The US Is Still Steaming Along With E-Health initiatives. Real Progress It Seems.

The following appeared a little while ago

Monday, May 06, 2013

Federal Health IT Activity Continues in Q1 2013

by Helen R. Pfister, Susan R. Ingargiola and Christine D. Chang, Manatt Health Solutions

The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the first quarter of 2013.

Highlights

The first quarter of 2013 saw a number of important developments:

• CMS Releases Interoperability and Health Information Exchange Request for Information. On March 7, CMS released a request for information on ways to accelerate electronic health information exchange within the health care industry. The RFI seeks input on potential policy and programmatic changes to further advance interoperable HIE beyond what is currently being done through the Office of the National Coordinator and the Electronic Health Record Incentive Programs. Comments are due April 22.
• ONC Announces Consumer Engagement Plan. In February, Office of the National Coordinator for Health IT published a perspective piece in Health Affairs, titled, "A National Action Plan to Support Consumer Engagement Via E-Health." In the piece, ONC reviewed current consumer e-health activity and described the federal strategy to increase consumer e-health, including leveraging meaningful use objectives. In March, ONC requested public feedback on its consumer e-health strategy.  Members of the public may submit feedback through May 9.
• CMS Launches eHealth Initiative. At the annual Healthcare Information and Management Systems Society conference, CMS announced its eHealth Initiative, which will organize CMS' health IT programs under one initiative. The Initiative is designed to help health care providers simplify their administrative and billing responsibilities by unifying CMS' electronic standards and health IT programs. Moving forward in the next few months, CMS' Office of E-Health Standards and Services will work with health care providers to identify ways to meet the challenges that providers face when participating in CMS' various e-health programs. Also at HIMSS, acting CMS Administrator Marilyn Tavenner announced CMS' meaningful use goals for 2013 and stated that the notice of proposed rulemaking for meaningful use Stage 3 will not be issued during 2013.

Lots more details here:

http://www.ihealthbeat.org/features/2013/federal-health-it-activity-continues-in-q1-2013.aspx

The full article is well worth a read to see just how much is going on in the US.

David.

Does This From The US Remind You Of What Has Been Happening In Australia?

This popped up a little while ago.

Beyond the HIT Boom

By Steven Heck

MAY 20, 2013 12:52pm ET

The thriving health care information technology industry is no longer news. But, much like the real estate market, there’s a crash coming, and soon.

The American health care industry is normally described in three distinct sectors – providers, insurers and life sciences. While all three sectors contribute to health care, they operate in very different ways, with periodic blurring of relative roles and responsibilities. Life sciences include multi-national pharmaceutical and biotech corporations that focus on research and manufacturing. The health care insurance industry has consolidated dramatically over the last twenty-five years and now less than half a dozen corporations provide the vast majority of private insurance in the United States. The insurance sector has periodically increased patient care related interventions, but normally has just passed on ever increasing medical expenses to employers. The provider sector consists of a highly fragmented delivery system of primary, acute and post-acute caregivers. This sector is mostly non-profit and historically local and/or regional in nature. All of these sectors are dramatically impacted by government policy and reimbursement rates.

In 2009, Congress passed the HITECH Act and a year later the Affordable Care Act (ACA). The laws created a set of “carrot” and “stick” incentives that resulted in the health information technology boom. The government, armed with $20 billion in incentives told providers to deploy electronic health records and use them in a very prescriptive manner. The activity level has been dramatic. Vendors, consultants and I.T. professionals have had the best bull market in their history. Virtually every health care provider across the country is automating and integrating. I.T. -related capital spending has garnered a disproportionate share for many years. I.T. operating expense has increased dramatically while internal governance struggles to identify and realize tangible offsets in overall operating costs. Given strict deadlines under law, most of these information systems are being “installed” rather than “implemented.” As a result, most providers have deferred difficult workflow and operational decisions until the “optimization phase” currently anticipated to begin in 2014-2015.

…..

Steven Heck, president of the consulting firm MedSys Group, has over 35 years of health care information technology experience. This includes consulting and sourcing skills in the provider, payer and life sciences segments of the health care industry.

Lots more here:

http://www.healthdatamanagement.com/blogs/-46161-1.html

Looks like it is not only in Australia can government policy and incentives can cause all sorts of distortions with both care providers and the vendor industry. We certainly have seen it in Australia.

David.

Here Is The US Approach To What We Call Wave Sites. Looks A Bit Smarter and Better Planned To Me.

This appeared a few days ago.

Mostashari: Beacons 'taught us'

By Tom Sullivan, Editor, Government Health IT

The Beacon Communities proved that organizations can advocate changes to how healthcare is paid for by working with payers and providers, while  improving quality and safety at the same time — lessons learned locally but applicable to the entire nation, said Farzad mostashari, MD, national coordinator for health IT. “These were the pillars of the Beacon Community activities, and they taught us,” Mostashari said. “They showed what we needed to do.”

Mostashari spoke May 22 during an online event titled The Beacon Community Experience: Illuminating the Path Forward. The idea was to assess how the 17 Beacon Communites had fared over the past three years. The 17 communities across the country were funded by ONC with $250 million to serve as models for changing healthcare. ONC named 15 communities at first, and added two later.

Changing large health plans' payment structure for a single community is one example of an idea that just didn’t make sense; another was the reality that getting data out of EHRs so caregivers can work as teams was just too hard in many cases.

“We needed national movement,” Mostashari said. “We needed national standards because the vendors couldn’t build something just for you.”

Mostashari announced  the release of a  learning guide for "Beacon Nation." ONC describes the guide as encompassing approaches, lessons learned and best practices of Beacon Communities in implementing automated alerts triggered by admission, discharge and transfer events, all with the goal of helping communities improve chronic disease care and reduce readmissions.

 “When we look back over the last three years, we’ve accelerated many of the objectives – lot of the vision we had in mind when we started our work," said Patrick Gordon, director of government programs at Rocky Mountain Health Plans and the program director of Colorado Beacon Consortium. "A lot of times it’s easy to just be consumed by the challenges and the next generation of work ahead of us. But, really, the learnings, the experiences, the networking and the trust fabric that’s been built over the last three years is incredible,”  “And I do believe that those kinds of experiences are universal … and certainly not limited to any particular community.”

More here:

http://www.healthcareitnews.com/news/mostashari-beacons-taught-us

This would seem to say there has been some useful progress. I saw an article about 12 months ago that explained what these sites did.

It's time for the Beacon Communities to shine

By Gienna Shaw

Created Apr 18 2012 - 11:08am

The 17 Beacon Communities [1] are funded to the tune of millions of federal dollars--and the healthcare industry as a whole has a huge opportunity to get a significant return on that investment.

The Beacons, under the aegis of the Office of the National Coordinator for Health IT, have been steaming along with a variety of pilot programs that use healthcare technology to improve healthcare delivery, quality and population health--and cut costs, to boot.  

In other words, the Beacons are working on problems that the entire industry is desperately trying to solve. And now they're poised to share what they've learned, not only from their successes, but also from the lessons they can share about what hasn't worked so well.

"We're looking [to] our Beacon Communities to play a substantive role in informing the national dialogue and in building allies across the country ... participating in learning collaboratives, interacting with trade associations--whatever that might look like," Jason Kunzman, an ONC project officer who oversees five of the Beacon Communities, said in a recent National eHealth Collaborative [2] webcast that featured the Western New York Beacon Community [3] and the Southeast Michigan Beacon Community [4]. 

"In the true sense of what a Beacon is [what they're doing] doesn't matter unless someone is actually looking at the light of the beacon," Kunzman said. "So we're looking at 2012 and beyond as an opportunity to really get the word out about the approaches and successes and lessons learned that each of our awardees have assembled during the course of their time with us at ONC."

Kunzman shared the progress and aims of several Beacon Community objectives, from better health information exchange [5] to fighting chronic disease through mobile health and wellness programs [6]:

Lots more here:

http://www.fiercehealthit.com/story/its-time-beacon-communities-shine/2012-04-18

This is really a good example of what Government can do best. Provide seed funding on a competitive and transparent basis to explore the cutting edge in areas like mobile health, patient engagement as well as more basic things like health information exchange while at the same time actually measuring how well things are going in terms of the three aims of improved health, better healthcare delivery and a lower cost.

I like the sound of all this, and the approach, a great deal and will look forward to seeing what finally flows as time passes. The first article certainly suggest real value is happening and reporting back to all the stakeholders

I wonder will we see similar measures applied to the Wave sites and have transparency here as to what is being achieved? Is anyone seeing to date what the funds have delivered in any concrete sense other than a system which does not seem to be all that much used as yet? Certainly measurement of any health impact has yet to happen. Lessons learnt from the Wave Sites are also thin on the ground as far as I know.

David

AusHealthIT Poll Number 169 – Results – 29th May, 2013.

The question was:

Does It Make Any Sense For the NEHRS / PCEHR To Have Three Different Unsynchronised Sources Of Medication Information?

It’s Perfectly OK 12% (6)

Might Not Be Totally Sensible 6% (3)

Is Clearly Not Sensible 12% (6)

It Violates Basic Principles Of Information Management 69% (35)

I Have No Idea 2% (1)

Total votes: 51

Most readers think this is purely bad information management practice. That is because it is.

Again, many thanks to those that voted!

David.

This Article Makes An Important Point That Is Just Being Skated Over By Government and DoHA.

This article appeared a little while ago.

eHealth measures missing the point

By David Glance on May 21, 2013 11:55 AM

Opinion: When will the PCEHR lead to patient outcomes?

One of the great challenges for eHealth is to convince governments, healthcare organisations, practitioners and the general public that it is worth the investment.

This involves first of all working out whether anyone is actually using the technology, then determining what they are using it for and finally trying to judge whether this use has any positive outcome.

These evaluations are all aspects of what is called “meaningful use” and apply to any technology, not just technology in healthcare.

When governments sell investment in technology to the public, they couch the benefits in terms of the positive outcomes of meaningful use, yet they measure the success of the deployment in terms of the more basic measures, specifically how many people are using the technology.

Use in this context can mean a download or registration. It doesn’t mean that they actually ever did anything further with the software or technology.

The use of download numbers or registrations can be useful if you are considering the deployment of the NBN for example, as it is very likely that people who connect to the NBN will actually use it.

When it comes to measuring the success in deployment of something like the PCEHR, it is very much less useful other than to serve as a distraction from the real issues of the success or failure of the investment.

In the case of the PCEHR, the Government is struggling to even get the registration numbers it had originally set out to achieve. It is falling short of its target of 500,000 registrants by June 2013 by a considerable margin. As of the end of April it had signed up only 109,000 people.

Lots more here:

http://www.itnews.com.au/News/343966,ehealth-measures-missing-the-point.aspx

There was a good comment following up from a regular contributor here on the blog:

Bernard Robertson-Dunn

Two points:

First: benefits are different from value. A technology solution may have lots of benefits but if nobody wants these benefits (i.e. they do not value them) then implementing it is probably not worth the cost. I think what the article is actually saying is that the indications are that very few people - patients or health professionals - see value in the PCeHR.

Second: IMHO, the value that might come from implementing technology such as the PCeHR should have been established before it was implemented. Otherwise you end up in the situation where a lot of money gets spent but no value accrues from that expenditure.

So we are now in the ludicrous situation where a technology has been implemented and nobody knows if has been worth it. There is no value assessment of any problem being solved, just a great big bill and a meaningless statistic of the number registered users. Trying to justify a technology spend after the event is a little naive.

So, I am agreeing with the thrust of the article but from the persepective of the value that comes from solving a problem, not from that of the costs and benefits of a technology solution. In the case of the PCeHR, no problem has been clearly identified and agreed amongst all the stakeholders, never mind the value of solving it.

The phrase White Elephant comes to mind.

----- End Comment.

Being a simple soul I have a different perspective. Part 1 is that it is clear the number of registered users really does not matter - what matters is the actual usage - in anger - (by which I mean for a purpose that the system was intended - if anyone is clear what that is?).

Part 2 is that usage statistics can easily be generated from the PCEHR to identify how many people are actually using the system - but I suspect hell will freeze over before they are made public.

The $ cost per real user would be a great statistic to have! Maybe some questions along these lines at Senate Estimates this week?

David.

Weekly Australian Health IT Links – 27th May, 2013.

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

An interesting week, with the range of articles reflecting the increasing role apps seem to be playing in e-Health.

I have to say that we are all pleased to know that NEHTA and IBM have settled their dispute. Pity we will never learn the lessons and understand just what happened.

Can I also suggest people follow the hashtag #PCEHR on Twitter. There are some interesting things being said.

This conversation for example:

David Guest@zeeclor

@Sue_Dunlevy #PCEHR is a long term project. ROI is still five years off.#amanatcon

12:00pm · 25 May 13 · TweetDeck

Rob Mitchell @rd_mitchell

@zeeclor @Sue_Dunlevy Still not convinced that public hospital IT systems will integrate w #PCEHR by then… #amanatcon

Dr.Peter Aquilina @Cyclenut66

@rd_mitchell @zeeclor @Sue_Dunlevy the electronic health record is on life support : if we can't get that right no chance integration

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http://www.itnews.com.au/News/343966,ehealth-measures-missing-the-point.aspx

eHealth measures missing the point

By David Glance on May 21, 2013 11:55 AM

Opinion: When will the PCEHR lead to patient outcomes?

One of the great challenges for eHealth is to convince governments, healthcare organisations, practitioners and the general public that it is worth the investment.

This involves first of all working out whether anyone is actually using the technology, then determining what they are using it for and finally trying to judge whether this use has any positive outcome.

These evaluations are all aspects of what is called “meaningful use” and apply to any technology, not just technology in healthcare.

-----

http://www.theaustralian.com.au/australian-it/it-business/australian-medical-association-call-to-vet-healthcare-apps/story-e6frganx-1226647166392

Australian Medical Association call to vet healthcare apps

• by: Chris Griffith
• From: The Australian
• May 21, 2013 12:00AM

HEALTH apps that offer medical advice, remedies and doses should be vetted so they do not endanger lives or give biased or misleading information, the Australian Medical Association said yesterday.

AMA president Steve Hambleton said the people who approved apps (at Apple and Google) should be part of the responsibility chain and it would be good to have medical expertise on the approval bodies.

"I think that wouldn't fit their business model, to be frank," he said.

However, there was an opening for an "aggregator" to endorse apps considered medically safe.

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http://www.medicalobserver.com.au/news/pcehr-10m-injection--for-advanced-care-plan

PCEHR $10m injection for advanced care plan

21st May 2013

Andrew Bracey

THE federal government is set to invest another $10 million in the personally controlled e-health record (PCEHR) system to allow Australians to inform their families and doctors of their advanced care directives and preferences.

The initiative would allow the directives to be stored in the PCEHR and accessed as needed by care providers who may otherwise be unfamiliar with a patient’s history or preferences.

Speaking at the 4th International Society of Advance Care Planning and End of Life Care Conference in Melbourne this month, Health Minister Tanya Plibersek said the initiative would make it simpler for end-of-life care preferences to be faithfully carried out.

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http://www.futuregov.asia/blog/2013/may/20/australia-fast-tracks-connected-e-health-services/

A survey of Australia's connected e-health services

By Shahida Sweeney | 20 May 2013 | Permanent link | 0 comments

Australia’s foray into connected healthcare brings together a smorgasboard of technology platforms to deliver quality care. These include citizens’ access to portals for information-sharing in an on-line environment.

Among the trends, mobile apps, digital information management, and “digital hospitals” are helping deliver quality care. Connected care will drive the healthcare agenda this decade. This network encompasses public and private hospitals, as well as grass-roots patient care.

But this connectivity is not just about high-profile investments in ICT systems and platforms. It involves connecting people with their personal information, and being able to communicate more readily with caregivers and medical practitioners.

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http://www.canberratimes.com.au/it-pro/government-it/solution-to-hospital-data-fiddle-not-ready-20130519-2jv1v.html

Solution to hospital data fiddle not ready

Date May 20, 2013

Peter Jean

Chief Assembly Reporter for The Canberra Times.

A key computer security measure designed to prevent a repeat of last year's Canberra Hospital data doctoring affair is unlikely to be rolled out across the ACT Health Directorate before next year.

Canberra Hospital said in March it would push ahead with computer system upgrades to avoid a repeat of the problem.

More than a year after Canberra Hospital executive Kate Jackson admitted making changes to emergency department performance results, police are still investigating what occurred.

An ACT Legislative Assembly committee last year recommended that the Health Directorate introduce ''rapid log-in'' technology designed to improve computer security without interfering with patient care.

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http://www.businessspectator.com.au/news/2013/5/21/technology/latest-budget-notes-downward-trend-it-spending

Latest budget notes a downward trend in IT spending

Harrison Polites

The Gillard government’s latest budget has allocated less funding to IT projects than the previous years, noting a downward trend in government IT spending.

According to The Australian, the government has allocated $902 million over four years to IT projects for its agencies. The government’s chief information officer, Glen Archer confirmed the figure is six per down from the previous year.

Given Mr Archer's estiamtes, the government last year allocated around $960 million to IT projects – with the lions share going towards its eHealth initiative.

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http://www.data.com.au/news/news/2013/05/17/dca-s-argus-solution-successful-with-nehta-s-smd-pod-trial

DCA’s Argus solution successful with NEHTA’s SMD-POD trial

DCA, Medical Objects and Global Health have successfully interchanged messages under NEHTA’s SMD-POD program, a trial of SMD interoperability.

NEHTA’s press release outlines the importance of the program for the adoption of technology in health and reports on the status of current SMD-POD members.

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http://www.rheumatologyupdate.com.au/latest-news/high-iron-app-for-gps

High iron app for GPs

21 May, 2013 Nicola Garrett

In a world first, doctors developed a simple web based app that quickly identifies patients with hereditary haemochromatosis (HH) and refers them directly to the Red Cross blood service for therapeutic blood donation.

Under the old paper based system, patients often have to wait up to three months for paperwork to be completed, delaying much needed treatment and potentially putting them at risk of organ damage.

Patients with high iron levels caused by another illness were also at risk of being incorrectly referred to the Blood Service, wasting valuable time and resources.

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http://www.medicalobserver.com.au/news/diagnostic-errors-claim-4000-lives-annually

Diagnostic errors claim 4000 lives annually

21st May 2013

Byron Kaye

UP TO 4000 Australians die every year as a result of diagnostic error yet there is still no comprehensive system to work out the causes, an international diagnostic error expert has said.

Dr Mark Graber, founder of the US-based Society to Improve Diagnosis in Medicine, told a Sydney healthcare forum last week that one in every 1000 primary care consultations resulted in a diagnostic error and, based on global rates, between 2000 and 4000 Australians would die annually as a result.

Another 21,000 Australian patients would experience “serious harm” as a result of diagnostic error, Dr Graber told the Sax Institute’s Hospital Alliance for Research Collaboration forum.

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http://www.itnews.com.au/News/343627,mater-cio-shows-qld-health-how-its-done.aspx

Mater CIO shows QLD Health 'how it's done'

By Charis Palmer on May 17, 2013 11:52 AM

Hospital offered to help fix bungled payroll project.

The CIO of Brisbane’s Mater Hospital has set out the case for the hospital’s staff to take over the failed Queensland Health payroll project.

A KPMG report into the bungled project, which required a major boost in staff numbers to ensure employees got paid, has suggested it will eventually cost $1.25 billion to fix.

But Mater Hospital has challenged some of the report's assumptions about the unique complexity of Queensland Health’s payroll, arguing it could be fixed for $172 million.

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http://www.smh.com.au/technology/sci-tech/teen-develops-algorithm-to-diagnose-leukaemia-20130522-2jzrg.html

Teen develops algorithm to diagnose leukaemia

Date May 22, 2013 - 8:44AM

Vignesh Ramachandran

Brittany Wenger isn't your average high-school student: she taught a computer how to diagnose leukaemia.

The most amazing part about science is you can answer questions and really revolutionise the world and our knowledge base. 

The 18-year-old student from Sarasota, Florida, built a custom, cloud-based "artificial neural network" to find patterns in genetic expression profiles to diagnose patients with an aggressive form of cancer called mixed-lineage leukaemia (MLL). Simply put, this means Wenger taught the computer how to diagnose leukaemia by creating a diagnostic tool for doctors to use.

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http://ehealthspace.org/news/indigenous-tele-eye-care-trial-could-reduce-person-ophthalmology-consultations-70-percent

Indigenous Tele-Eye Care trial could reduce in-person ophthalmology consultations by 70 percent

Posted Wed, 22/05/2013 - 14:57 by Fran Molloy

Around 900 indigenous patients at three remote sites will receive specialist-grade eye consultations over the NBN, in a $1.96 million Federal trial using an award-winning web-based Australian software called Remote-I.

The system under trial could reduce in-person ophthalmology consultations by up to 70 percent.

The NBN-enabled Indigenous Tele-Eye Care project will operate in WA’s Greater South Coast and Goldfields-Esperance regions and in the Torres Strait Islands in QLD over the next twelve months.

The software, which can be used by nurses and Aboriginal health workers, was developed by scientists from the CSIRO’s Telemedicine and Ocular Health research team, headed by Professor Yogesan Kanagasingam from the WA-based Australian e-Health Research Centre.

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http://www.nehta.gov.au/media-centre/assisted-registration

Get your personal eHealth record now!

Come along to the Queensland Aboriginal & Islander Health Council (QAIHC) conference in Palm Cove on 28-29 May 2013. The eHealth truck will be parked at the Novotel Rockford Palm Cove, Coral Coast Drive Queensland 4879.

• More information on tour dates

We will help you sign up to the eHealth record system.

The Australian Government has brought in the eHealth record system to make healthcare in Australia even better, safer and more effective.

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http://www.theaustralian.com.au/news/nation/plastic-surgeon-lashes-out-at-online-astroturfing-attacks/story-e6frg6nf-1226650262725

Plastic surgeon lashes out at online 'astroturfing' attacks

• by: Adam Shan
• From: The Australian
• May 25, 2013 12:00AM

ONE of Australia's leading plastic surgeons, Chris Moss, has claimed he was the victim of an "AstroTurfing" campaign aimed at creating "a frenzy of negative comments" to damage his practice.

It was once just a synthetic alternative to grass, but AstroTurf in the online age is a fake grassroots campaign designed to create a community movement against unsuspecting victims.

The Melbourne-based celebrity surgeon has brought a legal action in the Victorian Supreme Court against Craig Rodda, the managing director of a marketing agency, which he claims has driven business away from his practice.

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http://www.medicalobserver.com.au/video

ON THE PULSE

Online cognitive behavioural therapy 

Mental health special

 Professor Gavin Andrews speaks with Sheryl Taylor about treating anxiety and depressive disorders with online therapy, explaining GPs’ involvement, how ongoing assessment works, compliance rates, and what conditions are appropriate for treatment.

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http://www.zdnet.com/au/ibm-settles-with-australian-government-over-e-health-contract-7000015792/

IBM settles with Australian government over e-health contract

Summary: IBM and the National E-Health Transition Authority have settled a dispute over the termination of a key AU$24 million contract.

By Josh Taylor | May 23, 2013 -- 22:00 GMT (08:00 AEST)

Although it appeared bound for the courts, IBM and the National E-Health Transition Authority have settled a dispute over the termination of an AU$24 million contract for IBM to deliver an authentication service as part of the Australian government's billion-dollar e-health project.

In 2011, 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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http://www.healthlink.net/en_NZ/news/press-releases/survery-analysis-general-practices-attitudes-to-it-use/

Survery Analysis: General Practices' Attitudes to IT Use

In February 2013 HealthLink undertook a survey of general practices’ attitudes to use of information technology. We were interested in learning were whether or not the emergence of the internet and related technologies had changed practices’ attitudes to patient privacy, how much practices used their computers during clinical consultations and how keen they were to use their computers to find information about patients from remote sources.

We surveyed 1042 New Zealand general practices and received 364 responses.

Please read this document to view the results, here.

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http://www.6minutes.com.au/news/latest-news/ipads-may-interfere-with-pacemakers

iPads may interfere with pacemakers

20 May, 2013 Paddy Wood

A Californian teenager has discovered that iPads can affect implantable cardioverter-defibrillators (ICDs) and potentially interfere with life-saving shocks.

What started as a science fair project for Gianna Chien, 14, captured the interest of thousands of doctors at the Heart Rhythm Society’s scientific sessions in Denver, Colorado.

The high-school student found the iPad 2 can cause electromagnetic inference which switches ICDs to magnet mode and stop them shocking patients when needed.

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http://www.theaustralian.com.au/australian-it/it-business/hackers-could-trigger-heart-failure-from-afar/story-e6frganx-1226648960350

Hackers could trigger heart attacks

• by: Andrew Colley on the Gold Coast
• From: The Australian
• May 23, 2013 9:52AM

COMPUTER hackers could compromise pacemakers and implantable defibrillators with lethal effect, a software security researcher has found.

Software security firm IOActive yesterday demonstrated how these medical devices could be hacked from a distance of up to 15 metres by using simple security holes that are used to deliver shocks to the heart or reprogrammed in other potentially deadly ways.

Speaking at the AusCERT security conference on the Gold Coast yesterday IOActive’s director of embedded device research Barnaby Jack said the research applied to wireless pacemakers and Implantable Cardioverter Defibrillators (ICDs) approved by the US Food and Drug Administration since 2006.

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http://www.healthintersections.com.au/?p=1571

NEHTA: Guidance relating to Clinical Document Presentation

Posted on May 22, 2013 by Grahame Grieve

I am pleased to be able to draw your attention to a newly released document from NEHTA entitled “Supplementary Notes for Implementers Relating to Clinical Document Presentation“. Quoting from the document:

This document recommends a set of presentation guidelines for CDA document authors. It complements the CDA Rendering Specification and the CDA implementation guides by describing:

• how to ensure that the data is properly, consistently and safely represented in the presentation
• the recommended order of the sections in a document

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http://www.6minutes.com.au/news/latest-news/anonymous-sti-alerts-prove-popular

Anonymous STI alerts prove popular

20 May, 2013 Michael Woodhead

A text messaging service that allows people with STIs to inform their partners anonymously has proved popular with both patients and hoaxers.

The Let Them Know online service, launched nationally in 2008, allows people diagnosed with STIs such as chlamydia, gonorrhoea and syphilis to send either named or anonymous texts to notify sexual partners that they may be at risk of an STI.

A review of the service usage in 2010-11 found that there were more than 13,000 visitors to the website, of which 37% visits resulted in 4863 text message STI notifications being sent.

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Enjoy!

David.

I Missed These Being Published At Senate Estimates Web Site A Few Weeks Ago. Great Reading.

This article appeared a day or so ago.

IBM settles with Australian government over e-health contract

Summary: IBM and the National E-Health Transition Authority have settled a dispute over the termination of a key AU$24 million contract.

By Josh Taylor | May 23, 2013 -- 22:00 GMT (08:00 AEST)

Although it appeared bound for the courts, IBM and the National E-Health Transition Authority have settled a dispute over the termination of an AU$24 million contract for IBM to deliver an authentication service as part of the Australian government's billion-dollar e-health project.

In 2011, 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).

It was part of the Australian government's initial AU$466.7 million investment in e-health record systems that came online in July 2012.

The IBM National Authentication Service for Health (NASH) system was due to be delivered by June 30, 2012, however NEHTA and IBM confirmed in October last year that the contract had been terminated and it was an "ongoing legal matter".

In the meantime, the government implemented an interim NASH system.

While the IBM and NEHTA dispute appeared to be bound for the courts, in a response to Questions on Notice provided to Liberal Senator Sue Boyce in April, the NEHTA confirmed that it had settled with IBM.

"NEHTA and IBM Australia have reached by mutual agreement a conclusion to their discussions regarding the termination of the National Authentication Service for Health (NASH) Design & Build and Operate contracts. The terms of that agreement are confidential," NEHTA said.

More here:

http://www.zdnet.com/au/ibm-settles-with-australian-government-over-e-health-contract-7000015792/

This prompted me to go back to the Senate Estimates site.

There are 2 links:

http://www.aph.gov.au/Parliamentary_Business/Committees/Senate_Committees?url=clac_ctte/estimates/add_1213/nehta/Answers/Q4.pdf

This one says that NEHTA have given up hire cars after being questioned about their use.

More relevant is this one where we see Senator Boyce has almost had to pull teeth to get what has been going on.

 Senate Standing Committee on Community Affairs

QUESTIONS ON NOTICE

[DOHA-NEHTA] Portfolio

Additional Budget Estimates

February 2013

Subject Outcome: E-Health 10.2

Agency: NEHTA

Issue: Claims of Privilege

Name of Senator: Sue Boyce

QUESTIONS:

In the last session of estimates in October last year we submitted a number of questions related to E-Health and in particular its management by NEHTA.

We had asked a series of questions in regard to the contract entered into with IBM in regard to the completion of the NASH, a contract that was terminated by NEHTA.

NEHTA’s response to one key question, Question 6, essentially was to say and I quote; ” The subject matter of the contract termination between IBM, NEHTA is currently under legal process and privilege applies.”

We asked whether the terminated contract contained penalty clauses for non-delivery. How much had IBM already been paid under the terms of that contract and what percentage of that contract price will be written off or lost as a result of the contract termination.

1. Can you tell me what “legal process” between IBM and NEHTA is currently underway in regard to this contract?

NEHTA and IBM Australia have reached by mutual agreement a conclusion to their discussions regarding the termination of the National Authentication Service for Health (NASH) Design & Build and Operate contracts. The terms of that agreement are confidential.

2. In what way are the terms of the question I have just quoted subject to the strict legal definitions of privilege?

The questions previously asked went to the subject of legal advice which NEHTA received about termination of the contract and the discussions it was having with IBM at the time. In order to protect the privilege in that advice, NEHTA needed to ensure that its actions, including answers to your questions, did not waive that privilege.

The discussions which were occurring between NEHTA and IBM at the time of your questions were also confidential and subject to the privilege in aid of settlement. NEHTA needed, and continues to need, to ensure that it does not breach its confidentiality obligations.

As noted above, the terms of the final agreement with IBM are confidential. As such, the parties are bound, under contract law, to keep the terms confidential.

3. Who provided that advice regarding our questions and the issue of privilege and can we obtain a copy of it?

NEHTA obtained advice from its external lawyers regarding termination of the contract with IBM. That advice is protected by legal professional privilege and NEHTA will not waive its rights to that protection. NEHTA is concerned not to breach any confidentiality obligations it has, which may occur if privilege in the advice were waived.

4. What considerations were made re the balance between your notion of privilege and the public’s right to know how you are managing the expenditure of over 1 billion dollars of taxpayers money?

NEHTA takes very seriously its management of the implementation of e-Health in Australia, and the costs involved in that. It acknowledges that the public has an interest in how taxpayer dollars are spent.

Nevertheless, for NEHTA to achieve the best outcomes for taxpayers in relation to legal matters arising in the course of its operations, it needs to be able to access full and frank legal advice. Open disclosure of the advice which NEHTA received about termination of the contract and its discussions with IBM may have jeopardised those discussions and the ultimate agreement with IBM.

----- End Response

Here is the link:

http://www.aph.gov.au/Parliamentary_Business/Committees/Senate_Committees?url=clac_ctte/estimates/add_1213/nehta/Answers/Q5.pdf

Only one question - NEHTA is spending public money so now it is settled why can’t we - the public - understand what has been done, what lessons have been learnt and work out just who is to blame for this waste - and it is clear that is what this is - of money.

NEHTA get a gold star for obfuscation and cover up!

David.