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."

Saturday, September 29, 2012

Weekly Overseas Health IT Links - 29th September, 2012.

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.
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EHR vendors among Forbes' richest

By Bernie Monegain, Editor
Created 09/21/2012
NEW YORK – Epic Systems CEO Judy Faulkner and Cerner Chairman, CEO and President Neal Patterson are among the Forbes' 400 wealthiest people in America. Well-known billionaires Microsoft founder Bill Gates, Berkshire Hathaway Chairman Warren Buffett and Oracle CEO Larry Ellison take the top three positions.
Forbes describes both CEOs as “self-made.” Both started their companies in 1979.
Today, Cerner and Epic have the most market share of any EHR vendors, with Cerner ahead of Epic, according to a recent report from research firm KLAS.
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EMR jobs going gangbusters

By Mike Miliard, Managing Editor
Created 09/21/2012
NEW YORK – In August, more than 15,000 jobs were advertised online for healthcare professionals that have experience with electronic medical records in the United States, and the market is growing 31 percent year-over-year, according to market researcher WANTED Analytics.
The HITECH Act provides funding for health providers to convert patient records into electronic files, causing more medical organizations to employ this technology and recruit professionals with knowledge of these systems. The number of job ads increased 31 percent compared to August of 2011 and 88 percent since August 2010, and is currently the most commonly required skill in healthcare job ads, say WANTED analysts.
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10 EHR Vendors Pledge Patient Records Access Within Months

SEP 21, 2012 11:51am ET
The Office of the National Coordinator for Health Information Technology recently challenged electronic health records vendors to have their systems support patients viewing, downloading and transmitting their health information by the 2013 HIMSS Conference in March.
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Tuesday, September 18, 2012

Adoption and Diffusion of Health Information Technology - The Case of Primary Care Clinics

From the abstract: "We empirically examine the determinants of adoption of information technology by primary healthcare clinics using a large sample of physician clinics from several States in the U.S. Ours is one of the first studies to intensively investigate primary care clinics. These clinics are important as they represent the frontlines in the delivery of services in this large and complex market. Our study generates several interesting results related to the adoption and diffusion of Health Information Technology (HIT), including: (1) the adoption probabilities vary considerably by the specific type of clinic; (2) in contrast to numerous studies in the broader technology adoption literature, we find little evidence to suggest a relationship between firm (clinic) size and the likelihood of adoption; (3) there appears to be no definitive relationship between the age of a clinic and the likelihood of adoption; (4) there is a strong effect of geographic location, as measured by specific types of urban and rural counties, on the likelihood of adoption; (5) market competitive forces appear to have a mixed influence on adoption; (6) there is a distinct State-specific effect suggesting that information privacy, medical malpractice laws and State initiatives may play an important role in adoption; and (7) HIT is diffusing at a faster rate over time. Our findings have the potential to provide a better understanding of the longer-run effectiveness and efficiency in the provision of healthcare, and crafting appropriate policy responses. We note some future extensions of our work." Read more
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Wednesday, September 19, 2012

The Future of Health Care: Using the Internet to Deliver Health Interventions

From the blog:  "The best Internet interventions are sophisticated, structured, tailored, behavior treatment programs that you can log onto and get the same kind of personalized expert care very few people around the country are currently able to receive. These systems employ all the advantages of the Internet -- graphics, animations, audio, video -- and custom-tailor your intervention based on algorithms created and empirically validated in randomized clinical trials. Many are fully automated, requiring no human support, dramatically reducing costs. Some are supported with minimal clinician contact (maybe a personalized email or phone call). It's obviously not face-to-face care, but it's been shown to be almost, if not as good as, face-to-face treatment for many kinds of problems." Read more
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More Passwords, More Problems

The more we depend on the Web, the more passwords we accumulate—and forget. Some startups think they have a solution.
Friday, September 21, 2012
It's easy to remember one username and password. Keeping five or 10 straight is much harder. Password overload has long afflicted techies, but as we all spend more time doing everything from shopping to banking to playing games on the Web, it's become a more widespread problem.
A number of companies are trying to combat the problem. Approaches range from password managers that secure your login details with one master password to methods that eliminate the need for multiple passwords in the first place.
A 2007 study by Microsoft Research explored the strength, frequency, and usage of passwords belonging to 500,000 computer users. The study found that each person had an average of 6.5 passwords that they used for 25 different online accounts—meaning each password was being recycled about four times.
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Contra Costa County health doctors air complaints about county's new $45 million computer system

By Matthias Gafni Contra Costa Times
Posted:   09/18/2012 05:43:26 PM PDT
Updated:   09/19/2012 07:27:47 AM PDT
MARTINEZ -- One of every 10 emergency room patients at the county's public hospitals in September left without ever being seen by a doctor or nurse because of long waits -- a number rising since implementation of Contra Costa's $45 million computer system July 1.
One patient waited 40 hours to get a bed.
Dr. Brenda Reilly delivered the troubling news Tuesday afternoon to county supervisors. She was one of three dozen doctors in the supervisors' chamber complaining about EPIC, new computer software aimed at integrating all of the county's health departments to create a federally mandated electronic medical record for patients.
To allow for the major computer program installation and conversion, administrators cut doctors' patient loads in half, in turn cutting the number of available appointments in half.
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Too much EHR variation holding the industry back

September 19, 2012 | By Marla Durben Hirsch
This week's opinion article in the Wall Street Journal certainly has sparked some debate. There already are more than 100 comments on the article, which run the gamut, some in favor of electronic health records, and some against. Readers complain about privacy concerns and the foolhardy rush to what amounted to experimental technology. They place blame on the government (both sides), greedy vendors, and associations such as HIMSS.
It's really no surprise that the article's authors referenced studies that reveal that EHRs don't save providers money or improve care. EHRs are only as good as the information they contain and how they are used. Different research studies testing different hospitals, methods and training will garner different results.
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Patient demands should drive PHRs

20 September 2012   Rebecca Todd
Patients value online transactional services above the ability to view their electronic medical record; and patient access portals must be highly usable to succeed, a new report says.
2020health launched its report, 'Personal health records: putting patients in control?' with a round table at Church House in Westminster on Tuesday.
The government has pledged that all NHS patients will have online access to their GP record by 2015.
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Therapeutic video games empower patients

September 20, 2012 | By Dan Bowman
Video games can have a therapeutic and empowering impact on patients with conditions, such as asthma, cancer, depression, diabetes and Parkinson's disease, according to a perspective published this week in the journal Science Translational Medicine. What's more, the researchers from the University of Utah say interactive games also can help providers in disease management and prevention.
The researchers, who talk about their own patient empowerment exercise game and several others, call the tools "nonpharmacological interventions" that can "enhance … resilience toward various chronic disorders." Carol Bruggers, the paper's lead author and a physician at Salt Lake City-based Primary Children's Medical Center, said that such games "show promise" for behavioral changes in self-management habits.
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Southampton launches My Health Record

20 September 2012   Lyn Whitfield
University Hospital Southampton NHS Foundation Trust has become the first acute trust to launch a personal health record built on Microsoft’s HealthVault platform.
The trust booked a local cinema to launch My Health Record, which it has developed with Microsoft and US developers Get Real Consulting.
Dr Nick Marsden, one of the trust’s non-executive directors, presented it as a first step towards giving patients the kind of online and smartphone interaction with the NHS that they already have with retailers.
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Report offers tech advice for exchanges from 'early innovators'

September 20, 2012 | By Susan D. Hall
Calling technology challenges one of the biggest issues facing states with regard to setting up health insurance exchanges, a new report from the University of Massachusetts Medical School and the National Academy of Social Insurance examines lessons learned from "early innovators" and others well along in the process.
The biggest takeaway: Don't try to do it alone. The report's authors say collaboration for states falling behind is crucial both with states that are farther along and with the federal government on the required infrastructure.
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It's time to publicly compare EHR usability, IOM group says

September 20, 2012 | By Julie Bird
The world of electronic health records needs to open itself up to critical comparisons and earnest user evaluation if it wants to avoid formal regulation by the Food and Drug Administration, according to a discussion paper released this month by the Institute of Medicine.
Not only is there nowhere for health IT users to share publicly their experiences with different products, but vendors often prohibit users from sharing screenshots or otherwise publicly discussing EHR problems, notes the paper, "Comparative User Experiences of Health IT Products: How User Experiences Would Be Reported and Used."
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Docs blast EHR system as 'clunky' and 'time-consuming'

September 20, 2012 | By Dan Bowman
Add doctors to the list of healthcare providers with California's Contra Costa Health Services complaining about its recently installed electronic health record system.
Roughly three dozen doctors met with county officials earlier this week to blast the installation of its Epic system, which was completed in July. According to the doctors, long waits for patients have been only one of the side effects of the installation, as many called the system "clunky" and "time-consuming." One out of every 10 emergency room patients at the county's public hospitals so far this month left without being seen because of the waits--which ballooned from one hour to four, according to the Contra Costa Times. One patient waited 40 hours for a bed.
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Health Information Exchanges Struggle To Prove ROI

To survive, HIEs need to implement performance metrics to show they can improve quality of care and reduce costs.
To convince investors that health information exchanges (HIEs) are a worthwhile investment, organizers need to develop performance metrics that show HIEs can improve quality of care and generate a return on investment (ROI). A study published in the latest issue of Perspectives in Health Information Management, however, reveals that only 50% of surveyed HIE executives say they use or plan to use metrics to measure the impact of their exchange.
Amid doubts about the sustainability of HIEs, the results of the survey are disconcerting, lead author, Anjum Khurshid, director of the health systems division at the Louisiana Public Health Institute, and his colleagues conclude, because without incorporating quality of care and ROI metrics into their business model, many HIEs may not survive. AdTech Ad
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Test highlights how to do EHR data sharing right

By Mary Mosquera, Contributing Editor
Created 09/19/2012
WASHINGTON – The Department Veterans Affairs  and the Substance Abuse and Mental Health Services Administration have demonstrated how to securely share sensitive health information via electronic health records  (EHRs).
The test also showed how substance abuse and other sensitive data can be tagged so that when it is sent in a summary of care record to another provider with the patient’s permission, the receiving provider will know  they need to obtain the patient’s authorization to further disclose the sensitive information with others, according to a Sept. 17 announcement by the Department of Health and Human Services. SAMHSA is an agency in HHS.
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Electronic Staff Record up for re-tender

11 September 2012   Lyn Whitfield
The contract for one of the first, big national IT projects to be rolled out across the NHS will be re-tendered this autumn.
The Department of Health has issued a pre-tender for a framework contract to provide the Electronic Staff Record, which was built to replace a plethora of HR, payroll and associated systems with a single, national workforce solution.
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Research finds racial disparities in physician use of health IT

September 19, 2012 | By Julie Bird
A recent study found significant differences in how white and non-white physicians use health IT, suggesting varying degrees of acceptance of health IT among different physician populations, the researchers said.
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Mostashari says EHR incentives estimated to reach $20 billion by 2015

By Diana Manos, Healthcare IT News
There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, MD.
"Whoever qualifies, gets paid; there's no hard cap," said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.
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Doctors Use EHRs To Do 'Chart Biopsies'

Adoption of EHRs helps physicians to get up to speed on incoming patients before handoffs from the emergency department.
As the number of hospitals with electronic health record systems grows, a new study finds that inpatient physicians who receive patients from the emergency department have begun to do "chart biopsies" of electronic records to prepare for the handoffs.
Although the study in the Journal of the American Medical Informatics Association (JAMIA) doesn't reach any conclusions about whether chart biopsies are an improvement over traditional handoff methods, it points outs that "chart biopsies appear to impact important clinical and organizational processes. Among these are the nature and quality of handoff interactions and the quality of care." AdTech Ad
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The case for improving health data liquidity

By Kristine Martin Anderson, Senior vice president, Booz Allen Hamilton's healthcare market
While some disagree on the right approach to transform our healthcare system, most will agree that patients must remain at the core. In order to deliver on the promise of more affordable, convenient care, healthcare decision makers should look at every decision with the patient at the center. How patients experience health reform over the next few years will be the measuring stick of health reform success.
To date, progress has been made in a few areas but we still stand removed from a truly patient-centric healthcare system. To meet this objective, more should be done with patient data – from how it moves within the healthcare system, to how it is analyzed and presented.
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ONC unveils draft tests for 2014 EHRs

By Mary Mosquera
The Office of the National Coordinator for Health IT has unveiled its second set of draft test procedures to assure that electronic health records can perform functions required in 2014.
ONC also requested public comments and suggestions for the 2014 proposed certification test methods, according to a Sept. 14 ONC announcement. ONC released the first wave of test methods one week earlier.
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Two-Way Data Archive Aims to Control Costs

Scott Mace, for HealthLeaders Media , September 18, 2012

My daughter wonders why it would be preferable for everyone to listen to the same music in her art class. Surely it would be better if everyone could listen to their own music on their own iPods or other music players.
The art teacher points out that the point of listening to the same music is to have a shared moment, not merely to inspire a painting. But in a society populated now with people listening to their own private music or media, it's like swimming against a current.
When you think about it, those shared moments can be few and far between these days. Whether we're watching TV, or surfing the Web, or listening to music, it's all too easy to slip into solitary, passive receptivity.
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eClinicalWorks invests $10M in interoperability project

By Mike Miliard, Managing Editor
Created 09/17/2012
WESTBOROUGH, MA – In a bid to spur collaboration among providers, ambulatory electronic health record developer eClinicalWorks has launched Join The Network, a peer-to-peer communications platform that officials say will enable physicians to connect with each other, irrespective of the EHR they use.
With some 10,000 physicians already part of the network, eClinicalWorks officials say the firm is investing an additional $10 million over the next year to further expand the platform and connect physician practices, whether they're using EHRs or are still paper-based.
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Social Image-sharing Apps Exposing Patient Information

By David Fuhriman, MBA, CPA | September 17, 2012
Patients, employees, and radiologists are sharing more than ever of their lives online. With the proliferation of smartphones, cameras, high-speed Internet connections and photo-sharing services, life’s moments can be broadcast in real time to friends, strangers, and the entire world.
Social photo sharing is already a part of radiology, whether you are aware about it or not. Instagram, a mobile photo sharing app, allows users to take pictures on their smartphones and post to the entire world. Facebook recently bought the company, which does not generate any revenue, for  billion. This image sharing will surely begin to cause security and privacy concerns and damage reputations. A few simple searches on Instagram yielded some fascinating discoveries.
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HHS, VA Demonstrate Secure Sharing of Sensitive PHI

September 17, 2012
The Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) today announced a demonstration of the standards to allow sensitive health information to be shared responsibly and to comply with confidentiality laws and regulations among providers using electronic health records (EHRs).  The demonstration also showed how sensitive information can be tagged so that when it is sent to another provider with the patient’s permission, the receiving provider will know that they need to obtain the patient’s authorization to further disclose the information with others.
“This project helps demonstrate that with proper standards in place existing privacy laws and policies can be implemented appropriately in an electronic environment,” said Office of the National Coordinator for Health Information Technology (ONC) Chief Privacy Officer Joy Pritts, in a statement.
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Continua Alliance to help Denmark with telemedicine standards

By Eric Wicklund, Contributing Editor
Created 08/17/2012
BEAVERTON, OR – The homeland of Hans Christian Andersen, Tivoli Gardens and Hamlet is considered one of Europe's leaders in telemedicine. Now Denmark is relying upon the Continua Health Alliance to make sure that effort follows a uniform set of standards.
Officials at Continua, the Beaverton, Ore.-based non-profit organization focused on end-to-end, plug-and-play connectivity for personal health devices and services, say Denmark will be using Continua's design guidelines to develop an "Action Plan for Telemedicine." That plan will establish reference architectures and national standards for health IT "in areas including the secure collection, transmission and storage of personal health data from patients’ homes, sharing medical documents and images, and the management of health records, medical appointments and other related information."
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How Mobile Technologies Fuel TeleHealth Advances

Scott Mace, for HealthLeaders Media , September 17, 2012

This article appears in the September 2012 issue of HealthLeaders magazine.
Ever since the first experiments with telemedicine, providers have been taking steps to move healthcare closer to where patients live and work. Now, mobile technology—epitomized by the millions of such apps already downloaded to smartphones, but also appearing in nearly unlimited form factors—is accelerating those steps.
At Boston's Partners HealthCare, a system with 2,700 licensed beds, 45 employees scrutinize these developments at the Center for Connected Health. One early effort to equip cardiac patients with remote monitoring technology resulted in a 50% drop in readmissions, says Joseph Kvedar, MD, founder and director of the center.
"We're all committed to a healthcare delivery model that moves care out of the hospital, out of the office, and directly and continuously into the lives of patients," Kvedar says. "We find that the best technologies to facilitate that vision are monitoring and communications technologies properly applied."
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5 health IT insiders offer their takes on EHR usability

By Bernie Monegain, Editor
Created 09/17/2012
EHR usability is suddenly front and center, now that usability testing is part of the EHR certification criteria for meaningful use Stage 2. We talked with diverse industry insiders for their take on what is critical to user-centric design and what the usability factors might mean to healthcare and to the healthcare IT market. Here is a sampling of some of the topics on their minds.
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Most hospitals still seeking HIE solutions, study finds

By Erin McCann, Associate Editor
Created 09/14/2012
BURLINGTON, VT – Some 71 percent of U.S. hospitals plan to purchase new health information exchange (HIE) solutions, according to findings from the new "2012 U.S. Health Information Exchange Study" released Friday. 
The study, commissioned by the healthcare technology research firm CapSite, includes insight from more than 370 hospitals on the market adoption, marketshare, market opportunity and vendor perspectives across the U.S. hospital industry.
The numbers this year are down slightly from last year’s report, which found 74 percent of U.S. hospitals planning to purchase a new HIE solution. 
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4 Points for a Strong Leadership Agenda During Health IT Implementation

Written by Kathleen Roney | September 17, 2012
Social Sharing
Leadership is an important element in successfully steering a hospital through any health information technology implementation effort. Strong leadership will help hospital staff adjust to barriers that may accompany health IT implementations and slow down success. In a webinar hosted by the Health Resources and Services Administration, Terry Hill, MPA, executive director of the National Rural Health Resource Center in Duluth, Minn., and Joe Wivoda, CIO of NRHRC, discussed the importance of leaderships role during health IT implementations.
"Over the years we have learned [success with health IT] is about leadership. There is no exact formula to follow when implementing an EHR system. The places where we've seen really good implementation had really good leadership. Leadership that was prepared, aligned and supportive," said Mr. Hill.
In order for executives to exhibit strong leadership, they need to have an agenda, which should cover the following four points.
1. Adoption path. In order for hospital executives to lead successfully, they need to outline a clear adoption path. According to Mr. Wivoda, the adoption path should include the following steps:
• Assessment — Assess the preparedness of the hospital to fully adopt an EHR.
• Planning — Develop and prepare the request for proposals from vendors and IT companies.
• Selection — Evaluate vendors and negotiate contracts.
• Evaluation — Review system performance and effectiveness.
• Improvement — Conduct additional training to improve workflows.
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Consumers want health tech to connect but say docs don't deliver

September 17, 2012 | By Jeff Byers - Contributing Writer
Patients want online access to medical records, prescriptions and test results, and want to talk to their doctor using modern forms of communication, according to a recent survey from market research firm Harris Interactive. But physicians aren't meeting their tech-savvy patients' expectations.
For example, 85 percent of respondents said they wanted to communicate with their physician by phone or email and more than 50 percent wanted to schedule appointments  and pay bills online. Just more than 10 percent report their physicians offer these services.
And although 65 percent of the 2,311 surveyed adults said access to personal health information is "very important" or "important", only 17 percent said their physicians actually offer it.
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eHealth Initiative CEO Bordenick: Patients could drive provider data sharing

September 17, 2012 | By Julie Bird
Thanks to health IT, healthcare providers and other stakeholders are sitting on mountains of information--but it has yet to be mined to yield its full riches, says Jennifer Covich Bordenick (pictured), CEO of the Washington, D.C.-based eHealth Initiative, an independent, nonprofit organization geared toward improving healthcare quality and safety through the use of technology.
"We spent time figuring out how to collect data and the neat things we can do with it," Bordenick tells FierceHealthIT in an exclusive interview. "To do that, we need good analytic tools. CIOs recognize that, but a miniscule amount have the tools to do it."
The results of a recent survey from eHI and the College of Healthcare Informatics Management Executives "tell us a lot about what little we know," Bordenick says. That survey showed, for example, that while hospital CIOs considered the most important use of data to be analyzing clinician utilization and patient outcomes, the most common use of data was financial management.
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HHS touts Twitter app for public health

By Erin McCann, Contributing Editor
Twitter, the much beloved social networking site, is set to take on disease outbreaks, after HHS officials announced the release of a new Web-based application tool available to public health officials.
Officials at HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) announced Friday the arrival of MappyHealth, the winning submission in a developers’ challenge, “Now Trending: #Health in My Community,” sponsored by ASPR.
Health officials say they can use data gained through the app to complement other health surveillance systems in identifying emerging health issues and as an early warning of possible public health emergencies in a community. 
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Monday, September 17, 2012

Patients' Use of Social Media Spurs More Clinical Research

by Lisa Zamosky, iHealthBeat Contributing Reporter
At 38 years old and in generally good health, Katherine Leon was an unlikely candidate for a heart attack.
Yet, on April 30, 2003, just six weeks after giving birth to her second child, she experienced classic heart attack symptoms and was rushed to the hospital by ambulance. After a number of tests, doctors told her there was nothing wrong with her and sent her home.
"I cried to my husband when leaving the [emergency department]. I knew it was my heart. You just know when it's not right," Leon said.
Experiencing similar physical symptoms, Leon returned to the hospital just three days later. But this time, doctors conducted an angiogram that revealed a serious block that required immediate double bypass surgery.
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CSC to withdraw iSoft products from primary care

17th September 2012
CSC has denied speculation that it is pulling its iSoft products from the NHS primary care market.

The statement from the company, which acquired iSoft in April 2011, follows reports by the online journal eHealth Insider.
It claims it has received information from “reliable sources”, that CSC is withdrawing support for its GP systems in the UK.
However, a CSC spokesman said the company “remains fully committed to the primary care market” and that any suggestion otherwise is “speculation.”
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Dalton McGuinty admits eHealth troubles continued with diabetes registry

Published on Monday September 17, 2012
Rob Ferguson
Queen’s Park Bureau
Premier Dalton McGuinty acknowledged that continued troubles at eHealth Ontario led to a push to scrap its registry to help diabetic patients — once a cornerstone of the province’s push for electronic health records.
“It’s a complicated field,” the premier said Monday following the Star’s weekend revelation that the board of eHealth is recommending Health Minister Deb Matthews axe the $46.2-million registry because it has been eclipsed by new technology.
“Obviously there were some particular challenges associated with this technology and the amount of time that it was taking,” McGuinty added near Pearson International Airport where he was touring construction for the airport rail line to downtown.
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Enjoy!
David.

Friday, September 28, 2012

This Is A Must Not Miss Contribution To The Discussion Of The Value of Health IT.

The following appeared a little while ago:

The Trillion Dollar Conundrum

By
In Tuesday’s Wall Street Journal Op-Ed pages, physicians from Harvard and University Pennsylvania Medical Schools criticize subsidies for expanding the use of health information technology (HIT). The physicians cite a recent review article that failed to find consistent evidence of cost savings associated with HIT adoption. If true, this is bad news for the health economy, as supporters claim that HIT could cut health spending by as much as $1 trillion over the next decade.
How can something that is so avidly supported by most health policy analysts have such a poor track record in practice? In a new NBER working paper by myself, Avi Goldfarb, Chris Forman, and Shane Greenstein, we label this the “Trillion Dollar Conundrum.” One explanation may be that most HIT studies examine basic technologies such as clinical data repositories, while most of the buzz about HIT focuses on advanced technologies such as Computerized Physician Order Entry. In our paper, we offer a rather different explanation for the conundrum, one that would have eluded physicians and other health services researchers who failed to consider the management side of HIT.
My coauthors on this paper are experts on business information technology. They are not health services researchers. When I approached them to work on this topic, they insisted on viewing HIT much as one would view any business process innovation. As I have learned, this is by far the best way to study most any issue in healthcare management. Those who advocate that “healthcare is unique” – usually by ignoring broadly applicable theories and methodologies—often strain to explain data that are easily understood using more general frameworks. Such is the case with HIT.
Health services researchers have analyzed HIT much as they would analyze a new medical intervention. Some patients receive the treatment, others receive a placebo, and the treatment is deemed “successful” if the treatment group fares better than the control group and the difference passes statistical muster. While this methodology inspires a certain level of confidence in medicine, it has a critical shortcoming that has only recently been addressed through “personalized medicine.” The intervention might be effective for only some of the treatment group, and might be harmful to others. The typical research design masks these heterogeneous effects.
Lots more (and some really great comments) are found here:
Re the Author:
David Dranove, PhD, is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University’s Kellogg Graduate School of Management, where he is also Professor of Management and Strategy and Director of the Health Enterprise Management Program. He has published over 80 research articles and book chapters and written five books, including “The Economic Evolution of American Healthcare and Code Red.” This post first appeared at Code Red.
This all needs careful reading as we are seeing a range of perspectives on many aspects of the “value of Health IT” debate and balance and careful logical thought is vital!
Here is coverage from the Wall St Journal of the trigger article:
  • OPINION
  • September 17, 2012, 7:25 p.m. ET

A Major Glitch for Digitized Health-Care Records

Savings promised by the government and vendors of information technology are little more than hype.

By STEPHEN SOUMERAI And ROSS KOPPEL

In two years, hundreds of thousands of American physicians and thousands of hospitals that fail to buy and install costly health-care information technologies—such as digital records for prescriptions and patient histories—will face penalties through reduced Medicare and Medicaid payments. At the same time, the government expects to pay out tens of billions of dollars in subsidies and incentives to providers who install these technology programs.
The mandate, part of the 2009 stimulus legislation, was a major goal of health-care information technology lobbyists and their allies in Congress and the White House. The lobbyists promised that these technologies would make medical administration more efficient and lower medical costs by up to $100 billion annually. Many doctors and health-care administrators are wary of such claims—a wariness based on their own experience. An extensive new study indicates that the caution is justified: The savings turn out to be chimerical.
Since 2009, almost a third of health providers, a group that ranges from small private practices to huge hospitals—have installed at least some "health IT" technology. It wasn't cheap. For a major hospital, a full suite of technology products can cost $150 million to $200 million. Implementation—linking and integrating systems, training, data entry and the like—can raise the total bill to $1 billion.
But the software—sold by hundreds of health IT firms—is generally clunky, frustrating, user-unfriendly and inefficient. For instance, a doctor looking for a patient's current medications might have to click and scroll through many different screens to find that essential information. Depending on where and when information on a patient's prescriptions were entered, the complete list of medications may only be found across five different screens.
Now, a comprehensive evaluation of the scientific literature has confirmed what many researchers suspected: The savings claimed by government agencies and vendors of health IT are little more than hype.
Lots more here:
As I said - a contested space. Careful reading is vital!
David.

Thursday, September 27, 2012

I Am Struggling To Know Just Why This Article Was Commissioned by The MJA. Hardly By A Recognised E-Health Expert And Contains No Real News.

This appeared a week or so ago (behind a paywall sadly - hardly a way to get views into the public domain!)

e-Health records: beware of assumed benefit

Ray N Moynihan
Med J Aust 2012; 197 (6): 319.
doi: 10.5694/mja12.11282
Ray Moynihan rings some notes of caution coming from experiences elsewhere
Change is perennial in health care, but some changes are more significant than others, like the personally controlled electronic health record (PCEHR) currently being rolled out across Australia. An ambitious reform, its much-touted benefits are safer and more effective care, less duplication of unnecessary tests — and, of course, enhanced datasets for researchers. As with most things medical, potential adverse consequences can attract less attention than promises, so it may be timely to explore a few experiences elsewhere.
In 2007, the United Kingdom rolled out the Summary Care Record as part of the much bigger National Health Service National Programme for IT overhaul. Within the broader reform, a personal electronic health record system called HealthSpace was introduced, allowing people to view their record and record information like blood pressure readings. However, an independent evaluation of the system in 2010 was scathing.1
Of those invited to open an “advanced” HealthSpace account (which allows access to the summary record and opportunity to interact with health professionals, on top of the “basic” account containing an individual’s data), only one in a thousand registered, compared with predictions of 5%–10% uptake. Many people found it “neither useful nor easy to use”, and its “functionality aligned poorly with their expectations and self management practices”.1 Stressing the limitations of their evaluation — informed by experiences of very few patients — the researchers identified a fundamental flaw in the concept. HealthSpace was envisaged primarily as a “data container” to be “deployed”, rather than part of a dynamic and interactive “sociotechnical” network.
Led by Trisha Greenhalgh from the Healthcare Innovation and Policy Unit at Barts and the London School of Medicine and Dentistry, the evaluation team argued that unless the e-records “align closely with people’s attitudes, self management practices, identified information needs, and the wider care package ... the risk that they will be abandoned or not adopted at all is substantial”.1 Early in 2012, Greenhalgh and colleagues published a wider evaluation of the experiences across England, Scotland and Wales,2 explicitly offering lessons in introducing electronic health record systems. A key finding was that implementation had “rarely gone as planned”.
Lots more here:
There are 5 references provided.
I have described the NEHRS / PCEHR as an ‘evidence free’ initiative (especially in terms of proven utility and benefit) regularly for years so the title hardly tells us something we did not know.
See here:
and here:
Additionally it is not made clear what is being done in Australia is different to what has been done overseas and so did not offer not much utility.
There is no news at all here to anyone who follows the field. It also struck me to ask just why wasn’t Prof. Enrico Coiera (who is cited in the article and is an expert) or another e-Health expert, asked to provide this review if one was needed?
Indeed, I would also argue a lack of analysis and discussion, in context, of just what is going on now with the NEHRS / PCEHR leaves this article rather incomplete.
Interestingly Professor Greenhalgh’s (also cited) analysis of large national programs, such as the NPfiIT and successors, and failure to learn the lessons available is quite devastating. While similar in some aspects of course the NEHRS is fundamentally different and it is hard to know just how much transfers usefully - but certainly some generalities do!
I have written a blog on this paper:
The full paper is found here now:
The best bit is this two sentence quote from the abstract:
“Findings: National eHealth programs unfold as they do partly because no one fully understands what is going on. They fail when this lack of understanding becomes critical to the programs’ mission.”
How true!
Of course, as I mentioned above, there is also an College (ACHI) which has 30 or 40 Fellows who know a fair bit about this topic as well. There are plenty of experts around if you bother to look!
It’s all a little odd that none of them were asked - or if they were that they declined.
What is needed from the MJA - if they must commission articles - is commentary and insight from established Health IT experts who are recognised by the clinical community as such. Mr Moynihan has done some good and useful work in a range of areas in seeking to keep 'the establishment' honest, but, to my knowledge, has not been active for any significant period in the e-Health space. Others are better equipped to respond to such commissions in this space I believe.
Bottom line - we need authoritative commentary on e-Health in our leading medical journal and it should also be peer reviewed given the mess we now see. This really is not good enough. Pity about the accesses restrictions also!
David.

Wednesday, September 26, 2012

Senator Sue Boyce Announces Agreement To Recommend Improvements To The Public Scrutiny of NEHTA. A Good Thing!

The following was sent to me today by her office.
MEDIA RELEASE
September 26 2012

E-HEALTH SHOULD BE ACCOUNTABLE

The Senate Community Affairs Committee had taken the unusual step of recommending that a Government agency, the National E-Health Transitional Authority, be required to report annually to Parliament, Queensland LNP Senator Sue Boyce said today.
At present NEHTA is not required to provide an annual report because of its corporate structure, despite the fact that it has already spent up to $1 billion dollars of taxpayers' money on the attempted introduction of a national E-Health system.
The authority is "owned" by the Federal and State Governments with the secretaries of all Health Departments as directors.
NEHTA has attended a number of Senate Estimates hearings, at the request of the Committee, and has received a significant number of questions on notice arising from those hearings, including questions around the issues of funding, expenditure and governance.
“It has also been the subject of on-going questions and criticisms about its performance and the delivery of products and outcomes that work and further the roll out of a national E-health system," Senator Sue said.
“I believe it would be fair to say both the Government and the Coalition have reservations about the performance of NEHTA.
“In its regular review of annual reports supplied by Government departments and agencies the all-party Senate Community Affairs Committee, of which I am a member, has recommended: 'Given NEHTA's significant public funding and responsibilities that go to Commonwealth policy and funding, the committee asks the government to consider whether, as a principal shareholder in NEHTA, it should make arrangements for the report to be presented to Parliament'.
“I've tried to ensure NEHTA is accountable so I really welcome this recommendation. The Gillard government must surely take it up in the interests of transparency and accountability,” Senator Sue said.
“NEHTA was to launch the cornerstone of the E-Health system, the Personally Controlled E-Health Record (PCEHR), on July 1 this year after five years of work but all they launched was a toll free number that didn’t work.
“Taxpayers should be able to scrutinise how Government bodies spend their money and making NEHTA supply a detailed annual report will greatly assist that process in regard to E-Health,” Senator Boyce said.
The link is to the relevant committee page:
The italics are the important part of the release.
I asked Senator Boyce’s office about the possibility of the ANAO conducting an audit of all this. The answer was just wonderful.
“Auditor has replied to our entreaties by saying
a. They have it on a list of future possibles
b. They believe that they need outcomes before an audit would have value!!!!
(We have expressed the view that expenditure=no outcomes =need for urgent audit)”
Catch 22 in alive and thriving in Canberra!
Amazing and horrifying stuff!
David.

Tuesday, September 25, 2012

At Least The Financial Review Is Keeping An Eye on The ‘Non-Progress’ of the NEHRS. The Snails Are Way Out In Front So Far In the Race!

The following appeared today.

Progress slow in electronic health push

Emma Connors
Some 10,070 people now have a personal electronic health record as the government makes slow progress in addressing the concerns of consumers and doctors.
About 3240 signed up in the last month, joining the 6830 who were registered in late August.
However, obstacles remain. No GP practise is using clinical software directly linked to the new records system because the software is still not available. On the patient side, the Consumers Health Forum believes take-up would be faster if more people knew about the system, and if concerns about audit trails and governance were addressed.
Some teething problems have been addressed. Immunisations records and donor registration details have migrated to the new system as have Medicare and pharmaceutical benefit scheme records.
The government has also reached an uneasy truce with the Australian Medical Association after extending a cut-off date for technology allowances for surgeries and agreeing time spent updating e-records can be billed through the Medicare Benefits Scheme.
GPs will have to wait for software upgrades to link into the new system, but at least they now have some idea of how to charge for time spent on the new records, Australian Medical Association president Steve Hambleton said.
“We would have preferred separate item numbers but at least doctors won’t fall foul of the professional services review if they do itemise their accounts in this way,” he said.
Dr Hambleton hopes ease of use considerations will sit alongside security when access to the new health records becomes widespread.
“A big issue at the practise level is everyone will require a piece of hardware to prove who they are when they log into the new records system.
“I’m not sure how that will work with hot desking; we would prefer for that authentication process to take place through a mobile phone.”
Lots more here with discussion of Audit Trails etc.
All I can say is it is good that Emma Connors from the AFR is still on the case!
It is also useful to know that the total registration is still about 10,000 - which means we still a really tiny percentage involved (4.545 * 10-4 of the population).
We are now essentially at ‘go-live’ + 3 months and it is fair to say that what has been delivered so far confirms the stupidity on the part of DoHA on responding to clearly absurd political deadlines - rather than just commencing operations when they were properly ready. The system ups and downs since really emphasises the validity of that view.
The Consumer Health Forum concerns also are really valid - especially the governance ones - which I have to say are nowhere near good enough as far as I am concerned.
Well worth a full read if you have access or can find a copy of the paper.
David.

Monday, September 24, 2012

Weekly Australian Health IT Links – 24th September, 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 much more interesting week, with a lot of reporting on all sorts of initiatives from the developer and private sector - in the absence of much from the Government.
It is clear that ‘under the radar’ there is a lot going on. I hope some of this leads to some really useful outcomes over time.
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Doctors could reject e-health records

Consumer power restricted.

Consumers who customise their personally controlled electronic health record could miss out on its intended benefits, a Parliamentary committee into cybersafety was told.
Consumers Health Forum chief executive Carol Bennett told a committee hearing that doctors could refuse to use a patient's e-health record if that patient declined access to certain medical documents associated with the record.
The Federal Government's PCEHR initiative, launched on July 1, allows consumers to opt-in into the record and determine which clinicians or doctors can view records and health summary information associated with the record.
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e-Health records: beware of assumed benefit

Ray N Moynihan
Med J Aust 2012; 197 (6): 319.
doi: 10.5694/mja12.11282
Ray Moynihan rings some notes of caution coming from experiences elsewhere
Change is perennial in health care, but some changes are more significant than others, like the personally controlled electronic health record (PCEHR) currently being rolled out across Australia. An ambitious reform, its much-touted benefits are safer and more effective care, less duplication of unnecessary tests — and, of course, enhanced datasets for researchers. As with most things medical, potential adverse consequences can attract less attention than promises, so it may be timely to explore a few experiences elsewhere.
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New electronic health records for patients

Released 10/09/2012
The ACT Chief Minister and Minister for Health Katy Gallagher MLA today launched a pilot of a new secure system for Canberrans to access their health information online.
My eHealth enables patients to access personal information relating to their health care.
"My eHealth is a secure, online service which improves patients' access to their health information, and helps them keep track of their appointments," the Chief Minister said.
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Medical apps lack medical input

17 September, 2012 Michael Woodhead
Patients are increasingly relying on smartphone health apps for medical guidance, but many apps are lacking in evidence or may be used inappropriately, doctors have warned.
Paediatricians in the UK say they are seeing an increasing number of parents turning to health apps for medical advice and as a guide to what is ‘normal’ for their children.
In some cases the apps can promote ‘best practice’ and early recognition of medical problems, they say, but there is also the potential for mishaps, they write in the Archives of Diseases in Childhood.
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Online cognitive behaviour therapy cuts suicidal ideation

19th Sep 2012
PATIENTS with suicidal ideation should not be excluded from internet cognitive behaviour therapy (iCBT), results from a new Australian study suggest.
Research on nearly 300 patients prescribed an iCBT program by primary care clinicians showed that suicidal ideation dropped from 54% to 30% after the six-lesson online course, regardless of sex and age.
The course covers psycho-education, behavioural activation, cognitive restructuring, problem-solving, graded exposure and relapse prevention, with content presented in the form of an illustrated story in which the character gains mastery over their depressive symptoms.
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Skin cancer receives tele-treatment

An Australian led team has developed a new camera to more accurately detect melanoma as part of an innovative technological system to combat the scourge of sun-loving Australians.
The camera is the work of MoleMap by Dermatologists, a melanoma surveillance and diagnosis service which sees nearly 30,000 patients a year across Australia, New Zealand and the United States.
Known as tele-dermatology, MoleMap’s system involves a patient’s skin abnormality being photographed by a doctor or nurse. The images are sent electronically to a patient database and are reviewed remotely by a dermatologist who reports anything significant back to the GP.
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Medtech Launching eRx eScripts

Australian GP users of popular clinical software Medtech32 will have improved medication management at their fingertips with the launch of eRx eScripts in version 9 of the software this month.
Beta testing was successfully completed in June.
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Medtech Global to launch Patient Portal, PCEHR functionality in v9

Medtech Global is in beta testing for a major upgrade of its Medtech32 clinical information system, which will feature the company's ManageMyHealth patient portal along with new PCEHR capabilities.
The ManageMyHealth portal is one of the company's flagship products, chief technology officer Rama Kumble said, allowing patients to book appointments online, receive email or SMS reminders from their doctor about tasks such as monitoring blood glucose levels or taking medications, as well as request repeat prescriptions or enquire about pathology results.
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Standards – we’re doing so well…

Posted on September 17, 2012 by Grahame Grieve
Vince MacCauley has written an article about standards development in Healthcare IT in Pulse IT. He starts with an interesting claim:
Software standards in general and eHealth software standards in particular provide a methodology and governance framework to encapsulate community agreed best practice in a readily accessible and stable specification.
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Orion Health opens Singapore office

16:04 September 21, 2012 
Press Release – Orion Health
Orion Health Solidifies its Place in the Asian Healthcare Market Expands Regional Presence with Opening of Singapore Office
News release
Orion Health Solidifies its Place in the Asian Healthcare Market
Expands Regional Presence with Opening of Singapore Office
Singapore, 21 September 2012– To support its burgeoning success in Asia Pacific, Orion Health, New Zealand’s largest privately owned software exporter and a global leader in eHealth technology, today announced the official opening of its new Singapore office. This new facility provides a new home for the company’s Singapore-based services, development and technical support teams.
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ED performance data biased

THE validity of the emergency department waiting time performance data published on the MyHospitals website has been called into question by a study that shows hospitals with higher proportions of urgent cases are disadvantaged by the reporting methods.
The study of 158 Australian emergency departments (EDs), published in the latest MJA, presented an analysis of waiting times reported on the website according to the proportion of patients in each of five triage categories — resuscitation, emergency, urgent, semi-urgent and non-urgent. (1)
Correlating the data this way showed that hospitals with a higher proportion of patients in the “emergency” category had poorer waiting time performance, indicating that performance data was biased in favour of EDs that reported fewer urgent patients.
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Medibank Health Solutions to deploy video access to medical specialists

Telehealth services organisation to enable patients to access video consultations with its offsite specialists
Medibank Health Solutions is gearing up to extend its online consultation service – Anywhere Healthcare – to enable patients in regional Queensland to connect with selected medical specialists over a video link provided at their GP’s office.
Next month, Medibank is rolling out the service to around 20 GPs under the first phase of the program. The organisation is targeting medical practices in rural areas where individuals don’t necessarily have easy access to medical specialists such as psychiatrics and clinicians trained in chronic disease management.
Medibank delivered the Anywhere Healthcare service using online medical consultation software from American Well, which it purchased in mid-2011. The software is hosted at Medibank’s data centres in Melbourne and Sydney.
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Clinical Messaging – the Electronic Lifeblood of the New Zealand & Australian Health Sectors

by Tom Bowden on September 20, 2012
The New Zealand health sector has one of the highest levels of clinical messaging in the world – by my estimation we are second behind Denmark.  Clinical messaging has a wide range of uses, predominantly it is used for the exchange of pathology and radiology reports, specialist letters, discharge summaries and to send information to and from a range of databases.
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US patient records stolen by staff, possibly sold

Miami hospital hit by second breach this year.

The University of Miami Hospital has fired two employees suspected of stealing and possibly selling the personally identifiable information of patients.
The health system announced the breach last week — the second to occur there this year — and began notifying those affected. A website detailing the incident also was set up. 
A hospital spokeswoman declined to provide the number of patients impacted by the theft, in which employees accessed “face sheets” — documents that include the names, addresses, dates of birth, insurance policy numbers, the reason for the hospital visit, and the last four digits of patients' Social Security numbers, according to a letter sent to affected individuals.
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Johanna Westbrook: Cost of archaic care

FOR vulnerable residents in aged care facilities, a missed page at the end of a fax can lead to a medication mix-up with potentially devastating consequences.
It was shocking enough to see the recent report on the ABC’s Lateline that thousands of dementia patients may be dying prematurely due to the routine prescription of antipsychotic drugs. But, sadly, our work at the Centre for Health Systems and Safety Research, at the University of NSW, shows that this may be just the tip of the iceberg in terms of poor medication practices in aged care homes.
We have been undertaking research in a number of residential aged care facilities to look at the challenges they face in being able to safely deliver all types of medications to residents.
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Committee recommends bill containing new penalties after serious privacy breaches

AUSTRALIAN companies are a step closer to fines of up to $1.1 million for severe or repeated breaches of privacy regulations.
A parliamentary committee yesterday recommended passing a bill containing the new penalties in a report tabled in the lower house. It became the first of two parliamentary committees examining the bill to deliver its findings. A Senate committee is also due to report to parliament this month.
The bill was a response to the Australian Law Reform Commission's 2008 report on privacy and attempts to update current privacy laws for the digital age.
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New e-health record privacy penalties may be broadened

18th Sep 2012
THE federal government is considering broadening tough new mandatory reporting laws for e-health records, including fines for those who fail to report breaches, beyond the realm of health care, MO can reveal.
The personally controlled electronic health record (PCEHR) will be subject to Australia’s first privacy mandatory reporting laws after the Office of the Australian Information Commissioner (OAIC) released draft guidelines with fines of up to $55,000 for failure to notify.
Last week, Attorney General Nicola Roxon’s office confirmed that while the PCEHR would be the only area without “voluntary” reporting laws, “the government… is considering whether to introduce a mandatory data breach notification requirement more broadly”.
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Draft social media policy 'stifling' and costly: critics

17th Sep 2012
GPRA has raised concerns about AHPRA’s new draft social media policy, arguing that GPs need to “embrace” communication advances rather than “stifle” the progress and discussion that is possible using these platforms.
In a letter to the regulator GPRA said it supported moves to help educate doctors navigate the online world “but we fear it may be counterproductive to stifle the progress and discussion that is possible using social media.”
GPRA also asked why a separate policy was required when doctors were already bound by a code of conduct.
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Up to 15 per cent of Vic Human Services tech roles could go

  • by: Fran Foo
  • From: Australian IT
  • September 13, 2012 4:50PM
THE Victorian Human Services Department could slash up to 15 per cent of technology roles as part of the Baillieu government's workforce reduction program.
The department's IT division employs 300 workers, including contractors. Its chief information officer Grahame Coles said between 30 to 40 people could go as part of a state-wide voluntary redundancy scheme.
Human Services is set to lose 500 positions from its 1100-strong workforce.
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A robot with a reassuring touch

Date September 19, 2012 - 10:09AM

John Markoff

If you grab the hand of a two-armed robot named Baxter, it will turn its head and a pair of cartoon eyes - displayed on a tablet-size computer-screen "face" - will peer at you with interest.
The sensation that Baxter conveys is not creepy, but benign, perhaps even disarmingly friendly. And that is intentional.
It feels like a true Macintosh moment for the robot world. 
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A chip to repair the brain

Date September 16, 2012
Researchers are working on an implant to restore lost mental capacity, writes Benedict Carey.
Scientists have designed a brain implant that sharpened decision making and restored lost mental capacity in monkeys, providing the first demonstration in primates of the sort of brain prosthesis that could eventually help people with damage from dementia, strokes or other brain injuries.
The device, though years away from commercial development, gives researchers a model for how to support and enhance fairly advanced mental skills in the frontal cortex of the brain, the seat of thinking and planning.
The new report appeared on Thursday in the Journal of Neural Engineering.
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Australian engineers write quantum computer 'qubit' in global breakthrough

AUSTRALIAN researchers say the world's first quantum computer is just 5 to10 years away, after announcing a global breakthrough that makes manufacture of its memory building blocks possible.
A research team led by Australian engineers has created the first working "quantum bit" based on a single atom in silicon, invoking the same technological platform that forms the building blocks of modern day computers, laptops and phones.
It opens up the real prospects of new quantum computers performing calculations billions of times faster than now within a decade.
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Space shuttle Endeavour makes final flight

Date  September 22, 2012 - 1:50PM
The US space shuttle Endeavour took its final flight on Friday, making a spectacular series of flypasts over California before landing in Los Angeles where it will retire near its birthplace.
Piggy backed by a specially fitted Boeing 747, the shuttle flew over San Francisco's Golden Gate Bridge before heading south to take in the Hollywood sign and Disneyland, later landing at LA International Airport (LAX).
"It's so cool, and so sad," said Todd Unger, 28, who was among thousands who camped out from the early hours at the Griffith Observatory overlooking the city and the nearby iconic hilltop Tinseltown sign.
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Enjoy!
David.

AusHealthIT Poll Number 137 – Results – 24th September, 2012.

The question was:

Will The Huge Cuts We Are Seeing In State Health Systems Have A Major Impact On Progress In e-Health Going Forward?

No - All Will Be Well 10%   (5)
Possibly 12%   (6)
Probably 18%   (9)
Yes - E-Health Will Be Hard Hit 52%   (26)
I Have No Idea 8%   (4)
Total votes: 50
Very interesting response. Essentially about 70% think there will be at least some impact. One really has to wonder about the 8% who admit an absence of idea about the issue!
Again, many thanks to those that voted!
David.