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."

Wednesday, January 16, 2013

An Upcoming Workshop On Benefits Management In Health IT - Late February 2013.

Workshop Objective.
To understand how to manage the benefits of health IT and the fact that this depends on understanding the dynamics of learning to improve health systems.
Details.
There are places available for the 2 day and 5 day workshop in Sydney.
The title is: Dynamic Modelling: What, Why and How? Examples from New Technology Adoption, Infectious Disease and Health Care.
Two world expert practitioners and trainers Nate Osgood, ex MIT, and Andrei Borshchev, from St Petersburg, will be visiting from 18th to 26th  Feb. They specialise in combining different dynamic modelling methods including Discrete event, System Dynamics and Agent Based Simulation in Health and other Industries. There is a 2 day overview or a 5 day practical training option, and a likely choice modelling workshop the following week (Mon 25th and Tues 26th). The current details (including a downloadable flyer and online registration link) are on a temporary wiki page at
Please email geoff.mcdonnell@unsw.edu.au  for further details
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Seems to me that this may be very interesting for many in both the private and public sector - especially those involved in policy formulation and leadership.
I do hope you and your colleagues can attend this exciting event.
David.

Tuesday, January 15, 2013

The Countdown Has Now Really Started For The NEHRS / PCEHR To Prove Itself Adoptable and Useable.

2013 is going to be the year that makes or breaks the NEHRS. A couple of key facts point me to this view.
First we need to have a Federal Election before the end of the year and I suspect the outcome of that election will result in a binary outcome for the NEHRS. If Labor is re-elected the project will go on - at a level yet to be determined - and we will probably reach the stage where it becomes some sort of fixture. On the other had if the Coalition wins I suspect there will be a fairly quick review followed by a determination that enough money has been burnt on the current approach and a revised plan is needed. It may or may or not be funded in the remaining life of that Government.
Second with the commencement of the new upgraded e-PIP requirements in early February and early May we will be able to assess late in 2013 just what impact that upgraded incentive program has had on adoption and use of the NEHRS.
Third it is clear that neither the AMA or the RACGP are entirely comfortable with the various requirements and deadlines that are being imposed. This is the latest I have seen from the AMA.

Renewed calls for e-PIP extension

11th Jan 2013
MANY GPs could lose their eligibility for the e-health Practice Incentive Program (e-PIP) unless the 1 February deadline for software compliance is extended, says the AMA.
Prior to Christmas, AMA president Dr Steve Hambleton was calling for an eleventh-hour delay in the cut-off for payments if doctors do not achieve software compliance – required under new legislation to remain eligible – by the deadline.
Under the new arrangements practices can apply online through the Department of Human Services National Authentication Service for certification that their software is compliant.
However, Dr Hambleton argued during the holiday period many doctors in non-compliant practices were away and would not have been able to do any work to complete this process.
In an AMA poll taken in December asking GPs if they will be ready to have the first of the four e-PIP requirements in place by 1 February, 67% of 139 respondents said they would not be ready with just 33% saying they would make the deadline.
Dr Hambleton told MO he predicted it would be some months until most GPs would be fully compliant and renewed his call for the government to extend the deadline until at least 80% to 90% of practices are ready.
More here
I also note a distinct lack of confidence in being ready has not changed - Results  of GP Poll 13/01/2013 :

Will your general practice have the first four ePIP requirements in place by 1 February 2013?

Choices
Yes 32% (48 votes)
No 68% (102 votes)
Total votes: 150
To not have the clinical actors all lined up, trained and confident bodes pretty badly for what we are going to be seeing in the next 12 months. The bottom line is that this change and adoption task has simply not been managed properly or adequately resourced in my view.
In summary the next 12 months look to me to be make or break for all sorts of reasons, including that covered in Monday’s blog.
Time will tell and I don’t think many of us will die wondering.
David.

Monday, January 14, 2013

Weekly Australian Health IT Links – 14th January, 2013.

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

General Comment

I hope everyone had a great break!
On the e-health front things have been very quiet on the surface but we have seen things happening - especially with e-PIP preparedness - where I see on the list MD is now compliant with the Feb 1, 2013 requirements.
 I have had a look at my NEHRS record today and noted a forced password change and that loading the main screen was amazingly slow - at least 10 seconds of ‘wirly thing’ and please wait! I have no idea what that is about.
The next couple of weeks may be pretty interesting I suspect as we see efforts ramp up!
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Renewed calls for e-PIP extension

11th Jan 2013
MANY GPs could lose their eligibility for the e-health Practice Incentive Program (e-PIP) unless the 1 February deadline for software compliance is extended, says the AMA.
Prior to Christmas, AMA president Dr Steve Hambleton was calling for an eleventh-hour delay in the cut-off for payments if doctors do not achieve software compliance – required under new legislation to remain eligible – by the deadline.
Under the new arrangements practices can apply online through the Department of Human Services National Authentication Service for certification that their software is compliant.
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Practice won’t pay for ransomed records

9 January, 2013 Kate Newton 
A Gold Coast medical practice whose patient records were hacked and encrypted by foreign cyber criminals will not pay a $4000 ransom, instead choosing to recreate the records bit by bit.
GPS at Miami Family Medical Centre discovered last December that their server had been hacked and all 15,000 patient files encrypted, making them unusable.
The hackers, believed by Queensland police to be operating from eastern Europe, did not steal any patient details but demanded a ransom of $4000 to decrypt the files.
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Vigilance crucial to keep patient records safe from cyber-criminals

18th Dec 2012
THE RACGP has urged practices to be vigilant about their computer security following the recent hacking of patient records at a Queensland clinic by Russian cyber-criminals.
The hackers were able to access and encrypt patient records at the Miami Family Medical Centre on the Gold Coast and demanded a $4000 ransom in order to return the practice's access to the files.
RACGP president Dr Liz Marles said the case – the latest in a number of similar attacks which have left practices relying on paper records – highlighted the need for practices to apply risk management of their systems and security requirements to ensure every potential avenue for breaches was secure.
“Even large multinational corporations and governments are susceptible to sophisticated cyber-security breaches, however if the right precautions are taken early enough, the vulnerability of the system is greatly reduced and is less likely to be infiltrated,” Dr Marles said.
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Health record switch secure

By Kylie Stevens

Dec. 19, 2012, 10:48 a.m.
PATIENTS at Mount Druitt Medical Centre are among the first to register for a e-health record which they will control and could potentially save their lives.
It was the first western Sydney surgery to connect to the national Personally Controlled Electronic Health Record (PCEHR) system with the first successful upload of a shared health summary.
Patients who register for an e-health record will have their medical records and details about allergies, adverse reactions, immunisations and medications in the one spot.
Shared health summaries can be assessed by other health providers but patients can consent to who has access to personal information.
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General practices hit by telehealth funding cuts

3 January, 2013 Paul Smith
Hundreds of general practices will be hit by the $130 million cuts to telehealth Medicare funding which were introduced this week.
Under the original scheme – launched in 2011 – GPs, practice nurses, midwives and nurse practitioners in remote, rural and outer metropolitian areas were eligible for rebates for sitting in on patient telehealth consults with “remote specialists”.
The idea was to increase access to specialist care through technology.
But from this month telehealth rebates will be scrapped for patients in outer metropolitain areas – except those living in aged care facilities or receiving care from Aboriginal medical services.
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RACGP wary of "virtual" clinics plan

3 January, 2013 Paul Smith
A plan to set up “virtual” clinics allowing doctors to provide remote video consultations with unknown patients has sparked safety warnings from the RACGP.
Skype2doctor is due to be rolled out from January 14. Under the service, patients register free with a website and then book online appointments with GPs signed up to the system.
The website states: "Our unique virtual waiting room provides a countdown to your appointment and keeps you informed if your doctor is running late. Simply log in to Skype, relax in our waiting room and wait for your doctor to connect."
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Controversy over GP telehealth service

20 December, 2012 Jo Hartley
The launch of a new telehealth service that allows unknown patients to take part in direct video consultations with GPs has split the profession, with the RACGP warning that it could compromise patient safety.
The new service called skype2doctor was announced earlier this week by the company GP2U, which already offers patients Skype consultations with specialists inline with the federal government’s telehealth project.
The service offers online bookings, online GP consultations and online delivery of prescription medications in collaboration with Terry White Chemists. Patients also have the option for scripts to be posted out, faxed to their nearest chemist or home delivered.
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Do look now, there’s a revolution

| Dec 18, 2012 9:03AM
The e-health revolution has begun with a whimper.   As Associate Professor Craig Fry writes below, the lack of public awareness about the introduction of such a far-reaching development is a shame.
The low-key approach also appears to be part of a quietly-quietly tactic by the Federal Government.  That stems partly from the delay and snag-prone nature of the national e-health project which has been promised for the past decade, sucked in many hundreds of millions of dollars and not yet shown much return.
The delicate issue of patient privacy and the  big brother overtones of national patient record system,  which encouraged the Government to make it an opt in rather than opt out scheme,  also explains the lack of popular engagement with this revolution.
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An app a day keeps the doctor away

Date December 21, 2012

Melissa Davey

Health Reporter

First the medical centre changed our relationship with the local GP, now it's the internet.
When all you need is a medical certificate to show your boss the Friday you took off work was for illness - not a long weekend - hunting for a doctor who can fit you in is the last thing you want to do.
Particularly just for a piece of paper or an urgent prescription.
But it is a familiar scenario, with the 2012 Menzies-Nous Australian Health Survey finding that 30 per cent of Australians wait more than three days to get an appointment with their doctors. Half of us struggle to find a doctor after hours.
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Mind over matter: paralysed woman operates robotic arm

Date December 18, 2012 - 1:57PM
A paralysed woman has been able to feed herself chocolate and move everyday items using a robotic arm directly controlled by thought, showing a level of agility and control approaching that of a human limb.
Jan Scheuermann, 53, from Pittsburgh, was diagnosed with a degenerative brain disorder 13 years ago and is paralysed from the neck down.
These electrodes are remarkable devices in that they are very small. You can't buy them in Radio Shack. 
"It's so cool," said Scheuermann during a news conference. "I'm moving things. I have not moved things for about 10 years ... It's not a matter of thinking which direction any more, it's just a matter of thinking, 'I want to do that'."
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Robotic hand pushes new frontier for paralysis sufferers

  • From: AFP
  • December 17, 2012 1:11PM
PENTAGON-backed scientists say they have created a robot hand that is the most advanced brain-controlled prosthetic limb ever made.
The mind-powered prosthesis is a breakthrough, the team of neurologists and bio-engineers reported in The Lancet on Monday.
With further development "individuals with long-term paralysis could recover the natural and intuitive command signals for hand placement, orientation and reaching, allowing them to perform activities of daily living", they said.
Researchers have long been interested in the brain-machine interface, whereby implants pick up electrical signals in parts of the brain associated with movement.
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Wheeled workers heroes of hospital

Date December 27, 2012

Bellinda Kontominas

THEY don't take sick leave or smokos and their manners are impeccable. But the newest employees at Sydney's Royal North Shore Hospital did not attend the staff Christmas party.
For the past month, these automated guided vehicles have been going about their work, transporting the heavy trolleys of linen and food throughout the hospital's new main building and politely telling anyone who gets in their way to ''please step aside''.
There are 13 of the machines, which communicate with the building via Bluetooth and GPS technology.
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Life insurers entitled to DNA results

Date January 8, 2013

Vince Chadwick

AUSTRALIANS sending their DNA to be analysed cheaply overseas are obliged to share the results with life insurers and risk losing control of their most sensitive information.
Dr Gillian Mitchell, head of the Familial Cancer Centre at Peter MacCallum Cancer Centre, said one risk of recreational genetics was offering up the ''mine of information'' contained in our DNA to companies identified only online.
Fairfax Media reported on Monday that 180,000 people had sent their blood or saliva to be analysed by 23andMe, a company that assesses health risks and genealogy. The service now costs $99, and similar kits from other companies are offered online in Australia from $300.
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Former iSoft chief tied up in collapse of digital services group Kit Digital

Monday, 07 January 2013
The Australian arm of global tech services firm Kit Digital has been placed in administration, with dozens of workers now out of a job as the business continues to suffer problems around the world.
The collapse also affects the company's Australian subsidiaries, including tech services business Hyro – which counts former iSoft chief executive Gary Cohen as a chairman.
Cohen had attempted to stop the sale of Hyro to Kit Digital in June of last year.
PBB Advisory announced last month that Nicholas Martin, Marcus Ayres and Stephen Longley would be appointed as administrators to the company, which counts large firms including NAB and Foxtel as clients.
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Jan 05

Business Analyst - Demonstrated knowledge of NEHTA standards

Business Analyst - Demonstrated knowledge of NEHTA standards
  • Driving Change and Innovation
  • 12 month FTC
About our Client
Our client is a highly innovative, government-funded organisation working to improve health outcomes. They provide high quality digital and telephony services that offer advice and information to the Australian public. Operating since 2007, our client is in a high-growth phase, and is seeking a Business Analyst.
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Windows 8 fails to lift the PC market in Q4

PC shipments also fell in the fourth quarter due to a challenging economy and the growing adoption of tablets and smartphones
  • Agam Shah (IDG News Service)
  • 10 January, 2013 23:52
Microsoft's Windows 8 OS failed to provide a spark to PC sales during last year's fourth quarter, with worldwide unit shipments falling by 6.4 pe rcent compared to the same quarter in 2011, according to research by IDC.
Windows 8, the successor to the popular Windows 7, was released in late October, with PCs and tablets with the new OS shipping almost immediately after. But PC demand continued to be sluggish and the new OS failed to provide a spark, IDC said in a statement.
The problem was compounded by challenging economies and people holding back on spending to upgrade PCs, IDC said. The PC market also took a backseat to alternate computing devices like smartphones and tablets, which are being used increasingly for basic computing, Web browsing, video and email.
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Enjoy!
David.

Sunday, January 13, 2013

This Is Simply Not Acceptable For An E-Health System. It Is A Design Disaster.

This is what we see when we visit the Australia.gov.au site today.

Service availability and scheduled outages

Service                                                                                 Name    Status
Australia.gov.au
Australia.gov.au will be unavailable between 8pm Saturday 12 January and 6am Sunday 13 January 2013 AEDST. System upgrades are occurring during this period.
MyAccount
The MyAccount system will be unavailable between 8pm Saturday 12 January and 6am Sunday 13 January 2013 AEDST.
During this time users can login to existing Australia.gov.au accounts and access linked agency accounts (DHS, eHealth and DVA). However creating new Australia.gov.au accounts and linking to agency accounts will be unavailable.
There is a short interruption to the MyAccount system between 1.00am to 1.15am Saturday 12 January 2013 AEDST.
During this time users will be unable to login or create Australia.gov.au accounts, or link to agency accounts. However users already accessing agency accounts will be unaffected.
System upgrades are occurring during these periods. We apologise for any inconvenience.
For eHealth related issues contact the helpline on 1800 723 471 for assistance during these periods.
For more information see the links below:
·         Department of Human Services
·         Department of Veterans' Affairs
Mapping          
Mapping will be unavailable between 8pm Saturday 12 January and 6am Sunday 13 January 2013 AEDST. System upgrades are occurring during this period.
Search
Search will be unavailable between 8pm Saturday 12 January and 6am Sunday 13 January 2013 AEDST. System upgrades are occurring during this period.
The link were this is (was?) found is here Sunday (11am 23/01/2013):
It seems it is just tough if you (or a carer) need access to your NEHRS when these planned 10 hour outages are happening. On what basis would a decision be made to have access to the NEHRS provided by a portal that was not designed for 99.9999% uptime. What is happening is simply not fit for an e-Health system.
People do not stop having strokes, fits and heart attacks on the say so of the idiots who run this portal. Just what are NEHTA and  DoHA thinking in using this clearly unsuitable portal as a gateway to a billion dollar system. Why is there not a purpose designed portal? Hopeless clowns are what these policy makers are in my view.
On the list of stupid this decision this is right up there with the IBM’s view that the world would only ever need 10 computers - until it realised it was wrong and got rolling on a few more.
This design ‘feature’ of the NEHRS needs a re-think - and now!
For a great page of design wisdom - have a look here:
Might help guys.
These two especially appealed:
I have not failed. I've just found 10,000 ways that won't work. - Thomas Edison
For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled. - Richard Feynman
I wonder will the B2B and other routes to the NEHRS work when we are having these outages?
David.

AusHealthIT Poll Number 150 – Results – 13th January, 2013.

The question was:

Do The Government's Approaches To E-Health Have An Adequate Focus On Improved Clinical Outcomes Rather Than Reducing Health System Costs and Improving Efficiency?

Yes - They Really Care About Patients 12% (7)
Possibly 9% (5)
Probably Not 18% (10)
No - They Just Worry About Money 51% (29)
I Have No Idea 11% (6)
Total votes: 57
Very interesting.  It seems a good majority think the NEHRS / PCEHR may not be a clinically driven program. It is hard to disagree.
Again, many thanks to those that voted! 
David.

Thursday, January 10, 2013

It Seems Delivery Of Benefits Is A Bit Harder Than People Imagine. More Thought Required.

This very important article appeared overnight.

RAND: Health IT No Bargain Yet

Problems in design and implementation of EHRs, lack of interoperability, and provider resistance hamper productivity gains and cost savings, says RAND report.
Health information technology won't create the kind of cost savings predicted in a 2005 RAND Corp. study until the technology is far more widespread and is used to its full potential, a pair of RAND researchers conclude in a new Health Affairs report.
The earlier RAND report, authored by Richard Hillestad and his colleagues, predicted that the potential efficiency and safety improvements made possible by health IT could save the U.S. healthcare system $81 billion a year. Since 2005, annual health spending has soared from $2 billion to $2.8 trillion, yet quality and efficiency have improved only marginally, despite an increase in health IT adoption, note researchers Arthur L. Kellerman and Spencer S. Jones in the new paper. AdTech Ad
"In our view, health IT's failure to quickly deliver on its promise is not due to its lack of potential but to shortcomings in the design and implementation of health IT systems," they write. "As a result, we believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology, and the failure of many health care systems to implement the process changes required to fully realize health IT's potential."
Like many other observers, the authors spotlight the lack of interoperability among electronic health record systems as a key barrier. One reason for the inability of systems to communicate with one another, they say, is that providers "have little incentive to acquire or develop interoperable health IT systems."
In an interview with InformationWeek Healthcare, Jones pointed out that one way for providers to achieve interoperability is to join health information exchanges. However, many providers don't see a business reason to exchange information or support HIEs, which have not been very successful.
Here is the original abstract.

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

  1. Spencer S. Jones2

Abstract

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.
The abstract is found here:
The full article is available if you have appropriate access.
To me what this is showing is that successful delivery of Health IT is a good deal harder than the optimists imagine. Especially relevant is the lack of progress on genuine interoperability and in re-engineering clinical processes to fully exploit Health IT capabilities.
As others have made very clear Health IT is really not a technical program but an issue that needs to be addressed as the clinical and process level. It is not clear that DoHA and NEHTA get the distinction as yet.
Careful review of what we have and what we need for success is certainly a worthwhile project for the New Year!
David.

Wednesday, January 09, 2013

It Seems A Few Issues Are Emerging In The SA Public Hospital Program.

This arrived today:

12/166, 21 December 2012

DELAY IN COMPLETION OF THE EPAS DESIGN AND BUILD PHASE

The Enterprise Patient Administration System (EPAS) Program is one of the largest South Australian health care reforms ever undertaken in terms of its scale and impact.

The new EPAS system consists of several modules – Clinical Manager, Records Manager, Registration, Patient Flow, Scheduling, Patient Administration and Billing.

On Thursday 20 December 2012, the EPAS Program Board received notification from the vendor Allscripts, that there will be a delay in the delivery of some critical elements of the Billing Module. These elements are required to ensure the system is suitable for Australian financial needs, such as processing Medicare and Health Fund Claims.

While all of the remaining modules for EPAS have been designed and tested, all elements of the Billing Module are required to be completed for end to end acceptance testing to ensure the new system operates as it should prior to ‘Go Live’ at the first site.

As a result of this notification, the EPAS Program’s Design and Build phase will now be delayed for a minimum of two months, while the EPAS Program Office undertakes a risk assessment on Allscripts’ proposed timeframes to deliver the final elements of the Billing module.

Consequently a new Site Activation Schedule with updated Go Live dates for each hospital and health care site will be released in January 2013.

The EPAS Program Board is committed to ensuring that the Noarlunga Hospital, Noarlunga GP Plus Super Clinic, and the Repatriation General Hospital will remain the first sites to go live with EPAS.

For more information, please visit the EPAS Intranet site.


DAVID SWAN
Chief Executive

On the assumption that this is not a hoax...as we have seen with ANZ/Whitehaven/The Greenies... then this issue is worth keeping an eye on.

Thanks to anon for the contribution.

Here is an initial link on the project.

http://aushealthit.blogspot.com.au/2010/11/sa-health-takes-risky-path-recently.html


David.