicts of interest. "Serious improper conduct did occur," he found.
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NBN backlog in greenfields to take eight months to clear

Up to 3800 homes are waiting to be connected to the NBN in new housing estates.
NBN Co has admitted that its roll out of the National Broadband Network (NBN) is not keeping pace with demand in new housing estates, with 3800 premises waiting to be connected.
7:30 reported last night that NBN Co as said it would take until the middle of next year to clear this backlog in new developments.
The program reported several residents in new developments who have been unable to connect a fixed phone line or broadband services due to fibre not being rolled out in their new housing estate yet.
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Microsoft's big gamble with Windows 8

Date October 26, 2012

James Manning

Technology reporter

Microsoft has thrown down the gauntlet to Apple with the official launch of Windows 8, a new operating system that focuses largely on tablet and mobile devices.
As consumers increasingly turn to smartphones and tablets for their computing needs, sales of PCs are expected to decline this year for the first time in 11 years, says research firm IHS iSuppli.
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How Windows 8 changes the game for PC security

Date October 23, 2012 - 9:33AM

Lance Ulanoff

Windows 8 changes the security game in ways that attempt to push aside security software giants such as Norton and Symantec.
Security, or lack thereof, has dogged Microsoft Windows since the mid 1990s. This was bad news for consumers who were fond of risky practices such as sharing 3.5-inch floppies and downloading unknown files from services like AOL, UseNet Groups and, later, the web and file-sharing services. It was a boon, though, for a legion of security software companies that all dove into the breach to protect us from a vulnerable operating system and ourselves.
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Gartner: 10 critical IT trends for the next five years

ORLANDO -- Trying to stay ahead of the curve when it comes to IT issues is not a job for the faint of heart. That point was driven home at Gartner's IT annual IT Symposium fest here where analyst David Cappuccio outlined what he called "new forces that are not easily controlled by IT are pushing themselves to the forefront of IT spending."
The forces of cloud computing, social media/networking, mobility and information management are all evolving at a rapid pace. These evolutions are largely happening despite the controls that IT normally places on the use of technologies, Cappuccio stated. "IT was forced to support tablets, and end users forced them to support IM and wireless networks a few years ago. And more such technologies are on the horizon," he said.
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Enjoy!
David.

AusHealthIT Poll Number 142 – Results – 29th October, 2012.

The question was:
With The Contract For NASH With IBM Being Cancelled (See Senate Estimates) Will We Ever See NASH Actually Delivered As Intended?
Yes - Pretty Soon 16%
Yes - But Much Later 7%
Yes - But Very Much Later 7%
No 47%
I Have No Idea 23%
Total votes: 43
Very interesting.  Close to ½ think it will never happen and quite a few don’t know or are thinking later!
Again, many thanks to those that voted!
David.

Sunday, October 28, 2012

Is The Rocky Path Taken By NASH A Symptom Of A Broader Problem With NEHTA or A One Off?

This tiny remark on October 17, 2012 at Senate Estimates has set off all sorts of interesting commentary.
Senator FIERRAVANTI-WELLS: What is the status of the National Authentication Service for Health?
Mr Fleming : As you are probably aware, we did terminate the contract with IBM. We have been working with DOHA and DHS. We have implemented a NASH solution with DHS, which is in operation and rolling out. That is progressing.
Senator FIERRAVANTI-WELLS: When will this be complete?
Mr Fleming : NASH is doing what we need now. For PCEHRS there is a second component which will support secure messaging. DHS is working with some final phases there, and they will make some announcements in the very near future. Certainly everything we need NASH to do it is capable of and it is doing.”
For some reason it took till the next week for the story to take off despite the fact it had been common knowledge for months that NASH was a real mess.
This September 6, 2012 blog makes it clear what IBM was doing was in grave trouble.
This is the most comprehensive discussion I have seen.

IBM’s NASH deal gets terminated

news The National E-Health Transition Authority and IBM this afternoon confirmed Big Blue’s $23.6 million contract to build a key component of the Federal Government’s Personally Controlled Electronic Health Record project had been “terminated”, just 18 months after the contract was initially inked. However, it is unclear where culpability lies in the situation.
As part of a $466.7 million investment in the e-health records announced in September 2010 by the Federal Government, the nation’s peak e-health body NEHTA chose IBM in March 2011 to build and manage its new National Authentication Service for Health (NASH) system, which aims at establishing a nationwide secure and authenticated service for both healthcare organisations and personnel that have to exchange e-health information.
At the time, NEHTA chief executive Peter Fleming said NASH would improve healthcare for both professionals and patients. “Our agreement with IBM enables NEHTA to build a system that will give healthcare professionals timely and secure access to appropriate patient information,” he said in a statement. “In turn, the NASH program will take us one step closer to broader healthcare access for all Australians.”
The contract was to allow IBM to manage the delivery of the NASH project, offering its hardware, software and services capabilities which include assistance, security and access management technologies, as well as IT infrastructure management.
IBM Australia and New Zealand managing director Andrew Stevens said at the time that the delivery of the NASH would establish a more patient-centric healthcare system, while improving health outcomes for Australians. “This program will benefit over 600,000 Australian doctors, nurses and allied health providers and accelerate the delivery of smarter healthcare across the entire healthcare system,” he said.
The transition from existing healthcare systems was to have been ensured by the deployment of a software development kit (SDK) to be provided by NEHTA, which the authority said would guarantee transactions are authenticated and audited in accordance with Australian standards. Once functioning, NEHTA said the NASH would deliver clinical terminology, messaging standards, unique health identifiers and would become one of the fundamental building blocks for a national e-health system.
Lots more here:
Additionally there is some useful background here:

IBM loses key e-health contract

Human Services steps in as provider.

The National E-Health Transition Authority (NEHTA) has sacked IBM as provider of the National Authentication Service for Health (NASH) after it failed to deliver the service on time.
The NASH service designed and built by IBM was intended to provide a secure means for clinicians to connect with the Federal Government’s $467 million Personally Controlled Electronic Healthcare Record (PCEHR) system.
IBM won the $23.6 million NASH contract in March 2011 and was due to deliver the system on 26 June 2012.
Lots more here:
This paragraph of commentary on the overall PCEHR program is also of interest from the Delimiter article mentioned above:
“opinion/analysis
It’s hard to say what’s really going on here, as I don’t have much knowledge of what’s happening between IBM and NEHTA behind the scenes. However, as someone who’s kept an eye on NEHTA over much of the past decade, I have to say that I don’t have a huge amount of confidence in the organisation or the delivery of the PCEHR in general. NEHTA has suffered a number of communication and delivery problems in the past, and the e-health records area is incredibly complex and notoriously hard to navigate. There have been reports of problems with the PCEHR for months and months now, and I wouldn’t be surprised to hear that the project as a whole is gradually going off the rails.”
It is interesting to read Renai LeMay express this level of concern regarding the overall project and also rather refreshing given the lack of other commentary in the last few months. The utility of independent commentary is clearly seen here as the views expressed are much the same as I hear virtually every other day,
In this context and in the light of this recent comment from Eric Browne one wonders what is actually working

Australian Medicines Terminology browser update

2012-October-03 | 21:52 By: eric
Healthbase Australia has updated the online Australian Medicines Terminology browser to include the 2.36 version of the AMT released by NEHTA today. All deprecated versions are still available for browsing/searching.
It would be useful to hear from any organisation that has implemented, or tried to implement a clinical system based on the AMT, despite its current shortcomings. After all these long years, we are still not aware of any organisation that has a proper deployment where current AMT data is being shared and used by other systems!!
The note is here:
From the ePIP requirements we know that coding has not been standardised - despite all the work on SNOMED-CT over the years as well and I am also told some trying to use the Health Identifier Service are having problems getting reliable results.
Despite the recognised need for an End Point Location Service for the Secure Messaging Service this is still also being developed.
All in all for all that has been invested in NEHTA and the NEHRS Program this is really looking like gross underperformance.
I wonder what will now happen with the funding cuts etc. that we know have happened but not yet been announced. Even slower delivery?
David.