Quote Of The Year

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

Friday, February 28, 2014

Very Interesting Reflections From A Health IT Veteran On 10 Years Of Progress In The US.

This appeared a little while ago.

Glaser reflects on decade of health IT

Posted on Jan 20, 2014
By Bernie Monegain, Editor
To say that John Glaser has had a front-row seat in the health IT arena over the past 10 years – and the 10 years before that – would be wrong. He’s been in the trenches, sleeves rolled up. Glaser has advocated for the adoption of EHRs through his work with CHIME, HIMSS, AMIA, the eHealth Initiative, Markle Foundation and before congressional committees. He also did a stint as adviser at the ONC. As CIO of Partners HealthCare in Boston, he guided the health system into the digital age – long before many other care providers across the country could even conceive the possibilities. Today, he continues his HIT work through these many channels also as CEO of the Health Services Business Unit of Siemens Healthcare.
We talked with Glaser recently about the vast industry change he has helped to achieve over the past decade or two, and also to consider the possibilities for the future.
Q. What have been the challenges and the biggest change in health IT?
A: Over this last decade, and probably the decade before that, there have been challenges that are consistent. Dealing with new technology is a consistent challenge, whether mobile now or Web in years gone by. Even within each organization, their engaging people, revamping processes, clinical, revenue cycle – all that stuff is a consistent challenge. Helping an organization sort of design its direction – where should we go, where should we put our resources, how do we monitor the environment, how do we make sure it’s all working out the way we thought it should.
I think there’s one factor that is materially different in the last 10 years, it’s the role of government in HIT. You and I go back before the creation of ONC under President Bush, and now we have enormous influence whether it’s through the meaningful requirements, or certification, or the focus on interoperability, health information exchange and the standards that go with that – more recently EHR safety issue and the reporting of errors. There’s still a conversation about should government regulate all that. Government has always had a strong hand in privacy and security with the administrative transactions.
I go back to the early days of CHIME, and engaging the federal government just wasn’t on the radar screen. Now it’s really on the radar screen at CHIME and HIMSS and AMIA and all those other folks.
Lots more here:
This is a very interesting interview. As I read I thought there were more than a few parallels to the way things have played out in Australia. Well worth a careful read.
David.

Thursday, February 27, 2014

Pre - Budget Review Of The Health Sector - 26 February 2014.

As we head towards the Budget in Late May 2014 I thought It would be useful to keep a closer eye than usual on what was being said regarding what we might see coming out of the Budget.
According to the Australian Parliament web site Budget Night will be on Tuesday 26th May, 2014.
Here are some of the more interesting articles I have spotted this week.

Health policy expert sets agenda

17 February, 2014
The Abbott Government was elected with “almost no health policy” according to a leading academic who says it must focus on three key areas as a matter of urgency.
Professor Stephen Duckett (pictured), a health policy expert at La Trobe University and a director at the Grattan Institute, said despite an apparent health policy deficit coming into the job, the government now needs to set policies and priorities and make sure they are more than “just one-term quick fixes”.
At the very least, he says it must keep the Medicare promise, think beyond services by addressing the social determinants of health, and get governance right if it is to succeed.
Writing in the Medical Journal of Australia, he said it was critical to address the financial barriers to seeking healthcare and waiting times at public hospitals.
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The Trans Pacific Partnership Agreement negotiations and the health of Australians

17 February 2014
The Trans Pacific Partnership Agreement has the potential to negatively impact the health of Australians by raising the cost of medicine and limiting the government's ability to regulate tobacco and alcohol, argues this policy brief based on publicly available and recently leaked negotiating documents.
Executive summary
The purpose of this policy brief is to inform the debate from a health perspective in the final stages of the negotiations on the Trans Pacific Partnership Agreement (TPPA), particularly during meetings of chief negotiators and ministers in February 2014.
This policy brief outlines the evidence about the potential health effects on the Australian community of actions related to the TPPA, based on publicly available and recently leaked negotiating documents. The purpose of the TPPA is to enhance each of the countries’ economic development and that this may lead to improved social and health development. However, although there may be positive impacts on the health and wellbeing of Australians resulting from economic growth, there are also many ways in which the TPPA has the potential to have negative impacts on the health of Australians. This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs.
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Modelling finds GP fee no money-saver

Date February 23, 2014

Bianca Hall

Political Correspondent

EXCLUSIVE
A proposed $6 ''co-payment'' for a GP could add $2 billion to the states' and federal government's health bills, modelling shows.
The South Australian Health Department has estimated that the co-payment proposal would lead to 4 per cent of patients forgoing their GPs and instead attending their emergency departments to seek help for minor health complaints.
This proposal's going to greatly increase total health costs. 
The modelling showed that this would double the number of people presenting at emergency departments for minor ailments, tripling waiting times and costing an extra $145 million. Extrapolating the increased costs to the South Australian health system across the country, based on population, showed it would add $1.99 billion to the country's health costs. The Greens and Labor seized on the figures.
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GP co-payments? Don’t save on primary care

As the saying goes: a fool and his money are soon parted. We’ve all paid for super clinics, the PCEHR, Medicare Locals, phone lines – you name it. Unfortunately, all these ideas have yet to bear fruit. Some say we should have spent our precious health dollars more wisely, especially in the current climate of ever-increasing health care costs.
Many GPs warned that spending too much money on these and other (non-proven) novelties would eventually come back to bite us. I tend to agree. For example, instead of building expensive, non-viable super clinics, we should have improved access to care by expanding existing GP infrastructure.
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Pay-your-way overhaul of health

THE Coalition has vowed to maintain universal healthcare but says individuals will have to pay their way as part of a whole-of-government efficiency drive that's set to reshape Medicare and the federal health bureaucracy.
As the government builds its case for a major overhaul of health spending, Tony Abbott promised the overall pool of health funding would remain but it would be "crazy" not to improve the way funds were spent. The health industry is bracing for wide-ranging changes, including measures to allow private insurers to take stake in the primary care sector by allowing them to cover GP visits.
But a proposed $6 co-payment for bulk-billed GP visits is being dismissed as a "distraction", despite Health Minister Peter Dutton's support for the proposal.
Joe Hockey said Medicare was unsustainable, with its budget slated to rise by 15 per cent to $75 billion over three years.
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AMA president Steve Hambleton says co-payments and means testing for GP visits a 'distraction'

Date February 22, 2014
The federal government should abandon any discussion of means-tested access to GP services and medical tests and look at more promising policies that will save money and improve people's health, the Australian Medical Association says.
During the week, federal Health Minister Peter Dutton questioned whether people on high incomes should be paying more for health services, including GP visits, blood tests and X-rays. While he refused to say how actively the government was considering a means-tested payment for healthcare, any such move would eliminate universal access to free services.
In an interview with the ABC, Mr Dutton said: ''I want to make sure that, for argument's sake, we have a discussion about you or me on reasonable incomes, whether we should expect to pay nothing when we go to see the doctor, when we go to have a blood test, should we expect to pay nothing as a co-contribution and other taxpayers to pick up that bill? I think these are all reasonable discussions for our population to have.''
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21 February 2014, 6.19am AEST

Making the rich pay more isn’t the answer to a better Medicare

SShould The rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options…

Author

Stephen Duckett
Director, Health Program at Grattan Institute
Should the rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options – including a $6 co-payment for general practice visits – to get a hold on the rising health budget.
The argument is that government benefits should be tightly targeted to those who can’t pay. But there are a number of weaknesses with it.
Australians already pay comparatively high rates of health costs, either directly or via health insurance. Increasing out-of-pocket expenses will make us a real international outlier in terms of equitable financing and have significant consequences for many poorer households. About 16% of households report deferring visits to the doctor or not filling prescriptions because of costs; additional co-payments will worsen their plight.
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Medicare unsustainable, govt says

21st Feb 2014
FEDERAL Treasurer Joe Hockey has warned that Australia will run out of money to pay for Medicare and its welfare and education systems unless the government takes a hard look at the costs.
Mr Hockey said he was "ringing an early warning bell" about the sustainability of federal funding for vital programs, saying hard work will be needed in the future just to maintain the quality of life expected by most Australians.
"The starting point is if our health and welfare and education systems stay exactly the same, Australia is going to run out of money to pay for them," Mr Hockey told the Seven Network on Friday.
"We'll either have to have a massive increase in taxes, and that means fewer jobs at the end of the day, or we're going to have to look at ways we can restructure the system to make it sustainable."
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Bulk-billing limited to low-income earners under radical Medicare plan

February 21, 2014 8:21AM
Sue Dunlevy, Jennifer Rajca
News Limited Network
MEDICARE would be means-tested with access to bulk-billed doctor’s visits and medical tests limited to those on lower incomes under a radical plan being considered by the Abbott Government.
In an exclusive interview with News Corp, Health Minister Peter Dutton has questioned if high income earners should be able to see a doctor without dipping into their pocket.
“I question whether someone on an income of $200,000 can have an expectation of going to the doctor for free, that is one of the discussions, one of the conversations we have to have,” he said.
The minister’s proposal for means-testing on bulk-billing extends beyond GP visits and also includes blood tests, X-rays and other diagnostic services.
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Government flying a kite on GP tax

  • Editorial
  • Herald Sun
  • February 20, 2014 8:56PM
WHENEVER governments decide to fly a kite about a potential new tax people need to worry.
It’s too easy for state, federal and local governments to simply hit up taxpayers as they look to cover black holes dug through excessive spending by previous administrations.
We see it every year with new and higher government charges, additional taxes, increased permit costs, licence fees and parking fines.
All this while consumers pay double-digit increases in energy prices, the forecast CPI reaches beyond 3 per cent and unemployment kicks up to 6.4 per cent.
Now Health Minister Peter Dutton is fuelling speculation that a co-payment of about $6 for doctor visits may be used to reduce the heavy burden of an “unsustainable” Medicare budget, which has risen 124 per cent in a decade.
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Hockey flags changes to Medicare, pensions in tough budget

February 21, 2014
Jacob Greber Economics correspondent
Treasurer Joe Hockey has ramped up warnings about the need for budget spending reform, flagging changes to Medicare, pensions and education.
Speaking a week after receiving the first report from his Audit Commission into the budget, Mr Hockey said without changes to the current system of funding for health, education and welfare, Australia “will run out of money to pay for them”.
“We will either have to have a massive increase in taxes – and that means fewer jobs at the end of the day – or we are going to have to look at ways that we can restructure the system to make it sustainable,” Mr Hockey told Channel Seven on Friday.
The Treasurer indicated the budget for Medicare was slated to rise 15 per cent to $75 billion over three years.
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Paying for your health

18th Feb 2014
A CO-PAYMENT for bulk-billing threatens the concept of free healthcare. How ready are we to let go of this service?
It started as little more than a footnote in a largely overlooked policy paper from a little-known think tank and ended with a full-bodied interception from an irate Cabinet minister.
But in the three months in between, it became one of the hottest medico-political stories of the summer.
It was, of course, the end of Medicare as we know it, specifically the introduction of a $6 compulsory co-payment for every bulk-billed GP visit.
This small but significant change, which would rank among the biggest in Medicare’s three decade history, would save $749,000,070 over four years by discouraging people from going to the GP, without preventing them outright.
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Abbott pledges to be Medicare’s ‘best friend’

February 20, 2014
Joanna Heath
Prime Minister Tony Abbott has signalled caution on the potential for major Medicare reform, saying he wants his government to be “the best friend Medicare has ever had”.
“Obviously the budget generally is under pressure and it’s very important that we do what we can to fix the Budget as quickly as we can but we’ve got to do it in ways which are consistent with our pre-election commitments and don’t forget I said we were going to be a no-surprises, no-excuses government,” Mr Abbott said.
“As the Health Minister in a former government I used to say that that government was the best friend that Medicare had ever had. This leopard doesn’t change his spots. I want this government to be likewise the best friend that Medicare has ever had.”
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Doctors warn: restricting GP access may cost more

  • Jared Owens and Sean Parnell
  • The Australian
  • February 20, 2014 10:05AM
Peter Dutton has been accused of softening up voters for the introduction of a GP co-payment.
DOCTORS have backed Health Minister Peter Dutton’s call for a “national conversation” about Australia’s rising health costs, but warned restricting access to GPs could ultimately cost even more.
Mr Dutton yesterday declared the nation’s primary-care and hospital system was unsustainable in its present form, indicating baby boomers were set to pay higher out-of-pocket costs for medical treatment.
Mr Dutton has refused to quash speculation that the government could impose a $6 co-payment on general practice visits, prompting Labor spokeswoman Catherine King to accuse him of plotting to “dismantle” Medicare.
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Co-payments problematic, inquiry told

  • AAP
  • February 18, 2014 11:40AM
GP co-payments won't lead to worthwhile budget savings and will force the less well off and chronically ill to delay visiting their doctor, health groups have told an inquiry into the government's commission of audit.
Co-payments of up to $6 have been flagged as one way to tackle rising health costs, sparking widespread concerns the Abbott government will target Medicare in the May budget.
Prime Minister Tony Abbott has labelled talk of a co-payment a scare campaign, but others such as Health Minister Peter Dutton have refused to rule it out.
Chief of the Australian Health and Hospitals Association Alison Verhoeven said co-payments would make healthcare unaffordable for the most vulnerable, particularly those with chronic illnesses.
Appearing at the Senate inquiry in Canberra, she said hospital emergency departments could become clogged with those avoiding the GP fees.
"Requiring a more costly intervention," she told the hearing.
The administrative costs of co-payments would cancel out many of the savings, she said.
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18 February 2014, 6.44am AEST

Commission of Audit should know costs but appreciate value

Author:  Jane Hall
Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation at University of Technology, Sydney
The Commission of Audit is holding its third Hearing in Canberra today. Witnesses include the Consumers Health Forum and Australian Health and Hospitals Association, so health is clearly the order of the day.
Instituted by the Abbott government soon after it came to power, the Commission is charged with finding savings by eliminating waste and duplication of functions, and the consolidation of Commonwealth agencies. And the Australian National Preventive Health Agency (ANPHA) is widely held to be an easy target for it.
The agency was established as part of the raft of reforms under the 2011 National Health Reform Agreement, to lead in preventive health through surveillance and monitoring, policy advice, national social media campaigns, and by sponsoring research.
Eliminating the ANPHA would, of course, look like a positive contribution to the savings and agency reductions needed to justify the Commission of Audit. But the 40 or so ANPHA staff will not contribute significantly to the Commission’s targeted reduction of 12,000 public servants.
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Comment:
It seems clear there is a significant change coming on the basis of this week’s news. The best suggestion I have heard so far is that there will be a degree of means testing on access to bulk billing - and a tighter means test on access to the Senior’s Health card.
More next week.
David.

Wednesday, February 26, 2014

Here Is Why Quality Journalism Is Still Worth It. This Makes It Clear Why The Assistant Health Minister Should Resign.

This article appeared last week.

Abbott and Nash: PM blinded by tribal loyalty

Peter Hartcher

Sydney Morning Herald political and international editor

The Abbott government gleefully lashed Labor after Craig Thomson was convicted of criminal fraud this week. But there is no sign it has learned lessons from that disgraceful episode.
There were two central problems with Labor's handling of Thomson. First, it was careless in allowing him into Parliament. Second, it tolerated him even after his misdeeds were laid bare.
The Sydney Morning Herald broke the story of Thomson's crimes in April, 2009. The reporter, Mark Davis, had copies of Thomson's credit card statements. Excerpts were published on the front page in support of the story.
All the details were there from the very start, documentary proof of Thomson's payments to brothels and $101,533 in cash withdrawals, $100 to $600 at a time. All courtesy of the members of the Health Services Union.
It was not until three years later that Julia Gillard asked Thomson to leave the Labor caucus. The presumption of innocence is a tenet of law, not a tenet of the law of politics.
In those three years the Labor government and Labor Party suffered serious damage to their credibility. The trade unions fell into disrepute. The government lost power. The new government has set up a royal commission into union corruption.
The Thomson case was not the chief reason for Labor's woes, of course, but an important one. And the reputation of politicians everywhere sank even deeper into the mire of public disgust.
The essence was that a political party tolerated the intolerable because of tribal loyalty. Precisely this syndrome is on display in the Abbott government.
The details are completely different, but the government's handling of Assistant Health Minister Fiona Nash and her chief of staff reveal the same mindset.
Nash has not defrauded anyone of money. She is not accused of a crime. But consider this series of outrages exposed by Fairfax Media's Amy Corderoy in the past fortnight.
Nash is the minister responsible for food policy and alcohol policy in the federal government. She knowingly employed a former lobbyist for the food, beverages and alcohol industry as her chief of staff.
His name is Alastair Furnival.
He kept a half-interest in his lobbying firm while working for the minister. The other half was owned by his wife.
The firm's clients include the owner of the Cadbury and Kraft businesses. They also include the Australian Beverages Council, representing the $7 billion-a-year soft drink industry. And the firm has done work for the alcohol industry at least as recently as 2012.
The minister evidently gave Furnival power over policy decisions.
He made a series of decisions that favoured his firm's clients at the expense of public health interests.
He overrode Health Department objections and deleted a government website on a new rating system for healthy food on the day it went public. The ''health star rating'' system had been two years in the works, developed jointly with state governments.
The public servant who had objected was transferred six days later.
Furnival stripped the federal funding from a key public health advocacy group on drugs and alcohol, the Alcohol and Other Drugs Council of Australia.
The council has supported the idea of taxing alcohol by volume, and other policies opposed by the alcohol industry. Furnival told the group at a meeting in December that they were to be lose their funding.
Lots more here:
The clarity of this exposition of what the Minister has had happen on her watch is both clearly stated and frankly devastating. These actions are all so tainted with conflict with interest it is honestly quite alarming to even an old cynic like me.
To have the Senior Minister  (Mr Dutton) highlighting the risks of obesity and excess alcohol - as he did in a speech I linked to last week and have the Junior Minister working to undermine things is just an absurdity.
Here is the quote:
“One-third of Australia’s burden of disease is due to ‘lifestyle’ health risks such as poor diet, obesity, physical inactivity, smoking and alcohol misuse.”
The full speech is here:
The Junior Minister has no clue about health policy and really should just leave the Executive Government in my view. The Senate Estimates hearings which have just happened this morning will certainly have increased the pressure for some change. Will be interesting to see how it all plays out!
As reflected in the letter signed by 60 public health academics, there is a fair support for what was being done by the Department with the Web-site.
See here:
http://www.scribd.com/doc/209288593/Letter-on-HSR-system
One really wonders what influence evidence might have on this Government and thus how evidence based the e-Health outcomes we finally see.
Labor was an evidence free zone on e-Health - one hopes the other side can do better - but sadly on what we have seen to date there has to be some doubt!
David.

Tuesday, February 25, 2014

Seems It Has Been A Big Week For Privacy Breaches In Health And Elsewhere. The Privacy Commissioner Will Be Very Busy.

The Immigration Department would seem to have really messed up.

Asylum seekers’ identities revealed in Immigration Department data lapse

Exclusive: online database provides personal details of almost 10,000 people in serious and embarrassing security breach
The personal details of a third of all asylum seekers held in Australia – almost 10,000 adults and children – have been inadvertently released by the Department of Immigration and Border Protection in one of the most serious privacy breaches in Australia’s history.
A vast database containing the full names, nationalities, location, arrival date and boat arrival information was revealed on the department’s website, raising serious concerns that thousands of asylum seekers have had confidential details made public.
Every single person held in a mainland detention facility and on Christmas Island has been identified in the database, as well as several thousand who are living in the community under the community detention program. A large number of children have been identified in the release, which also lists whether asylum seekers are part of family groups.
The breach raises serious questions about whether those identified could be placed at risk of retribution if they are returned to their countries of origin.
The disclosure of the database is a major embarrassment for the federal government, which has adopted a policy of extreme secrecy on asylum-seeker issues.
The asylum seekers named, range in age from newborns to people over 80. They come from countries including Sri Lanka, Afghanistan, Iran and Syria and arrived in Australia as late as September. Some have been in detention for more than 1000 days.
Much more here:
After the event we have the Privacy Commissioner leaping into action.

Privacy commissioner to investigate immigration department

Department confirms report that a file with personal details of asylum seekers was publicly accessible
Federal Privacy Commissioner Timothy Pilgrim has confirmed he will investigate how a file containing the personal details of asylum seekers was made available to the public through the immigration department's website.
The Guardian this morning revealed the security lapse by the department.
The Guardian article by Oliver Laughland, Paul Farrell and Asher Wolf reported that the "vast database" contained the "full names, nationalities, location, arrival date and boat arrival information" of asylum seekers.
The file contained the details of almost 10,000 people, including every asylum seeker imprisoned in on-shore detention centres and on Christmas Island, as well as those in community detention, the newspaper reported.
"This information was never intended to be in the public domain," an immigration department spokesperson said in a statement sent to Computerworld Australia.
Lots more here:
Here is the link to the Commissioner’s statement:
We look forward to the explanation of what happened and some assurance that this won’t happen elsewhere.
The Privacy Foundation also seems to be keeping the Privacy Commissioner busy.
Go here to download a range of letters to the Commissioner from the Foundation.
Some extracts:
“Dear Commissioner Pilgrim,

Re: Privacy and the electronic health records: Victorian healthcare service

The Australian Privacy Foundation (APF) is the country's leading privacy advocacy organisation. I am writing in my capacity as Chair of the Health Committee of the APF.
APF has received communications from clinicians, patients (some now deceased) and information technology specialists who are anxious about the security and privacy of ehealth records. In particular, serious concern has been expressed about records that are curated by a regional health care service in Victoria. This would of course be in violation of privacy law and guidelines.
On the basis of the information APF has received, it appears that private e-health records at the regional health care service are accessible via a web browser after authentication - that is the provision of eligible user names and passwords. These are often transmitted in clear text without encryption over the Internet. Of two access portals shown to some of these concerned individuals, one permitted access using a plain http connection, that is no security, while another appeared to use SSL, a more secure http connection (https).
Further, specific security and privacy concerns expressed by the individuals are that:
1. Authorised user names and passwords can be intercepted.
2. Private data is revealed; the scope of the data includes most present and past patient
details, including full name and contact information, test results and diagnoses.
3. These individuals claim that security protocols around user names and passwords are
virtually non-existent or not enforced.
And.
Dear Commissioner Pilgrim,

Re: Privacy and the PCEHR record

The Australian Privacy Foundation (APF) is the country's leading privacy advocacy organisation. I am writing in my capacity as Chair of the Health Committee of the APF.
I refer communication received by a patient who was asked to sign up for the PCEHR by her General Practitioner (GP) during a medical consultation. The patient was anxious that her concerns did not receive adequate response when she consulted both her GP and your
office.
Her concerns are as follows:
“Information uploaded to my PCEHR will be kept for 30 years post mortem or 130 years if DOD unknown.
If I change my mind and wish to withdraw, while the information can be "cancelled", it is not deleted: it will still be kept as above and may still be accessed.
While we would expect that the information could be used only for health care, this is not so: it may be used also for law enforcement, medical indemnity insurance and other purposes.
Health care providers sign a participation agreement, which assigns all intellectual property rights to data uploaded to the PCEHR to the government. These rights can never be revoked, even on termination of the agreement.
Full access to my data may be gained from any PC in the country configured with NASH certificate, by invoking the "emergency access" criterion.
There is no guarantee that the government (System Operator) will not attach unspecified additional data to my PCEHR, without my knowledge or consent.
With the possibility of the Minister's review resulting in the scrapping of the PCEHR system now or later, there is uncertainty over what will happen to my data.
With less than 1% of those who have registered actually uploading shared health summaries, what use is the system anyway?
If I were in your position [the patient’s GP], I would be looking at the penalty provisions, which can amount to over $17,000 for individual and over $85,000 for body corporate and to whether my indemnity will cover me against possible action in connection with PCEHR.”
More at the web site above.
Seems there are some hard questions to be answered here. We need to keep an eye out for some answers.
The results of the investigations might appear here in due course:
It will really be interesting to see just how effective the Privacy Commissioner will be in creating improvement. Certainly the Asylum Seeker Incident should result in the relevant CIO leaving the public service.
David.

Monday, February 24, 2014

Weekly Australian Health IT Links – 24th February, 2014.

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

Interesting week with all sorts of things going on as we continue to wonder just when the PCEHR Review will become public.
I have been hearing about the Fiona Stanley Hospital for ages and it is utterly clear there as a major debacle at the planning stage of the Hospital as far as e-Health was concerned. Essentially they overlooked any Health IT beyond running some fibre around the hospital but with no plans for what it would be used for and with.
The most serious item this week is the leak by the Government of its data-base of registered asylum seekers. Hardly a re-assuring outcome for those trusting that their information will be kept secure by Government departments.
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Fiona Stanley Hospital IT could cost another $50 million

Botched build sucking investment out of eHealth, says Treasury boss.

Outgoing West Australian under-treasurer Tim Marney believes the state will have to spend another $25 million to $50 million to get the IT systems at its new Fiona Stanley Hospital up to scratch.
Marney was called to appear before a parliamentary committee investigating the troubled construction of the new facility last week. Opening of the hospital has been delayed by six months to October 2014, primary because planners were too ambitious about the IT implementation schedule.
He said the delays had cost the state an additional $330 million already, including up to $151 million in IT costs.
But Marney said the full bill was still being negotiated between the WA government and the outsourced hospital operator Serco, with the remaining IT exposure likely to be up to $50 million, or around $25 million “if things go really well."
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Pharmacy revamped with robotic machine

By MERRAN REED

Feb. 18, 2014, 12:30 a.m.
UFS Pharmacies Strathfieldsaye has renovated its store to lessen the chance of human error when dispensing medications. 
A robotic dispensing machine has cut down the time a pharmacist spends accessing medications, with 80 per cent of the most popular prescriptions dispensed using the machine.
Pharmacist Brownyn Capewell said the computerised system decreased the chances of mistakes being made 
The store is also now a 'Forward Pharmacy', which frees the pharmacist from working all day behind a counter. 
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Lives extended by genetic algorithm

19th Feb 2014
A GENETIC modelling algorithm that predicts patient response to three standard chemotherapy drugs used to treat ovarian cancer could extend patients’ lives by 21 months.
A retrospective study used data from an ovarian cancer registry to genetically profile over 3000 ovarian tumour samples from patients already on one of three common ovarian cancer drugs – paclitaxel, cyclophosphamide and topotecan – to discover differences between tumours that responded to treatment and tumours that didn’t.
The Canadian researchers said site-specific cancers have traditionally been considered to be homogenous, but increasingly, evidence is pointing to significant heterogeneity within the disease.
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‘Garbled and confused’: trust in e-health dives

18th Feb 2014
THE personally controlled electronic health record (PCEHR) is garbling patient information GPs upload, creating confusing and potentially misleading records, an e-health expert has warned.
The latest criticism of the billion-dollar scheme from former National Electronic Health Transition Authority (NEHTA) chief clinical lead, Dr Mukesh Haikerwal, comes as the health sector awaits the release of the review ordered by Health Minister Peter Dutton late last year.
A de-identified patient record entered into the PCEHR by Dr Haikerwal, and supplied to MO, shows that the reverse chronological order of visits was jumbled up and appeared in the e-health record in random order.
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Pharmacy Daily 18 Feb

New e-script incentives

Among the Agreement programs announcements last week was confirmation of a new incentive payment to eligible community pharmacies to boost the uptake of electronic prescriptions.

The Electronic Prescription Scanning Incentive (ePSI) is an allocation from the existing Electronic Transfer of Prescriptions (ETP) budget in the Agreement to better
drive the uptake and rates of scanning of electronic prescriptions.
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Asylum seekers’ identities revealed in Immigration Department data lapse

Exclusive: online database provides personal details of almost 10,000 people in serious and embarrassing security breach
The personal details of a third of all asylum seekers held in Australia – almost 10,000 adults and children – have been inadvertently released by the Department of Immigration and Border Protection in one of the most serious privacy breaches in Australia’s history.
A vast database containing the full names, nationalities, location, arrival date and boat arrival information was revealed on the department’s website, raising serious concerns that thousands of asylum seekers have had confidential details made public.
Every single person held in a mainland detention facility and on Christmas Island has been identified in the database, as well as several thousand who are living in the community under the community detention program. A large number of children have been identified in the release, which also lists whether asylum seekers are part of family groups.
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Privacy commissioner to investigate immigration department

Department confirms report that a file with personal details of asylum seekers was publicly accessible
Federal Privacy Commissioner Timothy Pilgrim has confirmed he will investigate how a file containing the personal details of asylum seekers was made available to the public through the immigration department's website.
The Guardian this morning revealed the security lapse by the department.
The Guardian article by Oliver Laughland, Paul Farrell and Asher Wolf reported that the "vast database" contained the "full names, nationalities, location, arrival date and boat arrival information" of asylum seekers.
The file contained the details of almost 10,000 people, including every asylum seeker imprisoned in on-shore detention centres and on Christmas Island, as well as those in community detention, the newspaper reported.
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Robotic pill to put a world of pain to bed

  • Timothy Hay
  • The Wall Street Journal
  • February 20, 2014 12:00AM
THE adage “take two aspirin and call me in the morning” is destined for a futuristic makeover. Doctors may just as easily recommend swallowing sophisticated gadgets instead.
That is the hope of prolific inventor Mir Imran, who has created a robotic pill to replace injectable drugs for chronic conditions such as diabetes.
The gadget, which is in preclinical studies and backed by Google’s venture-capital unit, consists of an ingestible polymer and tiny hollow needles made of sugar designed to safely deliver drugs to the small intestine.
Advances in technology and scientific research have recently led to two federally approved robotic pills. The US Food and Drug Administration this month cleared the PillCam, a pill-sized camera from Given Imaging that photographs human insides in a hunt for colon polyps. And Proteus Digital Health got clearance 18 months ago to put ingestible sensors inside pills to help patients and doctors determine how many they have taken.
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GP umbrella group drops Medicare Locals

20 February, 2014 Paul Smith
Medicare Locals have effectively been ejected from general practice's leading lobby group.
Australian Doctor learnt on Thursday that members of United General Practice Australia (UGPA) voted to remove the Australian Medicare Local Alliance (AMLA) as one of its members.
Set up six years ago, UGPA is made up of medical organisations - including the RACGP, ACRRM, the AMA and the RDAA - and is tasked with addressing general practice issues that "need urgent action".
Last year it played a leading role in forcing the Rudd government to scrap a proposed $2000 cap on tax breaks for continuing medical education.
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Medicare Locals face a political and public relations battle

| Feb 17, 2014 2:27PM |
A recent article in the News Ltd press demonstrates the political, media and public relations challenges facing Medicare Locals (MLs) in the review of their roles and functions, currently being overseen by former Chief Medical Officer Dr John Horwath.
The article extensively covers the AMA’s submission to the review, including the results of a ‘survey’ undertaken by the AMA on its members.  Leaving aside the credibility of these type of AMA push polls (and bearing in mind that less than 50% of GPs are AMA members), the article makes no substantial arguments against Medicare Locals.
The best case it mounts for change are the fact that ‘some sites are underperforming’ and ‘staff hate the name’(!)  Nevertheless, the article labels MLs and “Labor’s dud Medicare Locals” and is overwhelmingly negative about their future.
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National electronic health records and the digital disruption of moral orders

Publication Details

Garrety, K., McLoughlin, I., Wilson, R., Zelle, G. & Martin, M. (2013). National electronic health records and the digital disruption of moral orders. Social Science and Medicine, 101 70-77.

Abstract

The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships.
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NeHTA’s eHealth Clinician User Guide

NeHTA has released an eHealth Clinicians User Guide which aims to support medical practices in navigating the complexities of eHealth (including the national eHealth record system) from planning, preparation, registration and implementation through to meaningful use.  To view the user guide, please click here 
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Australian Medicines Terminology (AMT) v3 Beta Feedback Summary Results

Created on Monday, 17 February 2014
The Australian Medicines Terminology (AMT) v3 Beta Feedback Summary Results document summarises the responses received from stakeholders during the AMT v3 Beta feedback activities undertaken during 2013.
The document outlines important changes that have been made to the AMT v3 model, components and artefacts since the publication of AMT v3 Beta in February 2013.
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#FHIR – still a long way to go yet

Posted on February 18, 2014 by Grahame Grieve
While working with one of my Customers (NEHTA), this diagram went past, a powerpoint mock-up of a GP system went past. They’ve given me permission to take it out of it’s context, and use it for something else (thanks). So here’s the GP system mock-up:
What I thought I’d do with this image is indicate which fields on here correspond to existing resources, and which don’t. That would be helpful to implementers, and also give some ideas as to where the project team needs to go yet.
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NBN now a long, slow and unspectacular slog

Date February 18, 2014 - 1:05AM

Tony Brown

OPINION
It is  fast approaching six months since the Coalition came to power and assumed responsibility for the national broadband network –  one of the highest-profile issues in the last federal election campaign – and in the post-election period the temperature around the NBN debate has barely cooled.
Since taking over as Communications Minister  Malcolm Turnbull has infuriated supporters of Labor’s all fibre-to-the-premise network by planning a redesign to incorporate a mix of technologies including fibre-to-the-node and existing hybrid fibre coaxial  networks; what Mr vTurnbull has called a multi-technology mix (MTM).
NBN Co has already launched talks with Telstra to renegotiate the NBN deal signed with the former Labor government – although Telstra chief executive David Thodey has reiterated the telco would be protecting the financial value of that original deal.
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NBN Co lifts first-half revenue as capex soars

In the six months to December, NBN Co capex jumped to $1.2 billion, while revenue rose to $47.8 million, up from $29.3 million in the prior corresponding period.
Max Mason and James Hutchinson
NBN Co executive chairman Ziggy Switkowski has slammed plans to disconnect copper services to up to 100,000 homes per month as part of the national broadband network rollout as too ­ambitious and likely to cause issues for consumers.
The plans, formulated by the company’s previous executives as a means to force people onto the NBN, mean existing copper phone and broadband services would be disconnected 18 months after the NBN became available in a given area.
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Security 101: Top tech tips to stay safe

Date February 18, 2014 - 10:31AM

Adam Turner is an award-winning Australian freelance technology journalist with a passion for gadgets and the "digital lounge room".

Be smart with your passwords and think beyond your PC, security experts advise.
Security is one of the main themes at this week's Tech Leaders forum on the Gold Coast, as it tends to be every year. Of course sometimes the pitches from anti-virus vendors can have a whiff of scare tactics about them. To cut through the hype I asked several vendors for their top three practical tech tips – apart from "buy our software" – to help people stay safe online. 
By "update everything", McKinnon and the guys from BitDefender mean take a holistic approach to security, thinking beyond the desktop to consider security options for your mobile devices. 
AVG's Australian security advisor, Michael McKinnon:
1. Update everything
2. Don't reuse passwords
3. Back up everything
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Nursing homes are exposed to hacker attacks

  • Rachael King
  • The Wall Street Journal
  • February 19, 2014 8:58AM
COMPUTER-SECURITY researchers have discovered on a website documents that could allow hackers easily to obtain electronic medical records and payment information from healthcare providers.
The documents — found by two cybersecurity firms on a site commonly used by hackers — detail the type of equipment used in computer networks, the internet addresses for computers and other devices, and the passwords to network firewalls run by US healthcare providers such as nursing homes, doctors’ offices and hospitals.
If such networks were accessed, cybercriminals easily could find personal details on individuals, security experts said. Such information could be used to sell credit-card data and medical information that could be used to commit insurance fraud.
A search by The Wall Street Journal of the website, 4shared.com, turned up information from three nursing homes: the Bronx Center for Rehabilitation & Healthcare in New York; the Glengariff Healthcare Center in Glen Cove, N.Y.; and the Campbell Hall Rehabilitation Center in Campbell Hall, N.Y.
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Minister announces eHealth Ambassadors

Health Minister Tony Ryall has tonight named a group of seven innovative GPs who will lead the way in a national rollout of patient portals this year.
"A patient portal is an online service which allows a patient to securely log in and do things like check their latest laboratory test results, order a repeat prescription, or send a message directly to their GP - all from the convenience of their home," says Mr Ryall.
"This gives patients much greater access to their own health information and the ability to manage more aspects of their own care. The portals also offer huge benefits for doctors, and I’ve already received great feedback from GPs about the benefits of having this service in their practice.
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Microsoft extends Windows 7 shelf life as Windows 8 struggles

At least it's not Vista

By Nick Farrell  February 17th
It seems that Windows 7 will remain on sale to business users until at least early 2015, if not longer, following a change to Microsoft's Windows lifecycle.
As spotted by ZDNet, the updated lifecycle indicates that Microsoft has not yet decided on an end-date for the OS and could be a long way off yet.
Microsoft has promised to give businesses at least a year's warning before it kills off Windows 7 Professional.
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Enjoy!
David.