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, March 05, 2016

Weekly Overseas Health IT Links - 5th March, 2016.



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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Unsecured doors on truck cause huge records breach

Published February 22 2016, 11:55am EST
Old paper medical records being trucked to an incinerator blew all over a street in Fort Myers, Fla., resulting in more than 480,000 individuals being notified that their protected health information was compromised.
The truck’s driver failed to secure the container door, and staff and physicians at Radiology Regional Center spent three days combing the area and retrieving “virtually” all the records, according to information sent to affected patients.
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HIT Think Moving beyond CDs in exchanging diagnostic images

Published February 25 2016, 2:23pm EST
There is a growing need to exchange and share imaging studies with outside entities. Hospitals that have foregone the traditional merger and acquisition route to become affiliates, for example, have a need to share both individual patient and population health data, although their modalities for exchange and viewing may be very different.
Patient transfers—between facilities, specialty and professional consultations, and even telehealth opportunities—have created a new way of thinking about the delivery of images between two related, yet independent points of care. CDs, however, still remain both the most used and one of the largest bottlenecks in healthcare today.
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Before its EHR went in, Ontario Shores started over

Published February 26 2016, 5:30am EST
For Ontario Shores Centre in Whitby, Ontario, the journey to its 2015 Davies Award started with preparation. A lot of preparation.
Ontario Shores went shopping for an electronic medical record system in 2007, selected Meditech's EMR system in 2008, and rolled it out in late 2010. Between the vendor selection and the go-live date, the institution had to completely rethink its processes.
“We were a purely paper organization—we didn't have any [electronic] clinical systems for documentation,” says Sanaz Riahi, the center's director of professional practice and clinical information. “But we realized we couldn't fit our paper workflows into this new technology.”
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PCORI taps FHIR to give patients easier access to EHR data

Initiative launched at White House Precision Medicine Initiative Summit
February 26, 2016 11:13 AM
The Patient-Centered Outcomes Research Institute announced a plan to make it easy for individuals to access data in their electronic health records and share it for research that could improve care for their conditions.
PCORI Executive Director Joe Selby, MD, revealed at Thursday’s White House Precision Medicine Initiative Summit that 20 of PCORI’s Patient-Powered Research Networks have pledged to help participating patients more readily obtain information from their EHRs.
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Joseph Kvedar: Physicians must embrace patient-generated data

February 26, 2016 | By Susan D. Hall
It took 20 years for the stethoscope to be widely accepted in clinical practice, but the industry doesn't have that time to waste before embracing patient-generated data, Joseph Kvedar, M.D., writes at MedCity News.
Home monitoring and similar services have shown to be useful in improving outcomes, reducing mortality and engaging patients in programs to control hypertension and diabetes. Yet physicians resist efforts to make use of patient-generated data, and are more willing to base care on information like blood pressure readings conducted a couple times a year, says Kvedar, vice president of Connected Health at Boston-based Partners HealthCare.
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IBM and New York Genome Center’s new cancer tumor repository aims to revolutionize treatment

Ariana Eunjung Cha February 25
At many of the nation's leading cancer centers, doctors have begun to sequence the DNA of their patients' tumors to better personalize their treatments. That information has saved a growing number of lives. It might tell you, for instance, whether a certain type of chemotherapy may be extra toxic for a particular individual or if a different drug that no one ever thought of may be the miracle you were praying for.
The problem is: This approach doesn’t scale. Today, figuring out how genetic mutations may impact a patient's response to a treatment is a time-consuming and manual process. It often involves a team of a half-dozen or more experts combing through hundreds of journal articles and consulting with colleagues around the world for a month. Even then, there's no guarantee that this will lead to useful information for the patient.
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Thu Feb 25, 2016 3:03pm EST
Related: U.S., Health

Verily, Vanderbilt to test enrollment in U.S. Precision Medicine pilot

The National Institutes of Health on Thursday named Verily, formerly Google Life Sciences, as adviser to Nashville's Vanderbilt University in a pilot program to launch the Precision Medicine Initiative outlined by President Barack Obama last year.
The pilot program, which aims to enroll 79,000 U.S. participants by the end of this year, is the first phase of an ambitious program to mine medical data, including genetics, environmental factors and lifestyle, to develop better ways to treat or even prevent a wide range of diseases.
Vanderbilt and Verily are slated to test approaches for engaging and enrolling volunteers through a web portal.
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February 26, 2016

An Educational Campaign Combined with an Electronic Alert Improved Sepsis Process Measures

Daniel J. Pallin, MD, MPH reviewing Narayanan N et al. Am J Emerg Med 2016 Feb.
A “best practice advisory” pop-up message in the Epic electronic medical record, combined with an educational campaign, improved time to antibiotics and other process measures in sepsis patients.
Electronic alerts from electronic medical records systems have obvious promise but can be a hassle (NEJM JW Emerg Med Dec 2015 and Ann Emerg Med 2015; [e-pub]). Investigators compared sepsis process and outcome measures before (111 patients) and after (103 patients) an emergency department intervention that involved an educational campaign and a new pop-up alert in the hospital's Epic electronic medical record system.
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Report: Healthcare providers protect wrong data, putting patient health at risk

Focusing on patient data fails to protect true attack openings, ignores specific hacker strategies, Independent Survey Evaluators report says.
February 24, 2016 08:35 PM
Too many healthcare organizations are focused on securing the wrong assets, leaving them vulnerable to cyberattacks and putting patients at risk, a new report from Independent Survey Evaluators claims.
When healthcare leaders focus primarily on protecting patient data, they often fail to address actual cybersecurity threats that directly affect patient health, the report said. So if an active medical device or electronic work order were infiltrated by cybercriminals, the patient could be directly affected. On the other hand, an electronic health record is secondary – it requires a provider to alter the data before it could potentially harm a patient.
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Electronic Health Records and Patient Safety

Recent studies have provided conflicting information about whether or not EHRs improve patient safety. One study, conducted by the Agency for Healthcare Research and Quality (AHRQ) and published in the Journal of Patient Safety found that fully electronic health records (their definition for fully electronic health records is records that include physician notes, nursing assessments, problem lists, medication lists, discharge summaries and provider orders are electronically generated) lead to fewer adverse events such as hospital acquired infections. However, an analysis of a large malpractice claims and suits database maintained by CRICO, an evidence-based risk management group of companies owned by the Harvard medical community, found that there were 248 malpractice cases showing serious unintended consequences from the use of EHRs.
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EPR implementation led to 'catastrophic loss of confidence'

Rebecca McBeth
25 February 2016
Problems with the introduction of the Epic electronic patient record at Cambridge University Hospitals NHS Foundation Trust led to a catastrophic loss of confidence in the system that took months and a “huge amount of effort to rebuild”, the president of the Royal College of Surgeons has said.
Clare Marx, who is also chair of the strategic clinical advisory group to the National Information Board, was speaking about a visit to Cambridge at a Westminster Forum on electronic patient records this month.
Cambridge went live with Epic in October 2014 as part of a £200 million eHospital programme. It is the first and only trust in the country to have deployed the EPR, which is widely used in the US.
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Cambridge: big bang reality

Cambridge University Hospitals NHS Foundation Trust went live with its Epic electronic patient record as part of a £200 million eHospital programme in October 2014. Sixteen months later, Digital Health News editor Rebecca McBeth gets an inside perspective on the system, its deployment, and outstanding issues.
25 February 2016
The words “disaster” “chaos” and “confusion” feature strongly in reactions from staff to Cambridge University Hospitals NHS Foundation Trust’s implementation of a new electronic patient record in 2014.
Unison’s Cambridge Acute Hospitals Branch joint communications officer Carole Proctor found a number of staff willing to answer questions from Digital Health News about the trust’s implementation of Epic 16 months ago.
While most of the clinical and administrative staff that she spoke to say things are much improved and benefits are starting to be realised, Proctor herself describes the period immediately after deployment as “pretty chaotic”.
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We're all looking at the same patient safety elephant

February 25, 2016 | By Marla Durben Hirsch
There's been little fanfare about this week's survey results from global physician social network SERMO regarding the apparently different views American and European doctors have about electronic health records and patient safety. More than half of the European doctors polled viewed EHRs as improving patient safety; just 11 percent thought that EHRs negatively impacted patient safety.
American doctors were much more doom and gloom, with only 27 percent believing that EHRs improved patient safety, and 39 percent saying that they worsened it.
This dichotomy of opinion is reflected in the studies about EHRs and patient safety, which according to SERMO is the reason why it ran this survey in the first place.  For example, SERMO pointed to a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ) which found that hospitals using EHRs had fewer adverse events, such as hospital acquired infections. SERMO contrasted that finding with an analysis of malpractice claims and lawsuits maintained by CRICO, owned by the Harvard medical community, which found 248 malpractice cases showing serious unintended consequences from use of EHRs that caused patient harm.    
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Andy Slavitt on ICD-10: 'Y2K fears didn't come to pass'

February 25, 2016 | By Dan Bowman
Teamwork, accountability and a focus on stakeholder concerns all have enabled a smooth transition for the healthcare industry to date from ICD-9 to ICD-10, according to Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt.
In a post to The CMS Blog Feb. 24, Slavitt (pictured) touts the effort put forth by CMS and the industry at large to make the shift, although he stops short of calling it a win.
"With good implementation, we never declare victory, and are still at the ready to continually improve," Slavitt says. To that end, he says, "Y2K fears" never materialized, and the transition was one that most outside of the healthcare industry weren't even aware of.
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HHS launches Interoperability Proving Ground website to highlight projects

Carten Cordell, Federal Times 1:41 p.m. EST February 24, 2016
HHS’s Office of the National Coordinator for Health Information Technology has launched a new site to spread the gospel of interoperability and its developing projects.
The ONC, which is tasked with helping update the nation’s health IT infrastructure network, debuted its Interoperability Proving Ground on Feb. 24 as a network to share and update stakeholders about ongoing interoperability projects.
“At ONC, we are focused on providing you with the chance to inspire colleagues, share experiences, and describe lessons learned when it comes to interoperability,” said Steven Posnack, ONC’s director of the Office of Standards and Technology, in a post announcing the Interoperability Proving Ground.
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HIT Think What healthcare can learn from Facebook and Amazon

Published February 23 2016, 2:44pm EST
Users of Facebook, LinkedIn and other social media applications are often amazed by how omniscient the technology seems to be. How do a bunch of algorithms know, out of billions of users, who you might consider a friend, or which videos you should consider watching just because you liked “The Dark Knight”?
A big part of the answer is a core social media technology that holds great promise for transforming healthcare by making true interoperability at last possible.
It’s called the graph database. Designed specifically to interpret relationships between different sets of data, the graph database is the foundational technology that lets social media applications, as well as companies like Amazon, build sophisticated social networks around each account owner. For instance, it’s what enables us to look at our friends’ friends and navigate through their interests and connections.
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Special report: picture archiving and communications systems

Bringing down the walls
The refresh of picture archiving and communications systems triggered by the end of national contracts is almost at an end.
Trusts are now turning their attention to sharing images with different ‘ologies’, with different trusts and – shortly – other services, such as primary care. Kim Thomas reports on some of the different approaches that trusts are taking.
The dust has almost settled on the refresh of picture archiving and communications systems occasioned by the end of the contracts negotiated under the National Programme for IT.
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Employee education vital in defense against ransomware

February 24, 2016 | By Susan D. Hall
Employee education and awareness are healthcare organizations' greatest defenses against ransomware, attorney Mary Ellen Callahan advises in an AHA News article.
The malware in such an attack usually infects a network through a phishing scam, though unlike those that hit Magnolia Health Corp. in California and more recently St. Joseph's Healthcare System in New Jersey, the hackers aren't interested in identity theft, but in collecting a ransom.
Hollywood Presbyterian Medical Center in Los Angeles, whose computer systems were offline for a week in a ransomware attack, decided to pay about $17,000 in the cybercurrency Bitcoin to the hackers. However, law enforcement officials advise against paying ransom. There's no guarantee you'll get your data back or that hackers, now knowing you'll pay, won't subject you to ransomware again.
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SCCM: Technology Poised to Transform Critical Care Medicine

Technology is transforming the treatment of critically ill patients

by Salynn Boyles
Contributing Writer

ORLANDO -- Google Glass didn't exactly take the world by storm, as tech prognosticators told us it would, but the technology could end up playing an important role in bridging the information gap between first responders and hospital-based medical personnel, a well-known critical care specialist said here Sunday.
The head-worn technology is being used experimentally in several sites in and outside of the U.S. to facilitate live-streaming of videos from paramedics caring for patients en route to hospitals to the clinicians who will treat them once they arrive.
The observation was made at an afternoon presentation on the future of critical care medicine by ICU specialist Jean-Louis Vincent, MD, PhD, of Erasme University Hospital, Brussels, Belgium, at the Society of Critical Care Medicine 45th Critical Care Conference.
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Telecritical Care Saving Lives Using Skype

Fran Lowry
February 22, 2016
ORLANDO, Florida — Using telemedicine to provide remote support from critical care specialists to community hospitals reduces mortality, the number of patients needing to be transferred to tertiary care hospitals, and costs, new research shows.
"One year after we started our telecritical care program for community hospitals caring for acutely ill patients, mortality rates in the intensive care units and in the hospital were both decreased by almost 40%," said William Beninati, MD, from Intermountain Healthcare in Salt Lake City.
"There was also a small decrease in ICU costs," he said here at the Society of Critical Care Medicine's 45th Critical Care Congress.
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6:57 pm ET
Feb 22, 2016

Security

Health Care Needs To Do a Better Job Encrypting Data: Report

  • By Rachael King
Health-care organizations need to do a better job encrypting sensitive personal information such as medical records and Social Security numbers, according to a report by California Attorney General Kamala Harris.
In 2015, the records of 24 million Californians were breached, up from 4.3 million in 2014. The cyberattack on health-care insurer Anthem Inc. accounted for 10.4 million records and another attack on UCLA Health compromised 4.5 million records.
About 55% of compromised records in the health-care sector are the result of a failure to encrypt data, as opposed to just 16% of breaches in other sectors, according to the California Data Breach Report, released February 16.If companies encrypt information like Social Security numbers and other personally identifiable information, it’s not considered a breach under state law. “The industry appears to be improving in its use of encryption to protect data on laptops and other portable devices, but there is still a long way to go in addressing this preventable type of breach,” according to the report.
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Ransomware: What will it take to be prepared?

Much of the ransomware seen in attacks like the one at Hollywood Presbyterian is well known, and detectable with the right tools and strategies in place.
February 23, 2016 04:16 PM
Last week we all read another sobering account of the disruption that cyber incidents can cause. The ransomware attack at Hollywood Presbyterian Medical Center was despicable in its nature and alarming in it what it says about the overall preparedness of healthcare to deflect these threats.
Healthcare is one of our most critical infrastructures and important to every American. The CEO for this institution eventually opted to pay the ransom to return his institution's systems back to service. A decision only he and the leadership of that hospital could make and one I'm sure not easily arrived at.
In most instances the majority of security and law enforcement professionals would advise against paying the hackers, because, 1) there is no guarantee you will get the decryption key, and 2) there is the fear that it will encourage others to follow suit. I would argue that is easy advice to give if you are not the one looking down the barrel of the ransom note. Until you have walked in those shoes you don't really know what you will do.
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The best way to share health records? An app in patients’ hands

The technical and regulatory pathway to consumer-mediated sharing is clear. From here, patients must demand that providers enable them to authorize who can and cannot access their health information.
February 23, 2016 09:00 AM
This time of year, millions of Americans file taxes. We are required to move sensitive financial data from employers and banks to the Internal Revenue Service. In the old days, we waited for paper W2’s and bank statements to arrive by mail and then spent hours with pencils and stacks of paper. But now tax preparation software enables automatic retrieval and upload of data in seconds and without error. Why is this possible? Because each of us controls our own financial data. 
Now imagine that we want our sensitive health records transferred to a new doctor. We fill out paper forms, mail or fax them, pay fees, and if we are lucky a stack of printed paper records arrives by fax or mail at our new doctor’s office weeks or months later. Weeks after that they might be scanned into an electronic health record as images but, even then, they can’t be searched easily.
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David Blumenthal and Aneesh Chopra: HIT requires alignment of incentives

February 23, 2016 | By Susan D. Hall
While some people working in healthcare say electronic health records have slowed digitization in the industry, two former federal IT officials believe that there are other factors preventing a digital health revolution.
David Blumenthal, M.D., former National Coordinator for Health IT, and Aneesh Chopra, former U.S. chief technology officer, in a Harvard Business Review post, defend the estimated $31 billion the federal government has spent on pushing the adoption of electronic health records.
"Underlying the challenges facing the digital health revolution are economic and social issues that must be addressed if the potential value of electronic records is to be realized," they say.
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ONC pushes adoption, evolution of standards through new initiative

February 23, 2016 | By Katie Dvorak
The Office of the National Coordinator for Health IT is embarking on a new initiative to help healthcare organizations "adapt and evolve ONC's standards and technology work processes."
The ONC Tech Lab "will provide internal and external stakeholders with common connection points to ONC's standards and technology efforts," Steven Posnack, director of the agency's Office of Standards and Technology, writes for the agency's Health IT Buzz blog.
This initiative, Posnack says, ties in with all of ONC's latest interoperability efforts, including its Interoperability Roadmap and Federal Health IT Strategic Plan. The agency, in December, unveiled its finalized 2016 Interoperability Standards Advisory.
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Philips Announces Launch Plans for Wearable Biosensors

Feb. 23, 2016
Royal Philips plans to introduce medical-grade, wearable biosensors for monitoring at-risk patients in low-acuity hospital settings.
The biosensor measures vital signs and transfers data to a clinical decision support software application that can be set up to automatically notify the caregiver or clinician.
Philips says it expects to unveil a portfolio of solutions that will connect to analysis tools and dashboards — all with an eye toward improving patient care and lowering healthcare costs. — Anisa Jibrell
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Epic, Cerner lead EHR mindshare: This and 9 more health IT purchasing trends

Written by Akanksha Jayanthi (Twitter | Google+)  | February 22, 2016
As hospitals and healthcare systems consider purchasing options, Epic and Cerner continue to lead the pack in EHR mindshare in 2016, according to a new report from research firm peer60.
peer60's latest research report analyzes year-over-year trends related to health IT purchasing, including mindshare, marketshare and IT priorities, among other metrics.
Here are 10 trends to know about health IT purchasing in 2016.
1. Epic Systems holds the largest inpatient EHR mindshare segment in 2016, at 32 percent. Second for inpatient EHR mindshare is Cerner, with 23 percent of the market.
2. Following Epic and Cerner in inpatient EHR mindshare are MEDITECH (20 percent), athenahealth (7 percent), Allscripts (7 percent), CPSI (6 percent) and McKesson (2 percent).
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Survey: Security, Big Data and Mobility are Top Priorities for CIOs in 2016

February 22, 2016
by Heather Landi
Most CIOs and health IT leaders see security, business intelligence/big data and mobility as the top areas impacting their organizations in 2016 and initiatives related to mobile health and patient engagement are likely driving these IT priorities, according to a survey conducted by TEKsystems.
IT staffing and services firm TEKsystems surveyed healthcare IT leaders, including CIOs, IT vice presidents, IT directors and IT hiring managers, as part of its annual IT forecast and the survey results indicate that 45 percent of IT leaders expert their organization’s IT budget to stay the same this year. Only 41 percent of health IT leaders expect their budgets to increase this year, which represents the lowest percentage expecting budget increases in the past four years. And 14 percent of respondents expect their budgets to decrease.
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Healthcare Meets Minority Report, and Patients Like It

Scott Mace, for HealthLeaders Media , February 23, 2016

Using technology associated with a Tom Cruise movie to identify hospital patients is an actuality at one Louisiana hospital, where it saves time at check-in, reduces chances for patients to receive the wrong care, and has already paid for itself.

At Terrabonne General Medical Center, a 325-bed acute care hospital in Houma, Louisiana, patients check in by having their photo taken by a greeter at the door to the waiting room.
Technology behind the scenes scans the unique markings on each patient's irises, matches these patterns up to previous registration data, or flags the patient as being new. The whole iris-matching process takes a couple of seconds. Even identical twins have unique patterns, and the whole thing works with patients as young as nine months old.
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After a hack, four steps to manage the crisis

Published February 19 2016, 2:08pm EST
2015 was marked by far too many digital security breaches, a trend that every organization hopes to see reversed in the coming year. Unfortunately, it is unlikely that we’ll be able to stop them all. In this digital era, security breaches are part of the new normal.
So what should you do when facing a security breach? The most important thing that you can do is stay calm. If you keep your wits about you, you will be better able to approach the problem and implement a solution to protect your organization. Here is how to move forward in the face of a digital security breach.
Plan ahead. While you may not be able to plan for the exact details of a security breach – if you could, then you could prevent it from happening – what you can do is prepare a preliminary plan of action for any future breach. Write out a general timeline for what actions need to take place and in what order. This way, when something does happen, you do not lose any time giving direction. All you need to do is to fill in the specifics of the event.
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Mobile heart disease risk calculator can interface with EHRs

February 22, 2016 | By Dan Bowman
A mobile tool that helps physicians predict the risk of heart disease for their patients is expanding its abilities and now can interface with electronic health record systems.
The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, developed by the American College of Cardiology, uses "multiple algorithms within one analytic" to determine 10-year and lifetime risks for ASCVD, according to an announcement; the tool is available on Android and iOS devices, as well as via the Web. Now, through a partnership with health analytics company Apertiva, the tool can integrate with a provider's EHR.
"The whole industry is moving to free the data and allow physicians and patients to be able to integrate it with other tools," ACC CIO Dino Damalas recently told Health Data Management. Damalas added in the announcement that the partnership will broaden the availability of the decision support-tool, which already has been downloaded more than 250,000 times.
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Mobile device security: Health IT execs discuss their strategies

February 22, 2016 | By Katie Dvorak
The following is an excerpt from an article published in the FierceHealthIT's eBook "Best Practices for Securing Your Mobile Network." Download the eBook here to read more.
For executives in charge of mobile device and network security at hospitals and health systems, many factors must be taken into consideration. Employees increasingly are bringing in their own mobile devices, tools that can get lost or stolen, and hackers continue to find new ways to illegally access systems.
The latter, especially, worries Tom Barnett, vice president for health information technology at NorthShore University HealthSystem.
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How use of big data can cause harm in healthcare

February 22, 2016 | By Susan D. Hall
Big data must be coupled with rigorous observational methods to prevent grave errors in assumptions, according to an article published at the American Journal of Managed Care.
Austin B. Frakt, Ph.D., health economist with the Department of Veterans Affairs, and Steven D. Pizer, Ph.D., director of healthcare financing and economics at the VA Boston Healthcare System, note that for every 5 million packages of x-ray contrast media distributed to healthcare facilities, about six people die from adverse affects.
With big data, those deaths can be found to be highly correlated with things like electrical engineering doctorates awarded and per-capita mozzarella cheese consumption. 
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Vocera showcasing enterprise solutions for communication and collaboration at HIMSS

Written by Staff | February 19, 2016
Vocera Communications, Inc. will showcase the Vocera Communication Platform at the 2016 HIMSS Conference and Exhibition in Las Vegas, Feb. 29 through March 4, 2016.
The enterprise-grade solution enables HIPAA-compliant communication via voice and secure text messaging on a variety of mobile devices. The Vocera Communication Platform also integrates with more than 70 clinical systems, including electronic health records, nurse call, and physiologic monitoring systems.
Vocera arrives at HIMSS16 with strong momentum after recently announcing the selection of its communication solutions at Franciscan Alliance and Massachusetts General Hospital. That energy will continue at HIMSS16 with two Vocera customers sharing their success stories at the health IT event.
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A Unique Identifier Could Protect Patient Privacy

Giving every American a unique patient identifier could reduce errors in retrieving their medical records while improving data sharing and security. A national identifier could also help protect patient privacy, or at least not further erode it. Those are key conclusions from Identity Crisis, a RAND study I coauthored several years ago…
The remainder of this commentary is available at statnews.com.
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Electronic Health Records: Yesterday's Ebola and Today's Zika

An aedes aegypti mosquito is pictured on a leaf in San Jose, Costa Rica, February 1, 2016
Photo by Juan Carlos Ulate/Reuters
When I showed up at the obstetrical urgent care unit at Brigham and Women's Hospital, the care I received was swift and appropriate. I saw a nurse quickly and a doctor soon after. They asked relevant questions and immediately put a plan for further evaluation in place. Only then did the nurse turn to the computer to enter everything into the electronic record. As she worked her way through the required documentation, she asked several more questions. Any allergies that weren't already in the system? Surgeries she should note? And, of course, importantly, had I been to an Ebola-infected country recently?
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Enjoy!
David.

Friday, March 04, 2016

If This Is Even Half True It Is A Total Travesty. Just What Does It Take For People To Grasp That Medical Records Are Private!

This appeared last week:

Lambie spent $30k to keep records private

February 25, 2016
Lambie spent $30000 to keep record private
By Belinda Merhab AAP
Lambie spent $30k to keep records private
Independent Senator Jacqui Lambie claims she was forced to spend $30,000 to keep her private medical records from being splashed across News Corp newspapers.
The former soldier told parliament a journalist from The Australian went on a fishing expedition to get access to her medical records following her long battle against Veterans' Affairs a decade ago for compensation.
She spent $30,000 fighting it and managed to redact details from the records after the Administrative Appeals Tribunal granted the journalist access.
But the legal battle didn't cost the journalist a cent.
She alleged the tribunal's then deputy president Major General Gregory Melick, now Tasmania's Chief Integrity Commissioner, may have granted access in retaliation for her speaking out about corruption in army ranks.
"You can imagine what fun Mr Murdoch would've had at my expense if my legal team had not been able to redact a large portion of my personal medical records.
"I suppose the balance of power in the Australian Senate is a matter of high stakes and all is fair in love and war to some people."
More here:
My view is that such behaviour is utterly unacceptable - I don’t care who the target of the investigation is. That such behaviour is not illegal is the worry as far as I am concerned.
David.

Thursday, March 03, 2016

The Macro View - General And Health News Relevant To E-Health And Health In General.

March 3 Edition
The macroeconomic stresses seem to have eased ever so slightly - but are probably resting rather having been resolved.
This article provides a few hints:

Budget 2016: as jobs go, global economy falters, says G20 report

  • The Australian
  • February 26, 2016 12:00AM

David Uren

Scott Morrison will come under pressure at his first G20 meeting in Shanghai this weekend to use the budget to launch a new round of stimulus spending — the first since the global financial crisis — as the IMF warns finance ministers that the world is at risk of a new downturn.
In a bleak report prepared for the meeting — and against the backdrop of thousands of new job losses in Australia after the closure of the Dick Smith retail chain — the International Monetary Fund says the global economy is faltering and governments have done too little to boost demand.
“The global economy needs bold multilateral actions to boost growth and contain risk,” it says. “The G20 must plan now for co-ordinated demand support using available fiscal space to boost public investment and complement structural reform.”
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Also, in Australia, we are now see a continuing bun-fight on pathology funding, health insurance costs as well as negative gearing and superannuation. Will be fun to watch. Mr Morrison seems to have disappointed with the lack of a clear plan.
Last week we heard there would be a before the Budget announcement of  tax proposals so that will happen soon. Stay tuned!

Thursday Update: Markets have perked up more than somewhat - will it be sustained? Who knows...
Here is a summary of interesting things up until the end of last week:
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General Budget Issues.

Iron ore recovery offers budget boon hopes

Date February 22, 2016 - 9:48AM

Mark Mulligan

Senior markets and economy writer

Treasurer Scott Morrison is facing a potential multibillion-dollar revenue windfall as he prepares his first budget, with a surprising rally in the price of iron ore coming at just the right time for the government.
The commodity has surged to its highest level in three months – putting it back to about $US48 a tonne –as Chinese steelmakers ramp up production after their Lunar New Year break, a sign that global demand for iron ore could increase significantly in coming months.
Share prices have soared for iron ore miners, with BHP Billiton jumping 17 per cent in the last four weeks to $16.61 a share, and Rio Tinto climbing11 per cent, to $42.62 a share.
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Turnbull government ponders radical move to bring forward the federal budget

Date February 22, 2016 - 1:40PM

James Massola

Political correspondent

EXCLUSIVE

Senate reform goes to parliament

The government is legislating to change senate elections. Malcolm Turnbull says the current system has been 'gamed' by 'preference whisperers'.
A radical idea to bring forward the federal budget from May 10 has been floated among senior members of the Turnbull government.
Although such a radical move is considered unlikely by Turnbull government insiders – and it has not been formally considered in forums such as cabinet – Fairfax Media has confirmed the idea has been discussed.
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  • Feb 24 2016 at 12:43 PM
  • Updated Feb 24 2016 at 3:01 PM

It's official: Treasury gets budget revenue forecasts wrong by $682b, PBO says

It's official - the size of the nation's budget forecasting blunder across the boom and bust years since 2002 is $682 billion.
That's the staggering combined amount of revenue that successive Coalition and Labor governments both under-estimated during the upswing in the years leading up to the global financial crisis, as well as the even greater shortfalls in revenue posted since the end of the commodity price surge in 2011.
The bad news is that the downgrades during the near seven years of budget famine forecast out to 2018-19 are $124 billion greater than windfalls received during the years of relative budget plenty between 2002-03 and 2008-09. 
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  • Feb 24 2016 at 6:25 PM
  • Updated Feb 24 2016 at 6:25 PM

Turnbull moves to defuse state funding election bomb

Malcolm Turnbull is moving to defuse a bruising election-year clash with state premiers over health and education funding cuts with a deal that would result in a further deterioration in the federal budget bottom line.
While Treasurer Scott Morrison has been maintaining pressure on states to fix their own budget shortfalls, the Prime Minister is signalling to state leaders that he is open to an interim funding fix.
The stop-gap measure would still leave open the longer-term question of the division of funding and service responsibilities between states, territory and federal governments – something that would need to be addressed in years to come.
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Turnbull walks away from tax reform: only caps on super, negative gearing left

Date February 25, 2016 - 7:27AM

Peter Martin

Economics Editor, The Age

Tax reform eludes government

The government all but abandons serious tax reform - at least for now. Peter Martin explains what's in and what's out.
The Turnbull government is preparing to abandon serious tax reform.
It has ruled out major change in favour of a pair of savings measures seen as politically safe: curbing the excessive use of negative gearing by wealthy investors, and reducing extensive parking of pre-tax income in superannuation accounts.
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Terrified on tax: why Malcolm Turnbull will squib it

Date February 25, 2016 - 12:15AM

Peter Martin

Economics Editor, The Age

So much for big reforms. Don’t expect Malcolm Turnbull to present a bold tax plan. He’s too scared of putting voters offside.

Tax reform eludes government

The government all but abandons serious tax reform - at least for now. Peter Martin explains what's in and what's out.
A decade ago in a speech titled The Way Ahead, Malcolm Turnbull labelled negative gearing "tax avoidance". Tellingly, he observed that "every tax deduction, once created, develops a constituency which will fight to defend it".
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Defence white paper: big spending means other portfolios hit

  • The Australian
  • February 26, 2016 12:00AM

David Uren

Defence will become one of the fastest growing budget programs, with spending rising by an average of 6.8 per cent a year across the next decade, demanding big savings from other portfolios.
The rapid growth in defence outlays, which will raise its share of government spending from 7 per cent to 8 per cent, comes as Treas­ury has been downgrading its estim­ates of economic growth.
Although the slower growth has made it easier to get defence spending to 2 per cent of gross domestic product, a commitment made by Tony Abbott in the 2013 election campaign, it has made Scott Morrison’s budget challenge more difficult.
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  • Feb 26 2016 at 1:23 PM
  • Updated Feb 26 2016 at 3:45 PM

The path to reforming our economic leader Malcolm Turnbull

Where does Malcolm Turnbull, economic leader, go from here?
It's a depressing moment. Having given up the battle to expand the role of the GST, the government appears to have scaled back its cuts in personal income and company tax. The economic gains from the change in the national tax mix now will depend in part on how cleverly the premiers fill the gap left by Turnbull's GST decision.
At the same time, the prime minister has used the opposition's proposed policy on negative gearing to launch a scare campaign rather than seize the opportunity to embrace the Henry tax review's proposed tax discount for all income from personal savings, including capital gains on highly geared rental properties.
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Malcolm Turnbull hasn't been the messiah and doesn't seem to have a gospel

Date February 26, 2016 - 11:30PM

Jack Waterford

Canberra Times columnist

Over the next month Malcolm Turnbull will make – must make – the decisions which will determine the period of his prime ministership. He's still an odds-on favourite to be prime minister at the end of the year, but, in the past month, he has looked beatable.
Some decisions before him involve the budget that his Treasurer presents in early May, and others the policies that he puts to the public at the next election. Another involves the timing of the election itself, and whether he has much to gain from double dissolution.
Much more important, however, are decisions by which he shows voters a sense of purpose and direction, laying out a path Australians will want to follow. Only by that can he demonstrate that he is still in charge of his, and Australia's, fate. His decisions will show if he has become, as Tony Abbott, Kevin Rudd and Julia Gillard did before him, a prisoner of his past, increasingly unable to control his future.
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Health Budget Issues.

Government could save $175m a year by ending pathology companies' ‘free ride’

Pathology industry has massive efficiency savings that are not shared with taxpayers and the government, leading health economist, Stephen Duckett, says
The federal government could save $175m each year by ending the “free ride” it has given to pathology companies, a leading health economist, Stephen Duckett, says.
Duckett has called for reform to the way pathology is paid for so the massive efficiency savings the industry enjoys are shared with taxpayers and the government
The federal government announced in its budget update in December that it would scrap the bulk-billing incentive it pays to health professionals for pathology services, representing savings of $101m per year.
As a result, the pathology industry has threatened to pass the costs onto patients by introducing a $30 co-payment for common tests, including pap smears.
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Sonic Healthcare, Primary Health Care hogging profit from automation, says report

Date February 21, 2016 - 9:00PM

Simon Evans

Federal Health Minister Sussan Ley has stepped up the fight against big pathology companies opposing cuts to bulk-billing incentive payments for blood tests, X-rays and MRIs, saying a report by the Grattan Institute is further proof they are embarking on a scare campaign to protect profit.
Big ASX-listed pathology companies such as Sonic Healthcare and Primary Health Care are at the forefront of vigorous lobbying and a consumer campaign running in 5000 pathology collection centres. They are attempting to stop $650 million in cuts to bulk-billing incentive payments for providers identified by the federal government in December 2015 in a budget update.
A new report by the Grattan Institute released on Sunday revealed that taxpayers had got "minimal benefit" from the automation of processes across the industry, which had led to "ever-cheaper ways of delivering services".
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Think tank needles pathology funding

  • The Australian
  • February 22, 2016 12:00AM

Sarah-Jane Tasker

Australia’s pathology services funding system needs urgent reform as top companies in the sector have fattened their bottom line on increased volumes subsidised by taxpayers, a new report has found.
Stephen Duckett, health program director at the Grattan Institute, has produced a report — to be released today — that outlines reforms to pathology payments could save the government at least $175 million a year.
The government, through Medicare, spent $2.5bn on pathology services in 2014-2015 and Mr Duckett argued it was the large corporate companies that were benefiting most from that spend.
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12:17pm February 22, 2016

Pathologists condemn Grattan report

By AAP
Pathologists say a scathing report into their industry is grossly inaccurate and at best a flawed opinion piece.
The Grattan Institute report accuses the industry of using patients as pawns to keep shareholders happy, saying proposed Federal funding cuts to its services don't go far enough.
But the Royal College of Pathologists of Australasia says the report contains many errors and misinterpretations, while the data used to support its conclusions is inconsistent.
The report rejects claims women may be forced to fork out $30 for pap smears and calls for a major shake-up of the industry to protect patients from co-payments and rein-in pathology costs.
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Healthscope boss urges federal spending fix on $96m profit

  • The Australian
  • February 24, 2016 12:00AM

Sarah-Jane Tasker

The head of Australia’s second largest private hospital group, Robert Cooke, says a reform of the federation is the “holy grail” of healthcare, adding a change to state funding would be a “game changer” for his business.
The Healthscope chief executive officer, delivering a 64 per cent jump in half-year profit to $95.9 million, said yesterday the federal government should roll out a national price for healthcare funding.
“They can give the states 40 per cent of that price for each patient in a public or private setting and then we would negotiate with a health fund on the other 60 per cent,” he said. “That would be a game changer for our business. We would be building more beds than what we are proposing at the moment.”
Despite his support for federation reform, Mr Cooke said it was unlikely to occur because of political reasons.
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Half of patients may face pathology gap fees

25 February, 2016 Alice Klein
One in two patients may be asked to pay a standard pathology gap fee of around $30 if impending cuts to bulk-billing incentives are enforced, say pathologists.
The warning has been issued in response to Federal Government cuts to bulk-billing pathology incentives, due to come into force on 1 July, which the industry says it is unable to absorb.
The incentive cuts - worth $1.40-$3.40 per service - would translate into out-of-pocket costs for all non-concession card holders, said Dr Michael Harrison, president of the Royal College of Pathologists of Australasia (RCPA).
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Health Insurance Issues.

Costing private patients an arm and a leg: Health Minister Sussan Ley demands quick price fix on prostheses

Date February 25, 2016 - 5:23PM

Heath Aston, Jane Lee

EXCLUSIVE
The price of hip replacements, heart valves and pacemakers is set to tumble for private hospital patients as the Turnbull Government seeks election-year relief from steep rises in health insurance premiums for consumers.
Fairfax Media has learned that the medical devices industry has been given less than a fortnight to identify more than $500 million in savings or face a blanket price cut in what health insurers have to pay for prostheses like new hips and knees.
Prosthetics procedures in private hospitals cost almost $2 billion a year and it is understood that Health Minister Sussan Ley wants that bill cut by about $600 million, with some reports suggesting the target is up to $900 million.
The federal government controls the cost of 10,000 medical devices, including human tissue, screws and plates, through the Prostheses List - similar to the pharmaceutical benefits scheme.
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nib profit jumps 5pc to $43m

Date February 22, 2016 - 4:19PM

Tim Binsted

Reporter

Private health insurer nib said it is alert for acquisition opportunities as smaller health funds question their future following the $5.7 billion privatisation of Medibank Private.
Group managing director Mark Fitzgibbon said that the renewed assertiveness of Medibank, which recently announced a $100 million profit upgrade and is planning an advertising spree, has changed the local industry.
"There is much more awareness of the competitive threat with the two behemoths, Medibank Private and Bupa. Smaller health insurers are worried about what the future looks likes and consolidation might be something worth revisiting," he said.
Mr Fitzgibbon said he had no particular takeover targets in sight, but he is alert to the possibility of a deal.
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Out-of-pocket costs a growing pain for health fund members

  • The Australian
  • February 24, 2016 12:00AM

Sean Parnell

Health fund members have copped the biggest increase in out-of-pocket expenses for hosp­ital treatment in five years as insurers seek to share the burden of rising costs.
According to the latest industry data, reported by the Australian Prudential Regulation Authority yesterday, out-of-pocket expenses for the December quarter rose 4.4 per cent compared to the same period in 2014. The dollar difference was about $12.50 to an average bill for members of $291.51, and followed several years of declining out-of-pocket expenses.
Over that period the industry enjoyed a 6.9 per cent increase in premium revenue, against a 6 per cent increase in benefits paid. Health funds are awaiting a decision on their applications to increase premiums again in April.
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Private health insurance providers’ profits soar as premiums rise faster than payouts

February 24, 2016 12:30am
John Rolfe Cost of Living Editor News Corp Australia Network
HEALTH insurers are getting more and more profitable, pocketing an extra $106 million in the past year — an increase of 10 per cent.
As policyholders brace for yet another budget-breaking premium increase of five per cent-plus, new official figures from the prudential regulator show funds’ collective net earnings rose to $1.19 billion in 2015 from $1.08 billion the year before.
The rate at which their profits are expanding sped up by 50 per cent, because the 2014 result was an increase of only $70 million.
This is due to a widening in their “gross margin” as premium revenue growth ($1.38 billion to $21.4 billion) outpaces the increase in payments to customers receiving treatments ($1.037 billion to $18.5 billion).
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7:41pm February 25, 2016

Private health fund members complain of financial pain despite insurance due to growing gap and out-of-pocket expenses

AAP
Australians with private health insurance are making gap payments more than ever before and are unhappy about the out-of-pocket expenses, a 9NEWS investigation has revealed. 
Out-of-pocket expenses for Australian patients have increased in the past year, with the number of operations that have a gap rising by 311,112. 
Dissatisfaction is also rising, with a survey of 40,000 people commissioned by the Health Minister and obtained by 9NEWS revealing that 71 per cent of respondents believed they would be out of pocket if they required treatment.

Superannuation Issues.

Super opt-out ‘despicable’: Labor

Allowing low-income earners to opt out of compulsory superannuation would be a “despicable attack” on people’s future retirement, Labor says.
The Turnbull government is reportedly being urged to consider the “opt out” idea in pre-budget submissions by industry groups.
The move could give thousands of part-time and casual workers earning less than $37,000 a 9.5 per cent pay rise — the amount paid by employers into superannuation — or up to $63 a week, News Corp reports.
“This is a despicable attack on the very foundations of a decent retirement for working Australians,” Labor’s superannuation spokesman Jim Chalmers told reporters in Brisbane on Sunday.
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Super reforms ‘discriminatory, unfair and dumb’

11:30pm, Feb 24, 2016
Mark Skulley Columnist
ANALYSIS: Superannuation changes could hurt women and young workers.
The suggestion that low-income earners should be able to “opt out” of the compulsory superannuation system is unfair, discriminatory and just plain dumb.
It would be particularly bad for women and young workers, who have enough trouble building a superannuation nest egg.
It’s unclear which employer group or groups proposed it, in the submissions being made to the Turnbull government ahead of the next federal budget in May.
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Pharmacy.

Give us control: Guild

Guild wants pharmacy to play a key role in chronic health management, despite resistance

Community pharmacy should be empowered to play a vital role in the management and prevention of chronic disease, the Pharmacy Guild of Australia believes.
Guild national executive director David Quilty and Victorian branch president Anthony Tassone have appeared before the House of Representatives inquiry on chronic disease prevention and management in primary health care to emphasise the key role they believe pharmacy can play in this area.
In its submission to the inquiry, held by the House Standing Committee on Health, the Guild coordinating the health system in an affordable way to manage chronic health “will only be facilitated by better alignment and coordination within the Federal Government though the Community Pharmacy Agreement”.
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Health is also clearly still under review as far as its budget is concerned with still a few reviews underway and some changes in key strategic directions. Lots to keep up with here with all the various pre-budget kites still being flown! Enjoy.
David.

Wednesday, March 02, 2016

The Pharmacy Guild And The AMA Are Talking At Crossed Purposes Regarding The mHR.

The AFR is continuing its interest in e-Health. This popped up in the Saturday Weekend paper.

Pharmacists, doctors feud over 'botched' e-health record rollout

by Ben Potter
Feb 26 2016 at 5:13 PM
Pharmacists and doctors are feuding over the federal government's struggling electronic My Health Record system.
The pharmacists' lobby chided doctors for failing to support My Health Record to help cut waste in the $155 billion healthcare sector. But the doctors' lobby said the system will not succeed in cutting waste because the rollout has been botched. 
"We have all got to be in it – it's either all in or none in," said George Tambassis, national president of the Pharmacy Guild of Australia. Health spending is being targeted by health minister Sussan Ley
Government data shows nearly half of medicines dispensed are wasted. Mr Tambassis said My Health Record could cut waste by identifying patients who were going to the doctor too often, doctor-shopping or pharmacy-shopping, doctors over-prescribing or pharmacies double-dispensing. 
But he said all healthcare providers had to be on board for this to happen and there was no excuse for them to stay out, because technology problems such as security and interoperability had largely been solved. 
He said pharmacies were already using technology to upload prescriptions into the cloud and track sales of over-the-counter products containing codeine and pseudoephedrine. 
But he said they were unable to share the data among themselves or with doctors until My Health Record was more widely used. 
Australian Medical Association president Brian Owler said the organisation backed e-health records as a way of controlling health costs, but the government had failed to ask medical specialists what they needed to make My Health Record work.
Professor Owler admitted many specialists did not use electronic health records, but said most medical practice software was aimed at GPs and was not suitable for specialist practices. 
"Until we start to engage with people as to how it might work and the software vendors are on board, it's never going to work," he told AFR Weekend.
Professor Owler said My Health Record would not succeed in cutting waste in pharmaceuticals because while most GPs used electronic prescribing, some hospitals, specialists and other healthcare providers don't, and where they do, their software "doesn't talk to each other". 
"The Pharmacy Guild owns chemist shops and they have point-of-sale systems, and they have electronic systems to print out the stickers, but that's a long way from our main interest, which is actually provision of care to patients." 
More here:
Sadly both sides are both right and wrong. Waste will not be addressed by the mHR without a fundamental system re-design - as it is just a store of old prescription data rather than a system that interacts with the prescriber - and we already know that is not on the agenda.
We also know the AMA is not going to get seriously involved unless all the usability and workflow issues are resolved so that the system actually adds value rather than costs time!
All that said it is good to see the AFR taking an interest.
David.

Tuesday, March 01, 2016

When The ABC Is Reporting HealthIT In WA Is A Mess Things Must Be Pretty Grim.

When this appeared last week I suspect most of us thought all the bad news was out. We have this:

WA Health avoids IT corruption inquiry, for now

But premier warns it could still eventuate.

By Allie Coyne
Feb 23 2016 11:47AM
The WA Corruption and Crime Commission has opted not to investigate the state health department's botched multi-million dollar IT contract with Fujitsu, but the state's premier has warned the department could still end up in front of the anti-corruption watchdog.
A damning report released last week by the WA auditor-general found the four-year, $45 million centralised computing contract had blown out by $81.4 million thanks to weaknesses in oversight and controls.
The audit office found the contract had been varied 79 times since its 2010 signing, with the department acquiring extra data centre equipment that it was unlikely to use.
Around half of the $81.4 million in contract extensions were made by staff that weren't authorised to make such decisions. The employees have since been sacked.
At the time of the report's release, WA health minister Kim Hames said the case had been referred to the Corruption and Crime Commission.
In the days following, the anti-corruption watchdog said it welcomed the audit report but would not undertake a separate investigation into the matter.
It said while the report highlighted "serious failings" in Health's systems, there was no evidence to suggest serious midconduct by individual employees had occurred.
Lots more here:
And for more browse here:

http://www.itnews.com.au/news/wa-govt-admits-to-systemic-it-issues-at-health-department-415455

But no! On Sunday this little ripper on an equally messy issue popped up from the ABC.

Warnings about problem-plagued digitisation of WA hospitals 'ignored', technology experts say

By the National Reporting Team's Courtney Bembridge
February 28, 2016
Technology experts say a plan to digitise hospitals was destined to fall short, and their warnings were ignored.

Key points:

  • Experts say problems should have been picked up sooner
  • Funds for multi-million dollar IT contract mismanaged
  • Fears IT problems could derail the Perth Children's Hospital project
With pockets full from the mining boom, Western Australia sunk billions of dollars into the introduction of "new hospital IT" — trying to bring hospitals into the 21st century and make paper records disappear.
Instead, implementing the new technology has been costly and plagued with problems.
It has caused lengthy delays at one major hospital, while systems have been shelved at another hospital because technical glitches posed an unacceptable risk to patients.
Curtin University researcher Shirlee-ann Knight has authored academic papers on health information technology.
She said the complexity of the health system was underestimated and IT systems were never going to live up to expectations.
"A one-size-fits-all approach, which is the way we've taken it, in my view just won't work in a hospital environment," Dr Knight said.
"It's inevitable that this would happen and it's inevitable it will happen again."
Do you know more about this story? Email investigations@abc.net.au
The problems first became apparent at the $2 billion Fiona Stanley Hospital, where technology was supposed to replace paper records.
The plan was abandoned, but not before the opening of the hospital was delayed by more than six months and a committee found the cost had blown out by $330 million.
Dr Knight said she raised concerns in the years before the hospital opened, but they fell on deaf ears.
"I think it's far more complex than what the people who were in positions of power in 2009, 2010 and 2011 actually believed," she said.
Problems have also been identified at the newly opened St John of God Midland Public Hospital.
The technology allowing health systems to share information with one another was found to be seriously flawed and could not be implemented.
The extent of the problem was outlined in an internal memo from October 2015, a month before the hospital opened.
It found that when Midland Hospital tried to update patient notes, it would override or delete existing patient information.
"Due to the incomplete data being sent by St John of God Midland Public Hospital which 'overwrites' the existing Department of Health data, an extreme clinical risk presented whereby public patient data, including alerts and allergies for each patient... would be inaccurate and not up to date."
IT experts are still working to fix the problem and the system is not expected to go live until later this year.
Much more disturbing detail here!
This quote from the Premier is just astonishing!
“Premier Colin Barnett conceded the plan to go paperless was too ambitious, and mistakes were made.
"Government has been notoriously bad at handling ICT contracts ... it has been one problem after another going on for several years," he said last week.
"The whole area of so-called eHealth which has been talked about for the last 10 or 15 years across Australia has got lots of these stories.
"We're not alone, and it's not an excuse, but we're not alone in this and other major hospitals and health systems have had the same difficulties."
This just confirms the poll of last week. Clearly a party in a brewery is way beyond out health IT bureaucrats!
Wanders off wondering how this can be fixed with head shaking sadly!
David.