Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, July 05, 2012

Another Day Another Issue With the NEHRS / PCEHR System - Or So It Seems.

Just when we thought we would have a day off from the continuing news-flow of issues and problems we had this appear.

Punctuation a stumbling block for e-health

4th Jul 2012
Medical Observer has found patients with apostrophes or hyphens in their name cannot register for an e-health record, as the government scrambles to get the rest of the patient registration process working.
Patient registrations were originally due to be made available online, via telephone or in person at a Medicare office from 1 July, before the government signalled online registrations had been scrapped.
Online registrations were briefly made available earlier this week but have since been taken offline again, along with the consumer portal patients were supposed to use to access their records.
A health department spokesperson said the department had been testing the performance of the system and the related links.
When MO attempted to use the telephone registration system yesterday the operator said an apostrophe in the surname to be registered could not be entered into the system, and that all names with special characters would require an update of the system before they could be entered.
Lots more here:
Additional coverage of the issue is found here:

E-health online registrations can't handle names with hyphens and apostrophes

IF Health Minister Tanya Plibersek's husband tried to register for an e-health record he would have no such luck.
The issue lies with Michael Coutts-Trotter's name: it has a hyphen and the newly launched, multi-million dollar personally controlled e-health record system hasn't been built to accept such characters.
As well, people with apostrophes wouldn't be able to register.
"The system hasn't been built for that," a government e-health hotline representative said. "It cannot accept those special characters".
She said if people with hyphens or apostrophes tried to register someone would "take down their details and call them back because they can't register".
A Health Department spokeswoman said the "issue has been picked up in our testing and is being addressed as a matter for urgency".
"Anyone affected can register in writing or contact the e-health telephone line to provide their details and they will be notified when the issue is resolved," the spokeswoman said.
The system had a low-key launch on July 1, with registrations only available via phone or at Medicare offices.
As the system went live, people couldn't enter their personal information, medical history and medication details as the consumer portal was unavailable.
More here:
For those of a technical bent there is a detailed note on the matter - with relevant standards and so on you can read here:

Validating Name Characters

Posted on July 4, 2012 by Grahame Grieve
Well, the pcEHR go-live hasn’t gone that well. One particular feature that’s attracted some attention is that fact that the pcEHR won’t accept people with some unusual characters in their surnames.
From http://www.medicalobserver.com.au/news/punctuation-a-stumbling-block-for-ehealth:
Medical Observer has found patients with apostrophes or hyphens in their name cannot register for an e-health record, as the government scrambles to get the rest of the patient registration process working.
It sounds like a glaring oversight… only, just what characters do you need to allow in a patient’s surname? I suspect that real experts would be fairly circumspect in commenting on this – it’s harder than it looks.
Full blog is here:
In response to all this I had a message from a colleague. It read:
“Well, if my Icelandic grandchildren came to live here we'd need ö. As their "surname" is Börgarsdottir (with an accent on the "i" as well).”
I only have two comments.
First - this is the sort of problem that is found when one bothers to actually do some basic piloting and testing before ‘going live’ with a national system. Clearly the efforts to test and pilot the NEHRS System has been inadequate. Had the testing been done a rather humorous but ultimately just hopeless outcome could have been avoided.
Second - I reckon you are entitled to have your name recorded as you desire. The system needs to suit all potential users - not force anyone to change or modify name. Really that is just silly for a health system to not provide such flexibility - especially in such a multicultural nation!
I wonder what will turn up next week? In the meantime I agree with the comments suggesting we all need to hear, formally and on the record, from the DoHA and NEHTA leadership regarding all the issues that are now out there.
David.

Wednesday, July 04, 2012

You Really Would Think A Proven and Cheap E-Health Intervention Would Be Adopted By A Government Flailing Around For Success. Seems Not.

The following interesting and related articles have appeared recently.
First we have:

NICE launches BNF smartphone app

14 June 2012   Chris Thorne
The National Institute for Health and Clinical Excellence has launched a free version of the British National Formulary smartphone app for health and social professionals employed by NHS England.
The NICE BNF app has been developed to provide easy access to the latest up-to-date prescribing information from the BNF, the most widely-used medicines information reference guide used within the NHS.
The app is available to download for free via the Apple App Store and Google Play Store. Users will need their NHS Athens user name and password to activate the app and download the content.
The app provides direct offline access to the latest version of the BNF, giving a user access to BNF on their smartphone or tablet even when there is no internet connection available.
Lots more here:
Second we have:

Research fills in Map of Medicine

21 June 2012   Rebecca Todd
About half of GPs and a quarter of community staff are using the care pathways tool Map of Medicine, new research suggests.
Map of Medicine is a collection of evidence-based practice-informed care maps, rolled out to GPs and community users as part of the National Programme for IT in the NHS.
Stockport NHS Foundation Trust IT Services manager Colin Cohen has been studying the Map of Medicine project as part of a thesis for his doctorate.
Phase one of his research involved sending an online questionnaire to GPs and community health staff in NHS Thameside and Glossop, which showed that 55% of GPs used Map of Medicine and 28% of community staff.
A similar survey about a year before revealed the same results. Cohen was surprised at the level of usage and felt 55% was “better than I might have thought."
He explained that his area might have higher usage than others because Map of Medicine was given a “big push” about a year ago by the primary care trust.
Lots more here:
So here we have to widely used and influential clinical support applications of the sort we know can make a difference to the quality of care that simply we see no interest from our Government in doing something similar.
See this paper for evidence of how useful such resources can be:
The bottom line here is that provision of useful information at or near the point of care can make a difference - and although recommended in the 2008 National E-Health Strategy zilch has happened. Maybe a small investment here could distract a little from the train-wreck elsewhere?
Half a billion dollars on an unproven PCEHR and they won’t even do for lots less money what has been proven to work on a national basis.
Shame.
David.

Tuesday, July 03, 2012

We Are Seeing The NEHRS / PCEHR Introduction In Really Amazing Disarray. It Is Pretty Sad And Public Confidence Destroying.

I have to say I could not have made up just how the first few days of all this have unfolded!
As reported over the weekend there was a July 1 update on the www.ehealth.gov.au site late in the afternoon that provided a link to application forms. There was nothing provided that could be described as an on-line registration application.
Here is the link to that blog.
Then out of the blue we had a claim from a blogger (who is sponsored by NEHTA) that there was an on-line registration process via www.australia.gov.au.
You can read about this from this link.
Interestingly this route of access to the PCEHR System now seems to have been closed down - having been open for only a few hours.
Then, this morning we have had the following reports.

The federal government's e-health platform hacked at birth

THE federal government's e-health platform was hacked while being developed but the incident went undetected for several months.
The revelation comes after Accenture, the main contractor for the personally controlled e-health record program, delayed delivery, resulting in only 40 per cent of the system being ready by its July 1 launch date.
The hacking incident raises issues of reliability and security of the system as people start to register for an e-health record that would contain their personal details and health information such as medications, allergies and immunisation details.
The PCEHR is intended to be a secure electronic summary of people's medical history that is stored and shared in a "network of connected systems".
According to sources close to the Department of Health and Ageing, the hacking incident occurred while the PCEHR system was being built late last year, but Accenture discovered it only four months ago. The sources declined to be named.
Lots more details here:
and this report:

Answers to identity verification questions not sufficiently secure

THE security of the government's e-health records are under question a day after they were launched because those registering have to provide only a Medicare card number and names and birth dates of family members to verify their identity.
Security experts say answers to the identity verification questions are so widely known it would allow a person to set up an e-health record for someone else by telephone if they wanted to access that individual's health details, such as medication or medical procedures.
"My advice is not to join until the security issues have been resolved," said Graham Ingram, general manager of AUSCERT, Australia's emergency response team for computer security incidents.
More details here:
What is also interesting is that in the Application Guide On-Line Registration is an option provided.

eHealth registration guidebook

A guidebook is available to help you understand the eHealth record registration process. The document explains the terms used, your eHealth privacy safeguards, details about how your information is handled, and where and how you can apply for an eHealth record.
See page 10. Clearly it is not present on the site yet:
See here:
Even worse - consider this section of the written Application Form found here:
(Page 2)
Privacy
The System Operator, who is the Secretary of the Department of Health and Ageing, is collecting the information in this form to work out if it can register you and/or your dependant(s) for an eHealth record, and for managing your and/or your dependant(s) eHealth record if your application is accepted.
 If applicable, the information will also be used to work out whether you are an authorised representative for your dependant(s).
 If you are registered, the System Operator will collect other personal and health information about you and/or your dependant(s) when that information is uploaded by healthcare providers or by you, or where permitted by law.
This is authorised under the PCEHR Act and the Healthcare Identifiers Act 2010 (HI Act).
The System Operator usually gives some or all of this information to the following as part of the normal day-to-day operations of the eHealth record system:
  •  registered healthcare providers involved in your and/or your dependant(s) care where this is consistent with any access controls you set, or in the case of a serious threat to an individual’s life, health or safety or to public health or safety
  •  your nominated representatives, if you choose to have any, consistent with any access controls you set
  •  repository operators, portal operators and contracted service providers that are registered to participate in the eHealth record system
  • the Chief Executive Medicare as the service operator under the HI Act, and
  • the Australian Government Department of Human Services and, if applicable, the Department of Veterans’ Affairs.
Your and/or your dependants’ information may be given to some other entities but only where this is required or authorised by or under law. Where information is given to other entities, those other entities may collect, use and disclose that information as required or authorised under the PCEHR Act, the HI Act and other laws.
The information provided in response to parts of this form is collected by the System Operator on behalf of the Chief Executive Medicare (within the Australian Government Department of Human Services) or the Australian Government Department of Veterans’ Affairs. The collection of this information is authorised by the PCEHR Act and is for the purpose of the Chief Executive Medicare carrying out functions as a registered repository operator under the PCEHR Act.
The Chief Executive Medicare (as the service operator under the HI Act and, separately, the holder of Medicare and PBS records) may disclose information to the System Operator about you and your dependants to help the System Operator to make decisions about registration and authorised representatives. These disclosures are authorised by the HI Act and the PCEHR Act.
Further information about how personal information is handled in the eHealth record system is described in the Registration Booklet and Privacy Statement. The Privacy Statement can be accessed by you at www.ehealth.gov.au or you can request a copy by calling 1800 723 471.
----- End Extract.
If you go here to check the understand-ability of the above:
you get the following:
Indication of the number of years of formal education that a person requires in order to easily understand the text on the first reading
Gunning Fog index : 20.52
i.e. 6 years post high-school - i.e. 2 degrees or so!
So what we have so far is failed delivery on undertakings, irregular access routes to the PCHER system being made public and incomprehensible documentation needed for application.
And all this in just 3 days. I can’t wait for the next exciting instalment.
David.

Monday, July 02, 2012

It Seems The NEHTA Sponsored Blogger Has Been Told How To Apply On-line For A NEHRS / PCEHR When The Public Is In The Dark.


Go here to play with all the tricks. Multiple sites - have bills to hand and so on!


Pity the transparency is as one might expect. Zilch!

I look forward to hearing how people go! 

As I said 'Aggressively (Normal) User Hostile!

If true, I guess all this does show they have access to the various Medicare databases - if nothing else - and that at least a basic system is possibly in existence. Obviously the criticism stirred them along!

Maybe a visit to his site or two will cheer him up.

David.

Tuesday 1:30 pm update - the access window to the PCEHR System has apparently been closed. Looks like someone goofed big time!

D

Weekly Australian Health IT Links – 2nd July, 2012.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A big week with the ‘soft launch’ of the NEHRS.  Hard to know anything other than the impact will be pretty minimal for at least the next year or two. Of course we now know that the launch was not only soft but that it was a full fledged debacle - with people on the phone waiting up to an hour or battling with complex 12 page forms and explanations that are written for people with an IQ well in excess of 200!


I don't know what these people think they are doing but right now they are killing e-health stone dead with the way they are going about things. It really is astonishing!
Otherwise some interesting stuff about NSW Health and falling terminals at SA Health.
Will be very interesting to see how the rest of the week plays out - and welcome to a new financial and budgetary year!
-----

E-health patient record system (PCEHR) goes live on Sunday

SOFTWARE developers have two days to conduct testing for the $1 billion personally controlled e-health record system before its go-live on Sunday morning, following the proclamation of regulations.
"To date, all testing of the PCEHR system has been undertaken using test data, which comprises fictitious demographic and healthcare identifier details," an explanatory statement says.
"This proclamation enables real data testing of the system before it goes live on July 1."
Staff at Medicare offices and in call centres are ready to commence registration of any Australian wishing to sign-up for their own e-health record.
"People can register for a PCEHR by calling 1800 723 471 or by attending any service centre offering Medicare services," Human Services general manager Hank Jongen told The Australian.
-----

Underdone e-health record system set for launch

THE personally controlled e-health record system which has swallowed hundreds of millions of dollars in funding will be launched next Monday with no capacity to register online and only a digital notepad for consumers to enter personal diary notes.
Labor senator Jan McLucas has conceded Australians will only be able to register for an e-health record by phone or in person at a Medicare office after the much-vaunted national system commences on July 1.
"To be frank, we are talking about bringing in a fundamental change to the way we provide health services in this country," she told the Senate before legislation permitting the operation of the PCEHR Bills was passed by both houses last week.
-----

Leading e-health sites to undergo $52m record transition

THE Gillard government will spend $52 million transitioning work done at three lead sites to the new personally controlled e-health record system over the next six months.
Three former GP divisions (now rebadged as Medicare Locals) -- in Brisbane North, Hunter Valley, NSW and in Melbourne East -- each received $5 million in mid-2010 to implement software supporting the PCEHR system and to trial the use of records by doctors and patients.
But in April, the Senate's Community Affairs committee was told the sites were yet to enrol patients for records trials scheduled to end on Saturday -- in time to be rolled into the PCEHR system when it goes live on Sunday.
-----

E-health records meet online deadline

By Josh Taylor, ZDNet.com.au on June 26th, 2012
From 1 July, consumers wanting to take part in the government's e-health records scheme will have the ability to register online, despite fears to the contrary.
After more than two years of development and over half a billion dollars worth of investment, the Federal Government will launch its personally-controlled e-health record (PCEHR) system on 1 July. Last month, the government indicated the system would launch with a whimper rather than a bang, as patients will initially only be able to register for the records and add their own information through an online portal.
-----

Fact and fiction of e-health changes

POLITICIANS have voted to introduce a shared e-health record system, but they have got a very different beast in the Gillard government's personally controlled e-health record, says Australian Medical Association president Steve Hambleton.
"Listening to the debate in parliament last week, I noticed that many of them don't understand the PCEHR," Dr Hambleton said.
"What they were talking about is a shared health record. This is not a shared health record, it's a personally controlled e-health record that contains a point-in-time health summary which is curated by a nominated health provider.
-----
Central Government, Government Procurement, Healthcare IT

Australia passes new e-Health law

Australia’s widely-debated personally-controlled e-Health record (PCEHR) system has passed both Houses of Parliament – with e-Health services to become available from 1st July 2012.
This PCEHR legislation clears the way to roll out Australia’s e-Health programme. This programme, and related laws, will operate concurrently with Commonwealth, state and territory privacy laws.
Initially, consumers can register for the e-Health system using a dedicated 1800 number. An on-line registration website is being finalised by the Australian Department of Health and Ageing, enabling citizens to register on-line through a dedicated portal.
-----

How not to set up e-health

IN the nation's capital you can check an X-ray result on your iPad.
Across the country thousands of patients already have a personally controlled shared e-health record and last year 100,000 doctor's appointments were made using a new online booking system for medicos.
E-health is happening in the private sector but when the federal government's $1 billion Personally Controlled e-Health Record (PCEHR) system is launched tomorrow, it will be an empty vessel. No doctor will be able to use it and no X-rays or pathology results will be attached to it.
Patients will be able to register for an e-health record and type in their emergency contact details, the location of advanced care directives, allergies, and medication, and set up a health diary.
-----

Accenture bags e-health contract

  • by: Karen Dearne
  • From: Australian IT
  • June 29, 2012 5:54PM
ACCENTURE has won a $47 million contract to operate the national infrastructure for the $1 billion personally controlled e-health record over the next two years, following its expected soft launch on Sunday.
The infrastructure has been built by an Accenture-led consortium at a cost of $90m and is currently being put through its paces ahead of go-live, although its real launch is not expected before August.
-----

PCEHR stumbles on GP support

The forthcoming July 1 kick off for the PCEHR will be the ‘softest launch in history’ unless the federal government radically changes its approach to the GP community, said AMA president Steve Hambleton.
Speaking with eHealthspace.org, Dr Hambleton said a meeting between GP group leaders and the federal minister for health, Tanya Plibersek earlier this week resulted in the GP groups declaring they were unable to support the PCEHR in its current form.
-----

Sceptics warn of risks and inadequacies in shared e-health records system

FROM Monday, the first results of a $1 billion, two-year experiment to reinvent a shared electronic health record for Australians will start to play out.
Makeshift arrangements for online registration may be in place but it's doubtful consumers will be able to do anything other than jot a few personal notes in an online diary not visible to doctors.
That won't matter initially, as this week leading doctors' groups told Health Minister Tanya Plibersek that they shared the vision but "could not support the Personally Controlled e-Health Record implementation in its current form".
-----

NSW unveils $1.5 billion ehealth strategy

New South Wales Health Minister Jillian Skinner has announced her department will spend more than $1.5 billion on information technology over the coming decade and will establish a new body, eHealth NSW, charged with oversight of the key ICT investments.
Speaking at the FutureGov Forum NSW, the minister declared: “Our ambitious ICT portfolio has placed NSW Health at the forefront of building and driving the nation’s eHealth agenda.”
-----

Hospital TV falls on patient, sparks state-wide investigation

  • By Jordanna Schriever
  • AdelaideNow
  • June 29, 2012 3:07PM
  • The 17-inch monitors dislodged from mountings
  • Patient injured when monitor fell on leg
  • Investigation will take several days

ALL bedside entertainment consoles recently installed across 12 South Australian hospitals are being disabled after four recent incidents - including one in which the monitor fell on a patient.
An urgent investigation is being held to ascertain why the 17-inch monitors - which act as telephones, computers and televisions - became dislodged from their mountings at Port Augusta Hospital, the Lyell McEwin Hospital and the Women's and Children's Hospital.
-----

TGA sets up searchable side effect database

26 June, 2012 Michael Woodhead
The TGA is setting up a  publicly accessible database of adverse event reports for medicines and vaccines used in Australia.
The database will collate notifications of adverse events from doctors and other sources and will allow users to see how many adverse events have been reported for a particular drug or vaccine over a specific period.
-----

Pharmacists to use iPhone ECGs to screen for AF

27 June, 2012 Michael Woodhead
Pharmacists are to screen customers for undiagnosed atrial fibrillation using an iPhone ECG app and refer them on to their GPs for stroke thromboprophylaxis.
A feasibility study is being launched in which 10 community pharmacists will be trained to perform a pulse palpation on customers and record the result, then assess cardiac rhythm using an iPhone-based single-lead ECG device.
-----

Add Pathology Report Attachments to NEHTA Clinical Documents

Posted on June 28, 2012 by Grahame Grieve
In previous posts, I’ve shown how to represent a pathology report in a NEHTA Clinical document, and how to convert the PIT format and the TX format into the CDA narrative format. I pretty much left it as an exercise for the reader to represent the pathology report as an attachment. This post explains how to do that.
Firstly, the Pathology report structure in a CDA document includes the logical field “Pathology Test Result > Test Result Representation” (defined in the SCS/SDT, which is the logical structure of the documents). The definition of this is:
“Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they must be semantically equivalent”
-----

Nursing homes see benefits in e-health

29 June, 2012 Michael Woodhead
Electronic health record systems are perceived as having substantial benefits for residential aged care homes by staff, residents and the aged care organisations, a study  has found. 
In a survey of nine nursing homes in NSW, Queensland and the ACT, staff said records would reduce their work burden by giving them easier access to data and providing a more holistic view of residents under their care.
-----

Health check response shows ‘stick’ didn’t work

25th Jun 2012
THE federal government’s scrapping of GP incentives for child vaccination faces fresh criticism, after the government admitted a similar “stick” introduced for child health checks resulted in almost half of eligible families potentially being penalised because they failed to respond.
The government in its 2012–13 budget said it would ditch the GP Immunisation Incentive Scheme and would instead attempt to maintain high vaccination rates – around 90% nationally – by threatening to withhold the Family Tax Benefit A supplement from families who failed to have their children immunised.
-----

Telstra signs $474 million contract with Human Services

Five-year deal part of Telstra strategy to grow network application and services business.
Telstra has won a five-year, $474 million contract from the Department of Human Services to build and manage a unified communications network, according to the telco. The network will connect all of the Department and its master programs, it said.
-----

Newman government scraps $47.3m IT project

The Queensland government will scrap a $47.3 million IT project it argues should never have been approved.
THE Identity, Directory and Email Services (IDES) program was not value for money, and needed a further investment of $25 million over the next three years to be viable, Information Technology Minister Ros Bates says.
-----

No physical benefit from 'exergames': study

Randall Stross
June 25, 2012 - 12:01AM
Getting our sedentary, overweight children off the couch is a challenge. That's why the Nintendo Wii game console, which arrived in the United States six years ago, was such an exciting prospect. It offered the chance for children to get exercise without even leaving the house.
Tennis was one of the games in the Wii Sports software that came right in the box with the console. This was the progenitor of "exergames", video games that led to hopes that fitness could turn into irresistible fun.
But exergames turn out to be much digital ado about nothing, at least as far as measurable health benefits for children. "Active" video games distributed to homes with children do not produce the increase in physical activity that naive parents (like me) expected. That's according to a study undertaken by the Children's Nutrition Research Centre at Baylor College of Medicine in Houston, and published early this year in Pediatrics, the official journal of the American Academy of Pediatrics.
-----

UGPA slammed for lack of faith in MLs' abilities

28th Jun 2012
AUSTRALIAN Medicare Local Alliance has hit back at the GP umbrella lobby United General Practice Australia, (UGPA) declaring after hours services must be run by Medicare Locals rather than maintaining a “one size fits all” approach to incentive payments for individual practices.
The retort from AML Alliance chair Dr Arn Sprogis came after representatives of UGPA – of which AML Alliance’s predecessor AGPN is a member – told Health Minister Tanya Plibersek this week that the group was concerned by the axing of after hours Practice Incentive Payments (PIP) in July next year as “fledgling Medicare Locals do not yet have the capacity to take over after hours services… and could put existing successful services at serious risk”.
-----

Building traceability in Australian healthcare

CH2 implements GS1 standards and radio frequency system to improve its inventory accuracy
Healthcare logistics company, Clifford Hallam Healthcare (CH2), has undertaken a 10-year plan to improve its supply chain and warehouse initiatives to overcome data and traceability issues in the medical and pharmaceutical wholesale industry.
Partnering with GS1 Australia, CH2 CIO, Ged Halstead, said the company adopted the GS1 System — a set of universal standards for product identification — in 2006 to improve such inefficiencies within supply chain operations, as it “didn’t have enough products with standard identifiers” such as Global Trade Item Numbers (GTINs) and physical barcodes.
“We had to engage with our suppliers to make them realise that in the supply chain now, you’ve got to have a barcode on your product otherwise it’s invisible to us.”
-----

Look no hands! Google shows that the future of computing is on your head

Stephen Hutcheon in San Francisco
June 28, 2012
Google has taken the wrappers off Project Glass, a futuristic development in wearable computing.
The device, which was today named Glass Explorer Edition, is an augmented reality, head-mounted display, which looks like a set of spectacle frames.
Except there’s no glass, apart from a small display screen above one eye line, next to which is housed a camera.
The camera can shoot stills and video and the screen can show notifications, such as text messages and maps. You can also play music and make phone calls - all of which is operated hands free.
-----
Enjoy!
David.

AusHealthIT Poll Number 128 – Results – 2nd July, 2012.


The question was:
What Do You Think Has Been The Standard Of Debate On The National E-Health Program Recently?
Detailed And Incisive
-  0 (0%)
Not Too Bad
-  1 (2%)
Neutral
-  1 (2%)
Not All That Well Informed
-  11 (26%)
Really Uninformed And Incoherent
-  29 (69%)
Votes : 42
Good response and it looks like the vast majority do not think much of the standard of debate. Given the comments in Parliament I have to agree.
Again, many thanks to those that voted!
David.