Thursday, October 31, 2013

This Might Help NEHTA Avoid Being Sued by MMRGlobal. Seems Progress Is Being Made.

This appeared a few days ago.

US Congress to consider law against 'patent trolls'

Date October 24, 2013 - 4:32PM
The US Congress to soon review the behaviour of "patent trolls", a widespread practice some say is crippling innovation in the US and overseas.
A US congressman, who has led the charge against frivolous patent infringement lawsuits, introduced a bill on Wednesday to curb the behaviour of so-called trolls but faced criticism that some of the proposals go too far.
The bill from Representative Bob Goodlatte, chairman of the House Judiciary Committee, requires companies to provide specific details on what patent is infringed and how it is used when they file a lawsuit.
It also requires judges hearing patent cases to award fees to the winner in an infringement lawsuit, unless the judge decides that the loser's position was "substantially justified" or some other circumstances exist.
Goodlatte, a Virginia Republican, is working on the bill with his counterpart on the Senate Judiciary Committee, Vermont Democrat Patrick Leahy. Leahy indicated his legislation would be ready soon.
The White House urged Congress to take steps to curb abusive patent lawsuits in June. Other proposals are circulating on Capitol Hill, as well as a proposed study of "patent assertion entities" (PAEs) by the Federal Trade Commission.
PAEs or 'patent trolls' are companies that typically do not invent or manufacture products. Their business model is to buy the intellectual property of others and seek money from firms that may infringe those patents.
Last year, trolls accounted for the majority of patent lawsuits in the US according to Colleen Chien, a law professor at Santa Clara University.
Lots more here:
I last mentioned MMRGlobal in a recent blog found here:
We can only hope that having the law change in the US will mean the tiny MMRGlobal will simply go out of business and we can all just get on with life!
Seems the change will probably happening pretty soon.

Wednesday, October 30, 2013

Does This Remind You Of Anything That Has Happened In Australia Recently. Great Article.

This fantastic blog appeared a few days ago.

Halamka offers lessons on's rough go-live

Posted on Oct 24, 2013
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
CIOs face many pressures: increased scope, reduced timelines, trimmed budgets. After nearly 20 years as a CIO, I've learned a great deal about project success factors.
When faced with go live pressures, I tell my staff the following:
"If you go live months late when you're ready, no one will ever remember.
If you go live on time, when you're not ready, no one will ever forget."
I have hundreds of live clinical applications. Does anyone remember their go live date? Nope.
Were there delays in go live dates? Many.
With even the best people, best planning, and appropriate budgets, large, complex projects encounter issues imposed by external factors (new regulations, competing unplanned events, requirements changes) that cannot be predicted during initial project scheduling.
It helps no one -- the users, the business owners, or the IT department -- to slavishly adhere to a deadline when the project is not ready to go live.
I work on federal advisory committees in the Obama administration and truly believe in the goals of many administration programs: Meaningful Use, HIPAA Omnibus rule, and Affordable Care Act.
However, we've seen that in the interest of accelerating change, deadlines have been imposed that do not allow for sufficient testing, piloting and cultural change. The result is that haste makes waste.
As I've written in my blog many times, ICD-10 will become a crisis for the Obama administration. Payers and providers will not be ready by October 1, 2014. Documentation systems and clinician billing process changes will not be mature enough to support a successful go live. More time is needed. My experience with IT crises is that you can survive one at a time, but a succession of problems creates a pattern that users and oversight bodies will no longer tolerate. I hope the premature go live of the Health Insurance Exchange results in a review of ICD-10 go live dates.
Meaningful Use Stage 2 attestation criteria are good. The certification scripts need very significant revision. How did this happen? They were created in a rush to adhere to an artificial deadline, not reviewed by the federal advisory committees, and not piloted tested/revised. New regulation is needed fix them and that will take time. Again, the lessons of the Health Insurance Exchange should cause us to extend Meaningful Use Stage 2 deadlines by a year, deferring future stages of Meaningful Use until we have consolidated our gains and understood our successes/failures with current stages.
Lots more here:
Would it not be wonderful if there had been someone with the experience of Dr. John Halamka around a year or so ago when we had the mad rush to bring the PCEHR live in July, 2012.
As a result of that rush we are still trying to get it fixed up to the stage when it will be really useful a year + later.
The advice in the first few paragraphs is so right it hurts and must never be forgotten.
On a related topic this also appealed to me this week.

8 ways to manage change, not just HIT implementation

October 25, 2013 | By Julie Bird
There's a way to manage change associated with health IT, healthcare consultant Frank Speidel, M.D., says--eight ways, to be more precise.
Writing at, Speidel, chief medical officer for the Health IT staffing firm Healthcare IT Leaders, identifies what he calls eight "ates" for managing that change (check out the full post for more detail):
·         Contemplate the changes IT implementation brings to the health system and its operations by convening a diverse group representing different elements of the organization.
·         Communicate to understand "the why, where and what of the change" and where the change is taking the organization.
Lots more here:
Well worth a read for those involved in implementation.

Tuesday, October 29, 2013

It Seems The NEHTA Chairman Is In Line To Be Chairman Of ANZ Bank.

Only one comment.

I hope someone in ANZ makes sure they are comfortable with what has happened with NEHTA during his Chairmanship. I wonder is he planning to stay?

I can't say I have seen evidence of the level of oversight, scrutiny and management control of NEHTA I would have liked to have seen, and would have expected, from an excellent independent chairman.

What do others think?

Yes I have a personal interest as I have a few ANZ shares!


Does This Article Indicate Some Real Hope For The PCEHR Or A Last Gasp?

The following appeared a little while ago.

AMA puts flawed PCEHR on the mend

When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be.
“I asked the treating doctor how often do you get a patient’s medical history, including the medications they are on, their allergies and diagnoses, and he said ‘Never’,” Dr Moy recalled.
At the time, he was heavily involved with HealthConnect SA in developing an electronic care planning system for elderly patients.
“A by-product of that was that we were developing a prototype of the electronic health record,” he said.
The project was killed off prematurely when the global financial crisis hit in late 2008, bringing an abrupt end to the funding.
But it left an indelible impression on Dr Moy, who saw the potential for e-health to vastly improve health care and potentially save thousands of lives a year, by ensuring practitioners at the point of service had access to vital patient information such as medications, allergies and previous diagnoses.
So it was with mounting frustration and dismay that he, along with much of medical profession, watched as the Federal Government made basic blunders in building and introducing the Personally Controlled Electronic Health Record (PCEHR).
When he was approached by AMA officials last year to become involved in efforts to address problems with the PCEHR and turn it into something useful for clinicians and patients, Dr Moy was initially reluctant.
But the chance to help realise the potential of e-health to save lives and improve care convinced him to make the commitment.
A little more than 12 months later, he believes the AMA has achieved real progress toward turning the PCEHR from an IT-driven system with little appeal or usefulness for practitioners into something with real and practical benefits for both doctors and patients.
But it hasn’t been easy.
“The whole project had gone off track,” Dr Moy said. “It was being driven by IT people and programmers, and I could see that they were ballsing it up.”
He said they had developed the system with no understanding of how clinicians worked – a huge oversight given that it was doctors (mostly GPs) who would be creating the health records and bearing any risks arising from incomplete or incorrect information.
“I am not an IT person, I am a work flow person, and the program managers and IT people did not understand workflow.
“They did not understand that the way that doctors are going to interact with the PCEHR is through the GP desktop system.”
Through his work on the Department of Health and Ageing PCEHR Independent Advisory Council, combined with the efforts of other AMA officials – not least President Dr Steve Hambleton – progress is being made to turn the PCEHR into a practical and useful system.
This has included urging the development of a one-button navigation system for the PCEHR on GP desktop systems; trying to ensure the desktop PCEHR software packages each have a similar look, feel and work flow; promoting the development of demonstration PCEHR models to help doctors familiarise themselves with how it would look and work; and institute a moratorium on the addition of new features until the basics of a practical and usable system for doctors and patients are established.
“We don’t need to start again, but we need to make it useable, and our goal is to make sure that clinicians get to develop the workflow of it,” Dr Moy said.
He admitted that there was a considerable way to go, but said progress was being made, and urged sceptics to withhold judgement.
More here:
I found this a very interesting article. What it seems to be suggesting that all sorts of things are being done to try and make the PCEHR a little more clinician friendly at the behest of an Independent Advisory Council of the then DoHA.
Here is the link to the Council.
It seems to meet 4 times a year but does not seem to produce any minutes of its meetings that are publically available.
Only with dramatically improved transparency on just what these Councils are actually doing will we have any idea what is going on. On the face of it some of these changes seem reasonably sensible so why the secrecy?
This is certainly something the Deloittes Refresh of the National E-Health Strategy as well as the new Minister need to take an acute interest in.

Monday, October 28, 2013

Weekly Australian Health IT Links – 28th October, 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

Another week goes by and we still hear almost nothing from the new (now slightly less new) Federal Health Minister. The silence is really deafening!
Other than that interesting to see the US is looking at laws around patent trolls and that thought controlled computers are progressing to more and more reality.
I checked out my PCEHR record today. The system is still slow, had drug information that is 3 months out of date and is just as user unfriendly as ever. Just so you know!

E-health records in need of urgent help: GPs

The nation’s peak general practice organisations have called for urgent action to address serious shortcomings in the troubled electronic health records system.
At a summit held earlier this month at AMA House, United General Practice Australia (UGPA) identified major problems with the Personally Controlled Electronic Health Record (PCEHR) system that severely undermined its usefulness to both practitioners and patients.
“Currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement in patient health outcomes,” UGPA, which includes the AMA, the Royal Australian College of General Practitioners, the Australian Medicare Local Alliance and the Australian College of Rural and Remote Medicine, said.

Does the PCEHR meet the GP Data Governance Council criteria?

The General Practice Data Governance Council is “committed to profession-led governance regarding the issues of data collection activities in general practice,” in particular secondary use of patient data generated through clinical care delivery to patients.
GPs and consumers have voiced concerns with regards to secondary use of data uploaded to the PCEHR, so I thought it would be interesting to have a look at the PCEHR and see if it meets the goals of the Data Governance Council.
As outlined in an earlier post, it appears PCEHR data can be used by the government for:
  • Law enforcement purposes
  • Health provider indemnity insurance cover purposes
  • Research
  • Public health purposes
  • Other purposes authorised by law

AMA puts flawed PCEHR on the mend

When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be.
“I asked the treating doctor how often do you get a patient’s medical history, including the medications they are on, their allergies and diagnoses, and he said ‘Never’,” Dr Moy recalled.
At the time, he was heavily involved with HealthConnect SA in developing an electronic care planning system for elderly patients.
“A by-product of that was that we were developing a prototype of the electronic health record,” he said.

Clock ticking for scanning incentive confirmation

23 October, 2013 Nick O'Donoghue
Pharmacy owners are being encouraged to ensure they are meeting the criteria to receive the Electronic Prescription Scanning Incentive, even through the Government had yet to confirm it will be paid next month.
The first payment of the $2000 incentive is due to be made next month, however the Pharmacy Guild of Australia is waiting to hear if the recently elected Coalition Government will sign-off on it.
While the profession has yet to get confirmation that the incentive will go ahead as announced in August, a Guild spokesperson said the organisation was continuing to plan for its rollout, and urged pharmacy owners to take a similar approach.

Tasmania looks for core eHealth infrastructure replacement

Summary: Tasmania's eHealth infrastructure is beginning to show its age and needs to be replaced with an open standards system.
By Michael Lee | October 21, 2013 -- 06:29 GMT (17:29 AEST)
Tasmania's Department of Health and Human Services (DHHS) is looking for a contractor to replace the core systems behind its current eHealth integration infrastructure since the existing software is nearing its end of life.
The existing system runs on the Java Composite Application Platform Suite (Java CAPS), which was originally developed by Sun Microsystems and folded into Oracle when purchased in 2010. Oracle subsequently released Java CAPS 6.3 in 2011, but the tender documents show that DHHS wishes to transition from the suite.
Oracle itself is rolling features from Java CAPS into its Service Oriented Architecture (SOA) suite, and encouraging users to migrate to its new systems.

Review launched into e-health record scheme

The Abbott Government has ordered a review of the troubled shared electronic health record program amid concerns about poor take-up, cost overruns and implementation problems.
Health Minister Peter Dutton has ordered the review – the details of which are yet to be released – citing concerns that the Commonwealth so far has little to show for its $1 billion investment in the Personally Controlled Electronic Health Record scheme.
“We all support an electronic health record,” a spokeswoman for Mr Dutton told The Australian late last month. “However, we have grave concerns about the amount of money the previous Government spent on e-health for very little outcome to date.

Digitising data will reduce errors in patient care

Joshua Gliddon
With approximately 9.3 per cent of Australia’s gross domestic product spent on healthcare, there is significant scope for improvement in productivity to drive better health outcomes and better care per dollar spent.
One of the biggest challenges facing the health system in Australia is its highly fragmented nature. Funding is decoupled from the provision of care, and outcomes are not always matched with healthcare inputs, notes David Dembo, general manager for GE’s healthcare business.

Weaving a web of world eHealth strategies

Digital strategist Rachel de Sain is fascinated by the intersection of health and social media, so she jumped at the opportunity to present some of her own research at the recent Medicine 2.0 conference in London, adding a side trip to a US conference before returning to Sydney.
De Sain says that her own consulting agency, Flaxworks, reflects her indigenous New Zealand heritage.
“Technology doesn’t work effectively unless you really sit there with the community and understand what the problems are that you are trying to solve, and then look at all the various pieces of the organisation, the various sides of a challenge, the various stakeholders and weave them together into a solution,” she says.

eRx launches script app

24 October, 2013 Nick O'Donoghue
Pharmacy IT group, Fred Health, launched its eRx Express app which will enable consumers to order their prescriptions from smartphones, today.
Using the app, patients are now able to scan a QR code on their prescription, which is sent to a pharmacy of their choice where they can pick it up at their preferred time.
Paul Naismith, a pharmacist and CEO of Fred Health, said the app was vital to advancing e-health for pharmacy, health professionals and the wider community.

Approaching 19,000 hospitals across APAC region to adopt cloud solutions by 2018

Posted on Oct 09, 2013
By Dillan Yogendra
Globally, healthcare is embracing cloud technologies and the Asia-Pacific (APAC) region is in a hurry to explore innovative solutions that support patient-centric care through efficient capture and dissemination of medical and health information. Research by Frost & Sullivan: Analysis of Healthcare Cloud in APAC, recently reported the market for cloud technologies, which included software-as-a-service (SaaS) and infrastructure-as-a-service (IaaS) offerings, was valued at US$194.4 million in 2012 – and the market is expected to expand at a compound annual growth rate (CAGR) of 22.3% between 2012 and 2018.
"Healthcare providers are cognisant of the long term cost benefits of cloud solutions. What they are looking for now, are reliable technology partners who can address their concerns over data privacy and security," said Natasha Gulati, Connected Health Industry Analyst, Frost & Sullivan Asia-Pacific. Although many healthcare IT vendors emphasise the enhanced security and back-up support provided by cloud technologies, the message has yet to reach hospital CIOs. This is why healthcare continues to invest in private clouds while other industries are rapidly moving to public or hybrid cloud models. In addition, given the current pressures of rising costs and diminishing margins, healthcare CIOs are unable to justify the significant investment required for transitioning to a cloud environment.

New Zealand is the leading force in shared EMR implementation

Posted on Sep 26, 2013
By Dillan Yogendra
Canterbury in particular offers an ideal example to corroborate the claim that healthcare IT integration works best if accompanied by an integrated overall approach to medical care, as reported in HIMSS Insights.
Plans were already in place to install a centralized shared medical record that could be accessed from information systems of care providers, hospitals, and the community nursing agency but progress was slow. Then came February 2011 and New Zealand experienced one of the worst earthquakes in generations – many general practitioner (GP) paper-based archives were either lost or temporarily unavailable but Canterbury hospital’s electronic documentation remained accessible all the way through.

ULTRA pathology laboratory software back in the game and planning a new release

Australian-developed laboratory information system ULTRA will have a new lease of life thanks to a buy-out by Irish firm Cirdan Imaging, which has taken over the US-based Centricity Laboratory Division from GE Healthcare.
A Cirdan subsidiary, Cirdan Ultra, has been set up as a joint venture with software developer Kainos and there are plans to issue a new version of the product in January 2015, says Dave Crockett, who is Vice President of Sales and Marketing for Cirdan Ultra.
Crockett is currently in Australia visiting key clients and establishing a local office in Ballarat.
It’s full-circle for ULTRA, which pathology systems consultant Yvonne Sherlock says has been used by at least half of the laboratory staff in Australia at one time or another.

US Congress to consider law against 'patent trolls'

Date October 24, 2013 - 4:32PM
The US Congress to soon review the behaviour of "patent trolls", a widespread practice some say is crippling innovation in the US and overseas.
A US congressman, who has led the charge against frivolous patent infringement lawsuits, introduced a bill on Wednesday to curb the behaviour of so-called trolls but faced criticism that some of the proposals go too far.
The bill from Representative Bob Goodlatte, chairman of the House Judiciary Committee, requires companies to provide specific details on what patent is infringed and how it is used when they file a lawsuit.

Unniversal Device Identifiers in FHIR

Posted on October 25, 2013 by Grahame Grieve
The FDA and partners around the world are in the process of introducing a new identification framework for medical devices called the “Universal Device Identifier” (UDI). They asked for FHIR to “support” UDI. But what does that mean?
First, some background on what a UDI is, and then some analysis of the use cases for UDI in the scope of FHIR.
What a UDI is
A UDI is a barcode (or series of barcodes, or even an RFID) on a medical device that carries the following information:
  • Device Identifier (Mandatory)
  • Lot Number
  • Serial Number
  • Manufacture date
  • Expiry Date
The first element is the key piece of data – it represents the key that can be used to look up information about the device in the public device registry (GUDID or equivalent). It is referred to as the DI (Device Identifier). There’s also the other fields, which are called the PI (Production Information).

Telstra shuffles leadership deck, steers toward Asia

Telco has no option but to pursue Asian market, says Thodey
Telstra CEO David Thodey has announced a realignment of its senior executives and an increased focus on Asia.
Among the leadership changes, which are effective Monday next week, Brendon Riley has been appointed group executive of global enterprise and services. The $5 billion revenue business unit will include network application services, global applications and platforms, a new cloud division, ventures, enterprise and government and defence.
Kate McKenzie has taken Riley’s previous role as chief operations officer, which now includes the chief technology and innovation portofolios. She was previously managing director of the products and marketing group.
----- website 'didn't have a chance in hell'

The failure rate for software development projects is high generally, particularly large ones like, says Standish Group data
WASHINGTON -- A majority of large IT projects fail to meet deadlines, are over budget and don't make their users happy. Such is the case with
The U.S. is now racing to fix, the Affordability Care Act (ACA) website that launched Oct 1, by bringing in new expertise to fix it.'s problems include site availability due to excessive loads, incorrect data recording among other things.
President Barack Obama said Monday that there is "no excuse" for the problems at the site.

Casualty death rate higher on weekends

Date October 26, 2013

Lucy Carroll


Patients are more likely to die in hospital at weekends than on weekdays, according to ground-breaking Australian research that experts say shows hospital staffing levels must change.
They say continuing to operate on a five-day week business model will put lives at risk.
"Illness occurs 24/7, not just in normal business hours,'' said lead author Enrico Coiera, the director of the Centre for Health Informatics at the University of NSW. ''The idea that we can offer reduced levels of care at the weekend needs to be re-evaluated.''

Thought-controlled computers closer than we think

Date October 21, 2013 - 3:18PM

Drew Turney

We've gone from the mouse to Kinect-style gesture control in some 30 years. Might the next frontier in computer interfaces be controlling machines just by thinking about them?
A recent breakthrough from the University of Washington shows that when technology lets the brain control a device such as a robotic arm, the brain is behaving in the same way as if it was commanding the relevant muscles to carry out the act in reality. In other words, by thinking about kicking a ball, the area of the brain active in doing so behaves in the same way as if you were really kicking a ball.
That means that in brain/machine interaction, just thinking about an action might prompt a machine to do it for you. Mind-controlled technology itself isn't new. Last year American quadriplegic Cathy Hutchinson used a robotic arm to sip coffee from a bottle thanks to a sensor array connected to her brain that relayed commands to the arm via a computer.
Gains are also being made in computers responding to signals from elsewhere in the body. In September The Wall Street Journal reported on an amputee controlling an artificial leg using sensors that received nerve and muscle impulses to move the knee and ankle with much more precision than traditional artificial limbs offer.

Next supercomputer will be fuelled by electronic blood

  • Hannah Devlin
  • The Times
  • October 18, 2013 11:42AM
THE SUPERCOMPUTER of the future will be close to the efficiency of the human brain and fuelled by "electronic blood", the director of IBM research has predicted.
The company has unveiled an experimental version of its biologically inspired computer, which it claims could lead to a 10,000-fold increase in the efficiency of computers.
Speaking in Zurich, Matthias Keiserwerth said that the energy requirements of the world's most powerful computers were now so great that they were limiting advances in computational performance and artificial intelligence.

A Useful Update On the Status Of The PCEHR

The Week in Brief - With AIIA CEO Suzanne Campbell

 25th October, 2013
Personally Controlled Electronic Health Record (PCEHR) – this week a status update has been provided to the PCEHR Independent Advisory Council (IAC) confirming:
  • 3,500 new consumer registrations per day, with over 1 million people now registered
  • 5,582 healthcare provider organisations and 8,016 individual healthcare providers are now registered
  • 9,300 shared health summaries and over 2,000 discharge summaries are now recorded
  • 27,500 consumer entered health summaries, approximately 8,600 consumer entered notes and approximately 3,900 advance care directive custodian notices are now held
Found here:

For Information - It is important to note that 16 months after go live we have only 0.04% of the population  with a record for a cost of roughly $100 each. Hardly a raving or cheap success just yet.
The really telling statistic is that only 27,000 of the 1 million who have registered have actually added their own summary. The fact is the system is a hardly used white elephant.


Sunday, October 27, 2013

You Really Have To Wonder What The Evidence Is For All This Optimism. I Am Not Sure I Can Find It.

This appeared in the Financial Review a few days ago.

Digitising data will reduce errors in patient care

Joshua Gliddon
With approximately 9.3 per cent of Australia’s gross domestic product spent on healthcare, there is significant scope for improvement in productivity to drive better health outcomes and better care per dollar spent.
One of the biggest challenges facing the health system in Australia is its highly fragmented nature. Funding is decoupled from the provision of care, and outcomes are not always matched with healthcare inputs, notes David Dembo, general manager for GE’s healthcare business.
“The issue is that the left hand does not know what the right hand is doing. In providing care, the GP, the ­pharmacist and the specialist are only partially informed, and this is why errors are made,” he says.
“We spend an incredible amount of money on healthcare, and for that money you could have an incredible healthcare system, but we don’t yet because we ­execute it badly.”
According to Dembo, along with Australian Medical Association president Steve Hambleton, the key to extracting better productivity within the healthcare sector is through digitisation.
The introduction of the $447 million PCEHR (personally controlled electronic healthcare record) in 2012 under the previous Labor government was supposed to go some way towards breaking down the silos that exist in healthcare data, and provide a transparent way for patients and clinicians to interact.
The promise of the PCEHR has only been partially realised, however, with some insiders indicating the new Coalition government is going to take a significant look at the system. “The answer to increased productivity is digitisation, which means turning clinical information into information that can be shared,” says Dembo. “At the moment data is still locked up in silos, and the key is to create efficiency through transparency.”
Unlike some players, Dembo is optimistic about the impact the PCEHR can have, because it put in place systems, data standards and signifiers needed to begin breaking down the data silos that exist.
“It created a language where we can share information and enable data ­sharing,” he says. “It is giving people the incentive to share information.”
Sally Glass, founder of e-health consulting company CHIK Services, agrees with Dembo about the need for data ­sharing in order to promote productivity in the sector.
“We’ve been talking about the value of information flows in terms of increasing productivity and improving patient outcomes for years,” notes Glass. “But it’s only in the last couple of years that the technology has caught up with the concepts that were being floated around.”
Glass, along with Dembo and Hambleton, is also optimistic about the potential for big data to improve productivity and outcomes in the sector. “The reality is we have to use it,” she says.
Lots more here:
As I read through the full article what keeps striking me is the absence of evidence that what is presently happening with the PCEHR  is actually making a difference in any positive sense. Given the scale of the investment made - which is probably over a $A1 Billion in the last three years- there really should be clear  cut signs that some return is being achieved on this investment.
Instead what we keep hearing is that everyone is optimistic and enthusiastic - except for those who have looked a little harder and wondered if the emperor is wandering around without his clothes.
Everywhere else in the world there has also been optimism about improvements in the cost of health care and impacts on quality and safety. To my mind we see the level of inflation in healthcare costs march ever upward pretty much everywhere and we see any actual impact on quality and being still being pretty hard to demonstrate.
This report on the UK’s efforts makes really interesting reading in this regard.
All I can say is that in Australia in the last decade huge amounts have been spent with incentives and direct investment but I find a dearth of evidence of impact. If ever we needed a few serious studies to sort out what is working and what is not the time is now! Bland assertions from so-called experts really won’t cut it for too much longer.
Who wants to volunteer?

AusHealthIT Poll Number 189 – Results – 27th October, 2013.

The question was:

Does The Planned Review Of PCEHR Need To Include The Option To Scrap The Present System And Design A Totally New Approach?

No - The System Is Great As It Is 7% (3)

No - Fixing The Current System Is Possible 11% (5)

Possibly 2% (1)

Probably 5% (2)

Yes - The Option Must Be On The Table 75% (33)

I Have No Idea 0% (0)

Total votes: 44

Well it seems most of those who read are more than happy to see the option of getting rid of the PCEHR be properly explored. Interesting no-one didn't know!

Again, many thanks to those that voted!


Saturday, October 26, 2013

Weekly Overseas Health IT Links - 27th October, 2013.

Note: Each link is followed by a title and 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.

CHOP Researchers Introduce Data Navigation Tool

October 17, 2013
A team of informatics experts and biomedical researchers at The Children's Hospital of Philadelphia (CHOP) have created a software toolkit that aims to help researchers navigate different forms of data.
The software toolkit, called Harvest, is an open-source, interactive framework that helps users navigate quickly among different types and levels of healthcare data from individual patient records to aggregated reports of all patients in a database. The software allows users to query data by different subjects, such as age or ethnicity, individual blood test results or MRIs, or including or excluding specific diagnoses.

Toolkit designed to make biomedical data exploration easier

October 18, 2013 | By Susan D. Hall
Researchers have developed an open-source platform for creating software applications that make complex data understandable and accessible to those without sophisticated informatics expertise.
Commercial analytics tools tend to require biomedical researchers to understand underlying data models before being able to effectively explore and use large data sets, according to an article at the Journal of the American Informatics Association.
Researchers at the Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania have validated the platform, called Harvest, on two test cases: pediatric cardiology diagnostic and procedure data, and infectious disease data published by the OpenMRS open-source electronic health record (EHR) project.

EHRs can integrate genomic information to improve patient care

October 14, 2013 | By Marla Durben Hirsch
Electronic health records can help accelerate and advance the use of genomic medicine, as demonstrated in several articles published in a special issue of Genetics in Medicine, the official journal of the American College of Medical Genetics and Genomics.
The publication, meant as a "getting started" guide for the integration of genomic information and EHRs, includes a series of articles written mostly by members of the National Human Genome Research Institute-sponsored Electronic Medical Records and Genomics (eMERGE) Network, a federally funded consortium of nine institutions that have pioneered the use of EHRs. The authors note that these advances cannot be accomplished without the use of EHRs.

Big opportunities, still, for IT vendors

Posted on Oct 17, 2013
By Mike Miliard, Managing Editor
The healthcare market, especially health IT, remains "highly fragmented," with lots of openings for entrepreneurs who can solve providers' "pain points," according to the latest trend report from Berkery Noyes.
The report analyzes merger and acquisition activity for the healthcare sector during the first three quarters of 2013 and compares it with data from 2012. This market includes information and technology companies servicing the pharmaceutical, healthcare payer, and healthcare provider spaces.
"The healthcare market remains highly fragmented, with lots of opportunities for entrepreneurs with unique ideas looking to start companies that solve important pain points along the healthcare continuum," said Tom O'Connor, managing director at Berkery Noyes, in a press statement. "Large strategic buyers are also looking to acquire unique content/software solutions that are solving challenges in the healthcare market and are growing rapidly, offering exit opportunities for entrepreneurs at very attractive prices."

£1m national leaflet drop on

16 October 2013   Rebecca Todd
The government will spend £1m sending a patient information leaflet about the controversial programme to every household in England.
As part of a joint £2m public awareness campaign being run by NHS England and the Health and Social Care Information Centre, 22m homes will receive the leaflet in January and extractions will begin in spring next year.
The total cost includes around £800,000 in funding for a helpline to answer people’s questions about the scheme, to help take the pressure off GP practices.
The A5 leaflet will not be addressed to anybody in the household, but will clearly indicate that it is from the NHS and explain how people can opt-out of their data being extracted.

Report: Feds must make security less burdensome for workers

October 17, 2013 | By Susan D. Hall
Though insiders say federal agencies such as the U.S. Department of Health & Human Services and the Department of Veterans Affairs are vulnerable to cybersecurity threats, federal employees report bypassing burdensome security measures when those measures interfere with their work.
Federal security pros often fail to take user experience into account when implementing security measures, according to a new report by public-private partnership MeriTalk and underwritten by Akamai Technologies. The report urges federal security pros to work together with federal employees to ease their particular pain points while tightening security, according to an announcement.

Sharp HealthCare Rises to the Challenges Posed by This Digital Age

by Fred Bazzoli Thursday, October 17, 2013
When Sharp HealthCare in San Diego flipped the switch to move to an electronic health record system about a dozen years ago, sorting out duplicate records and multiple patient identities was a big problem.
"When we first started the department in 2001, we were creating 18 duplicates a day across the whole system," said Tommy Egbert, supervisor of Sharp's master patient index department. "Now, we're doing about four duplications a month, so it's had a huge impact."
In addition to gaining experience over the years, Sharp has added patient identification technology, such as palm vein recognition biometrics, to avoid mix-ups with patient identities and records. Because of its efforts to keep duplications out of its records, it's been able to accurately share patient information within the system, increasing patient safety and reducing unnecessary services, thus saving money.

The Case for Computer-Based Health Care

By Darius Tahir
October 16, 2013
The victory of Watson, an artificial-intelligence system designed to dominate the quiz show Jeopardy!, over the country's best nerds in 2011 may not be the equal of John Henry struggling against a steam-powered drill in the annals of man versus machine. But the replacement of Jeopardy!'s human competitors with a computer algorithm may signal a trend that could soon spread through the health care sector as Obamacare is implemented.
That's the prophecy of venture capitalist Vinod Khosla. Khosla, a prominent Silicon Valley investor, has predicted that computers will replace 80 percent of what doctors do in a couple of decades. The shift could counter another health-sector trend: stagnant productivity, which the Affordable Care Act aims to address with financial incentives for effective, efficient care, and which could encourage a move toward digital doctoring.
Between 1990 and 2010, productivity in the health care sector declined by 0.6 percent annually as employment increased by 2.9 percent, according to Robert Kocher, now a venture capitalist at Venrock, in an October 2011 editorial in the New England Journal of Medicine. Increasing productivity might bridge this disconnect, and computers could be part of the solution.

Lack of encryption brings breach blunder

Posted on Oct 16, 2013
By Erin McCann, Associate Editor
Device encryption may seem like a fairly straight forward undertaking, but it's proven one which HIPAA-covered entities and business associates frequently forgo -- much to their chagrin down the road when they're notifying individuals of a privacy breach involving unencrypted personal data. 
Legal Aid Society of San Mateo, Calif. is now seeing this firsthand. The public interest law firm recently notified 3,200 clients that their protected health information was compromised after 10 unencrypted laptops containing clients' Social Security numbers, medical data, names and dates of birth were reported stolen. 
"We are sorry that this incident occurred and want to assure you we are carefully reviewing our procedures and practices to minimize the risk of recurrence," wrote LASSM Executive Director M. Stacey Hawver, in an Oct. 10 letter mailed out to affected clients. 

Two Watson-based tools offer docs real-time analysis

October 16, 2013 | By Susan D. Hall
Scientists have trained IBM's "Jeopardy!" champ Watson to interact more naturally with doctors in two new projects aimed at improving patient care.
The work is a collaboration between IBM Research and the Cleveland Clinic along with Lerner College of Medicine of Case Western Reserve University.
WatsonPaths aims to help doctors diagnose patients and solve medical problems. To do so, it can understand spoken language and can consult reams of medical research in an instant, reports Crain's Cleveland Business.

Cleveland Clinic, IBM Making Progress on Watson Supercomputer

OCT 15, 2013 3:14pm ET
A year after starting work with IBM to develop ways for the Watson supercomputer to support medical training and serve as a doctor’s assistant, the Cleveland Clinic has issued a progress report that includes two new technologies.
The clinic and IBM have developed WatsonPaths, a new process to train the supercomputer to interact with clinicians in a way that is more natural, enabling them to understand the data sources that Watson consulted and how it made recommendations.

Watson joins the fight against cancer

Posted on Oct 18, 2013
By Mike Miliard, Managing Editor
First he won on Jeopardy!, now he's going to try to beat leukemia. The University of Texas MD Anderson Cancer Center announced Friday that it will deploy Watson, IBM's famed cognitive computing system, to help eradicate cancer.
The two organizations will leverage Watson's computing power to help clinicians uncover insights from MD Anderson's vast patient and research databases, officials say. After a yearlong collaboration, the two will showcase a prototype of MD Anderson's Oncology Expert Advisor, powered by Watson.
That technology seeks to integrate the knowledge of MD Anderson's clinicians and researchers, and to advance the cancer center's goal of treating patients with the most effective, safe and evidence-based standard of care available, say officials. Starting with the fight against leukemia, the Oncology Expert Advisor aims to help clinicians develop and fine-tune treatment plans for patients, while helping them recognize adverse events that may occur throughout the care continuum.

Hurdles to big data use in healthcare more social than technical

October 16, 2013 | By Ashley Gold
Are the real hurdles to using big data in healthcare social and not technical? A report authored by Gina Neff, a professor in the department of communication at the University of Washington in Seattle argues just that, saying that big data won't cure us because although data-intensive modeling has immense potential, figuring out how to use it is a bigger challenge.
"The ways in which health technology innovators have talked about the power of data neglects key aspects of the social interoperability or integration of data into health solutions," Neff's report says. "How will such data be integrated into care providers work practices; through the complex routines of clinics and hospitals; and into existing legal, social, political and economic frameworks?"

Big Ideas From The Forbes Healthcare Summit

Todd Hixon, Contributor
The Forbes Healthcare Summit in New York last week brought together very senior people across the U.S. healthcare spectrum: CEOs of big insurance companies, R&D heads of top pharma companies, CEOs of major medical centers, and CEOs of a few of the key upstarts: AthenaHeath, ASAP Urgent Care, Rothman Institute, MinuteClinic, etc. Here’s a summary of the big ideas that emerged.
No One Thinks Health Reform Is Going Away. Regardless of the drama in Washington, health reform is going ahead, and the major institutions are working to adapt to it. Beyond the ACA* the big driver for this is patient empowerment, which was the theme of the conference. Patients are being forced to pay more of the cost of their care, and because of this plus social change, they are taking more control and demanding more information and service.

Is ONC more essential than shutdown reflects?

By Tom Sullivan, Editor
There is little debating that when HHS drafted its contingency blueprints for a government shutdown, the architects of that strategy had to make some very difficult decisions — literally gutting ONC among those.
“The fact is ONC’s work is very important and it does disappoint that they aren’t able to continue doing that,” former deputy principal director of ONC David Muntz said in an interview with Government Health IT after leaving the office for a new job. “Because ONC is focused on deployment of HIT, anything that might slow that down, I think, is unfortunate.”
Muntz was not alone in expressing such disappointment. And with meaningful use Stage 2 commencing on the same day much of the government closed down, not to mention the health insurance exchanges opening, the timing was, at best, ill-fated.

Study: EHRs a Big Factor in Influencing Physician Satisfaction

OCT 14, 2013 4:10pm ET
Physicians believing they provide or facilitate high-quality care have higher professional satisfaction and how they feel about their electronic health records system plays a big role in that satisfaction.
Those are the key findings in a new study from RAND Corporation, which conducted in-depth surveys with 220 clinicians and administrators in 30 practices across six states. The American Medical Association sponsored the study.
“In the practices we studied, physicians approved of EHRs in concept, describing better ability to remotely access patient information and improvements in quality of care,” report authors note. “Physicians, practice leaders and other staff also noted the potential of EHRs to further improve both patient care and professional satisfaction in the future, as EHR technology--especially user interfaces and health information exchange--improves.

Provider workflow suffers after poor EHR implementation process

October 16, 2013 | By Dan Bowman
While one intention of electronic health record implementation is to improve provider workflow, that was hardly the case for pair of southern California hospitals, Medscape Medical News reported.
In fact, EHR implementation had the exact opposite effect for residents at both Riverside County Regional Medical Center in Moreno, Calif., and Pomona Valley Hospital Medical Center in Pomona, Calif.; it increased the average time of residents for seeing patients and charting the visits from 21 minutes to 37 minutes.
"Some of us were really excited. We thought it would improve patient care," Maisara Rahman, M.D., who helps to train family-medicine residents at Riverside County, said during a talk at the American Academy of Family Physicians' annual meeting in San Diego in September, according to Medscape. "But when implementation started, we saw inefficiencies."

Advice to the next National Coordinator

Posted on Oct 10, 2013
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
Over the next few months, Jacob Reider will serve as the interim National Coordinator for Healthcare IT while the search continues for Farzad Mostashari's permanent replacement.
What advice would I give to the next national coordinator?
David Blumenthal led ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the "regulatory era."
Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were spent, and the industry ran marathons every day to keep up with the pace of change. He was the right person for the "implementation era."
The next coordinator will preside over the "consolidate our gains" era. Grants largely run out in January 2014. Budgets are likely to shrink because of sequestration and the impact of fiscal pressures (when the Federal government starts operating again).

CIOs push for patient ID progress

Posted on Oct 15, 2013
By Neil Versel, Contributing Writer
The patient identification issue refuses to go away, mainly because nobody has quite figured out how to assure proper patient identity when engaging in health information exchange. At the College of Healthcare Information Management Executives Fall CIO Forum in Phoenix last week, some leading hospital CIOs emphasized the operational, clinical and financial importance of accurate patient matching.
Joey Sudomir, senior vice president and CIO of Texas Health Partners – the healthcare management affiliate of Arlington, Texas-based Texas Health Resources – said it costs about $600 to $800 to remediate duplicate patient identities following hospital discharge.
The IT department at Sharp HealthCare in San Diego has 10 full-time-equivalent employees just to investigate and clean up duplicate records, at a cost of about $1 million a year, according to Senior VP and CIO Bill Spooner. Matching also goes on in other departments of the health system, so the overall price tag is probably significantly higher, Spooner said.

EHR, informatics, health IT jobs 2.5% of all healthcare hiring

Author Name Jennifer Bresnick   |   Date October 11, 2013  
It might not sound like much, but 2.5% of all healthcare jobs are directly related to EHR system implementations, informatics, and other health IT strategies, according to research published in Industrial Relations: A Journal of Economy and Society. Most of the 434,282 positions open between 2007 and 2011 are due to opportunities created by the HITECH Act, says Aaron Schwartz and colleagues, with 39% of job listings posted by healthcare providers themselves.
Implementation support was the most sought-after skill, with 43% of listings requiring system installation, purchasing, or workflow design responsibilities.  This is not in the least surprising when correlated with the first stage of the EHR Incentive Program and the mad rush for providers to switch from paper to electronic record keeping.  The HITECH Act was associated with an 86% increase in monthly job postings containing the phrases “electronic health record” or “clinical informatics,” Schwartz says.

Biometric Tools Edge Into Health Care

by John Moore, iHealthBeat Contributing Reporter Tuesday, October 15, 2013
The term "biometrics" refers to measuring human characteristics -- a central task of health care since the invention of the science.
Indeed, industry executives contend that biometrics aren't anything new in health care, noting that X-rays, computerized tomography scans and a host of other medical technologies all represent ways to measure the human body. What is new, however, is the use of biometric authentication in health care. This technology aims to use human traits such as fingerprints and iris patterns to validate identity. Biometric authentication is just beginning to play a role in health care, which some observers find surprising.
"Health care is a strange environment in the sense that on the clinical side of health care we probably have some of the ... world's best technology," said Paul Donfried, chief technology officer at LaserLock Technologies, a security technology vendor. "On the business side of health care, it is almost the opposite. We actually have some of the most antiquated IT systems and IT infrastructure you can find anywhere."

HIX, A Disaster Foretold, Needs Time

Scott Mace, for HealthLeaders Media , October 15, 2013

It would be easy to focus on the price of the federal government's health insurance marketplace and expect it to work better than some Web startup launched by a couple of heavily-caffeinated kids. But it wouldn't be fair.

No one ever said information technology was foolproof. Even the most advanced systems today have their glitches. Now we can add to the list.
Last week, at the CHIME conference, my informal poll of healthcare CIOs found broad agreement that it's no surprise the federal health insurance exchange Web site,, has been overwhelmed by the number of unexpected visitors and other basic flaws.
Here's one example of how bad it is: A New York Times researcher successfully registered, but despite "more than 40 attempts over the next 11 days," was reportedly unable to log into
"I know the government spends a lot of money on their contractors and Web sites, and I also know that it's very difficult for them to make changes because of the process the government may go through," said Pam McNutt, senior vice president and CIO of Methodist Health System in Dallas, TX.

Robot Surgery Damaging Patients Rises With Misleading Marketing

OCT 10, 2013 1:26pm ET
Porter Adventist Hospital in Denver announced last year that Warren Kortz, a general surgeon on the medical staff, was the first in the Rocky Mountain region to use a technique known as robotic surgery to remove gall bladders through one incision in the belly button.
The operation, performed while the doctor sits at a video- game-like console, was “taking advantage of another breakthrough in robotic surgery” and is “easier on the patient,” the hospital said in a press release.
“It’s Star Wars stuff,” Kortz was quoted as saying in another article put out by the hospital touting another operation, robot-assisted parathyroid surgery, in 2010. “My prediction is it will eventually replace everything else.”
What the hospital and Kortz didn’t reveal was the risk. Even as Kortz promoted robotic surgery, 10 patients he treated suffered injuries or complications between 2008 and 2011, according to an April complaint by the Colorado Medical Board. Five had arteries punctured or torn. Objects were temporarily left inside two, and others had nerve damage. One died and another needed cardiopulmonary resuscitation. The complaint charges Kortz with 14 counts of unprofessional conduct, including sometimes not advising patients on alternatives to the robot.

HIE shows cost savings in emergencies

Posted on Oct 14, 2013
By Mike Miliard, Managing Editor
Beyond improving the quality of emergency care, giving physicians access to data from a health information exchange saved nearly $2,000 per patient during a study unveiled Monday by the American College of Emergency Physicians.
The research tracked patient care over a 12-month period, starting February 2012, during which there were 325,740 patient encounters and 7,525 log-ons to the HIE by 231 eligible clinicians at 11 emergency departments in South Carolina, according to ACEP. The study was based on a sample of 532 patients from this population who had information available in the HIE and for whom the clinicians caring for the patients completed a survey.
"Nearly 90 percent of participants [89 percent] said that quality of patient care was improved, and 82 percent of participants said that valuable time was saved, reporting a mean time savings of 105 minutes per patient," according to study author Christine Carr, MD, of the Medical University of South Carolina, in a news release.

Empathy essential for patient engagement success

October 14, 2013 | By Susan D. Hall
Though technology can go a long way to help engage patients in their own health care, a little empathy can be an essential ingredient, according to an article published at
Wearable tech and medical devices, patient portals, personal health records and mobile apps hold the potential to improve care, but to do so, patients and physicians must use them and organizations must integrate them into traditional efforts to engage patients, the article says.

Health Insurance Exchanges Plagued By Data Errors

Health insurance exchanges, especially the one run by Uncle Sam, are having problems sending files that can be opened and that have complete information.
The unexpected volume of visitors that overwhelmed the federally operated health insurance exchange last week is only one of many problems confronting this entity and the state-based exchanges.
For starters, some insurance companies have received faulty enrollment data from the U.S.-run insurance exchange, according to insurance industry consultants interviewed by Bloomberg News. Either the plans have been unable to open files forwarded to them from the exchange or have found that the information on the enrollees is incomplete.
According to consultant Bob Laszewski, the plans are trying to fix the errors manually. Another consultant, Dan Schuyler, told Bloomberg that unless these problems are rectified in the next few weeks, some enrollees might not have coverage on Jan. 1, 2014.