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."

Friday, June 26, 2009

International News Extras For the Week (22/06/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

  • JUNE 15, 2009

Transcript: Health Info Tech Coordinator David Blumenthal

'We don't care how you accomplish critical tasks, so long as you do so with electronic technology'

National Coordinator for Health Information Technology Dr. David Blumenthal spoke with The Wall Street Journal's Bob Davis about how he plans to convince hospitals and doctors to computerize their records. Below is an edited transcript.

* * *

The Wall Street Journal: What's the potential for health information technology?

Dr. Blumenthal: There's no way to transform the health-care system without information technology. Today we use the same technology for recording health-care information that Hippocrates used. It defies logic that we will be able to get the best out of health information with sheaths of paper flying around by snail mail.

WSJ: What are the potential cost savings?

Dr. Blumenthal: There are disputes about how much we'll save and how we'll show the benefits of health IT. The combination of an improved payment system, an improved education system about health IT and improved governance of the health care system that prioritizes quality and efficiency together with health information technology is where the real payoff is.

WSJ: How much money does the stimulus bill set aside from health IT?

Dr. Blumenthal: The stimulus bill sets aside $2 billion for the Office of the National Coordinator of Health Information Technology to lay the groundwork for the adoption of health information. It also creates Medicare and Medicaid payment incentives for physicians who are "meaningful users" of health information technology. There will also be penalties for those who aren't "meaningful users'" of health IT.

Estimates of the cost of those incentives and penalties vary. No one can tell you exactly how many physicians will use electronic health care records. The Congressional Budget Office estimates that the federal government would spend $29 billion on incentives, but it would produce savings of $12 billion. Other saving estimates run higher.

More here (subscription required):

http://online.wsj.com/article/SB124404155221081477.html

It seems the US administration gets it. Sadly not so in OZ!

Second we have:

Friday, June 12, 2009

Hospital to Collect Patients' Genomic Data

A Boston hospital aims to collect genome information from all consenting patients.

By Emily Singer

Boston's Brigham and Women's Hospital (BWH) has announced plans to collect blood samples for genetic analysis from all consenting patients and then feed that information into a large database, allowing scientists to analyze patients' genomes alongside detailed medical histories. The project aims to take advantage of the immense amount of patient information available in the hospital's electronic medical-record system, which is one of the most sophisticated in the country and houses a level of medical detail missing from most large-scale genetic studies of disease. The project could also serve as a model for how to incorporate genomic information into both electronic medical records and clinical care.

A growing number of both academic and privately funded efforts aim to link patients' genomes with their symptoms, but the BWH project is unique in its scope. As an academic medical center affiliated with Harvard Medical School, BWH serves a wide variety of patients, with nearly 400,000 routine visits, 58,000 emergency-room visits, and approximately 46,000 in-patient admissions per year. Researchers ultimately aim to open the project to the entire Partner's Healthcare System, a local network of hospitals and medical centers that sees hundreds of thousands of patients.

While new genomics technologies have allowed scientists to identify hundreds of genetic variants that raise the risk for different diseases, the role that these variants play in individuals is still unclear, as is how to use the information to tailor treatment and prevention strategies for individual patients.

Much more here:

http://beta.technologyreview.com/biomedicine/22799/

There is little doubt this is just the beginning of the huge and serious work to discover as many links as possible between genetics and illness. This will transform medicine over the next decades I believe.

Third we have:

Can Information Technology Cut Healthcare Costs?

Posted 12 June 2009 @ 10:15 am ET

As U.S. President Barack Obama refocuses efforts on universal healthcare, the burdensome question of how to fund it all returns. But without a handle on the rising costs in the current healthcare system, the possibility for new coverage seems a pipedream. A recent report from the Board of Trustees of Social Security and Medicare indicates that the trust fund supporting the federal Medicare program will be insolvent in 2019—a full seven years sooner than previously projected.

Additional statistics indicate just how dire the healthcare cost situation is becoming. According to figures from the White House, “the U.S. spent approximately $2.2 trillion on healthcare in 2007, or $7,421 per person—nearly twice the average of other developed nations.” Statistics from the Congressional Budget Office estimate that by 2025, “one out of every four dollars in our national economy will be tied up in the health system.”

With U.S. healthcare expenses and health insurance premiums skyrocketing in response, the current administration and Congress are turning their efforts to tech implementation in the sector as a way to curb expense. President Obama’s $787 billion stimulus plan allots $19 billion for health information technology, in an effort to push common protocols in the space, including interoperable electronic health records that could easily move between clinicians, diagnostic facilities, hospitals, and pharmacies.

A Congressional Budget Office (CBO) cost estimate released in March 2009 detailed that the stimulus plan, officially known as the American Recovery and Reinvestment Act of 2009, provides funding for expanded use of health IT—an effort to “reduce on-budget direct spending for health benefits by Medicare, Medicaid, and Federal Employees Health Benefits (FEHB) programs by $12.4 billion” over the 2009-2019 period. While implementation of the health IT provisions in the stimulus plan would account for increases in the “on-budget deficits by a total of $18.3 billion over the 2009-2019 period,” according to the CBO, “it would increase the unified budget deficit over that period by an estimated $17 billion.” The CBO reports that the offset in spending increases will come from the reductions in Medicare spending in later years, resulting in a savings after 2014. The added benefit, says the CBO, is the accelerated use of cost-saving IT bleeding over into the private insurance sector, resulting in lower health insurance premiums for employers.

Very full reporting continues here:

http://www.ibtimes.com/contents/20090612/can-information-technology-healthcare-costs.htm

The discussion continues!

Fourth we have:

June 13, 2009

Patient Money

Medical Problems Could Include Identity Theft

By WALECIA KONRAD

Brandon Sharp, a 37-year-old manager at an oil and gas company in Houston, has never had any real health problems and, luckily, he has never stepped foot in an emergency room. So imagine his surprise a few years ago when he learned he owed thousands of dollars worth of emergency-service medical bills.

Mr. Sharp, as it turned out, was a victim of a fast-growing crime known as medical identity theft.

At the time, Mr. Sharp was about to get married and buy his first home. Before applying for a mortgage he requested a copy of his credit report. That is when he found he had several collection notices under his name for emergency room visits throughout the country.

“There was even a $19,000 bill for a Life Flight air ambulance service in some remote location I’d never heard of,” said Mr. Sharp, who made this unhappy discovery in 2003. “I had emergency room bills from places like Bowling Green, Kan., where I’ve never even visited. I’m still cleaning up the mess.”

The last time federal data on the crime was collected, for a 2007 report, more than 250,000 Americans a year were victims of medical identity theft. That number has almost certainly increased since then, because of the increased use of electronic medical records systems built without extensive safeguards, said Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft.

And uncountable, Ms. Dixon said, are the people who do not yet know they are victims. They may not know that their medical information has been tampered with for months or even years until, as in Mr. Sharp’s case, it shows up in collections on a credit report.

Medical identity theft takes many guises. In Mr. Sharp’s case, someone got hold of his name and Social Security number and used them to receive emergency medical services, which many hospitals are obliged to provide whether or not a person has insurance. Mr. Sharp still does not know whether he fell victim to one calamitous perp who ended up in several emergency rooms or a ring of accident-prone conspirators.

In another variant of the crime, someone can use stolen insurance information, like the basic member ID and group policy number found on insurance cards, to impersonate you — and receive everything from a routine physical to major surgery under your coverage. This is surprisingly easy to do, because many doctors and hospitals do not ask for identification beyond insurance information.

Much more here:

http://www.nytimes.com/2009/06/13/health/13patient.html?_r=1

This is a possible problem here in Australia that we need to make sure we manage by engineering the NEHTA IHI etc to handle such fraud properly.

Fifth we have:

Does 'meaningful use' still have meaning?

By Joseph Conn / HITS staff writer

Posted: June 15, 2009 - 11:00 am EDT

Before passage of the American Recovery and Reinvestment Act in February, when the words “meaningful use” appeared together, did anyone even notice?

Now, however, a Google search on “meaningful use” produces about 179,000 hits, with the top 101 links heading to Web sites, congressional testimonies, white papers, magazine articles, blog ruminations and prospective definitions—all addressing the phrase exclusively in a healthcare information technology context.

Dangle, as Congress did, some $34 billion in federal IT subsidies in front of the healthcare industry, and make those payments contingent on a provider’s ability to meet federally set thresholds for meaningful use, and you wind up, as we have, with the 21st century healthcare IT version of the Y2K sensation.

Kent Gale, president and founder of healthcare IT market researcher KLAS Enterprises, Orem, Utah, didn’t miss the opportunity to try and divine the import of the meaningful-use doctrine from a market survey.

Last week, KLAS issued a 93-page report based on results from its own survey of provider organizations using electronic health-record systems. The report tries to determine which vendors’ systems might give their provider customers the best chance at meeting Gale’s own estimate of what the meaningful-use standard might require. (An official HHS description of meaningful use, which is expected to supplement the one already included in the stimulus bill, is due to be released soon.)

Much more here:

http://www.modernhealthcare.com/article/20090615/REG/306159980

Work is proceeding apace on this – we can expect to see some clear definitions out over the next few weeks. Meanwhile – with so much money at stake – discussion goes on.

A glimpse into the sorts of things being considered is found here:

First Look at 'Meaningful Use'

HDM Breaking News, June 16, 2009

Quoting from this report we read:

The workgroup's initial recommendations include 22 objectives--most covering inpatient and outpatient care--for EHRs in 2011. These include, among others:

* Use CPOE for all order types including medications;

* Implement drug-drug, drug-allergy and drug-formulary checks;

* Maintain an up-to-date problem list;

* Generate and transmit permissible prescriptions electronically;

* Maintain an active medication allergy list;

* Send reminders to patients per their preference for preventive and follow-up care;

* Document a progress note for each encounter;

* Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies;

* Provide clinical summaries for patients for each encounter;

* Exchange key clinical information among providers of care;

* Perform medication reconciliation at relevant encounters;

* Submit electronic data to immunization registries where required and accepted;

* Provide electronic submissions of reportable lab results to public health agencies;

* Provide electronic surveillance data to public health agencies according to applicable law and practice; and

* Comply with federal and state privacy/security laws and the fair data sharing practices in HHS' Nationwide Privacy and Security Framework, released in December 2008.

Much more here:

http://www.healthdatamanagement.com/news/meaningful_use-38487-1.html

For more information, click here. Scroll down and click on "meaningful use preamble" and "meaningful use matrix."

Certainly a list that makes more sense than the pathetic ePIP program.

More here also:

http://www.healthleadersmedia.com/content/234609/topic/WS_HLM2_TEC/Meaningful-Use-Defined-by-HIT-Policy-Committee.html

Meaningful Use: Defined by HIT Policy Committee

Carrie Vaughan, for HealthLeaders Media, June 16, 2009

G.E. Offers Loans for E-Health Record Purchases

By Steve Lohr

Update | 12:33 p.m. Clarifying G.E. comments on initial funding for health-records loan program in post and headline. While it is setting aside $2 billion for financing of health information technology, its initial commitment for loans to accelerate adoption of electronic health records is $100 million.

G.E. Capital has mostly been a headache for its parent company, General Electric, since the financial crisis hit last fall. But on Monday, the finance arm will be putting its muscle behind G.E.’s health care unit as it tries to grab a hefty slice of the market for electronic health records, a prime target for economic stimulus spending by the Obama administration.

G.E. is announcing that it will offer doctors and hospitals loans that will carry no interest until the institutions begin receiving government money, typically in 2012. The loans, of course, will be to buy G.E.’s Centricity electronic health records — either as conventional personal-computer software or as a Web-based offering.

The bridge-loan plan addresses one big worry for many doctors who are interested in taking advantage of the government incentives (up to $40,000 per physician over a few years) to make the move to digital patient records: a shortage of upfront capital.

But the other uncertainty is that the government has not yet defined the technology standards for what will be “qualified” electronic health records. The definition will presumably include being able to share data and as well as automated reporting of certain measurements of health care quality.

Much more here:

http://bits.blogs.nytimes.com/2009/06/15/ge-offers-loans-for-e-health-record-purchases/

An interesting approach indeed to gaining market share and facilitating EHR adoption.

More about this here:

http://caas.tmcnet.com/topics/caas-saas/articles/58016-ge-waits-with-healthcare-tech-industry-e-medical.htm

June 15, 2009

GE Waits with Healthcare Tech Industry for E-Medical Records Clarifications

Seventh we have:

Thursday, June 11, 2009

Spotlight on HIMSS Welcomed, But Shaded by Perspective

by George Lauer, iHealthBeat Features Editor

Scrutiny from mainstream media and volleys of reaction in the blogosphere last month aimed a new kind of spotlight at health IT. Many, especially those involved on the consumer side of the issue, welcome the light, but they also warn against being blinded by it.

The Washington Post published two stories in May examining the health IT industry's role in formulating the HITECH Act and other parts of the American Recovery and Reinvestment Act that direct billions of federal dollars toward health IT. The stories also examine various links between interests and personnel among industry groups, the Obama administration and Congress.

Motives Beyond Money

The first story detailed how the Healthcare Information and Management Systems Society "worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery."

Consumer advocates don't argue with that premise, but they do argue with the implication that the only motive was money.

"The vendor community -- all [health IT] companies and the various organizations they've created -- has played the largest role in [health] IT policy over the past five to six years, so yes, the industry has had the dominant role in driving [health] IT," Steven Findlay, senior health policy analyst for Consumers Union, said.

"I don't quibble with the premise of the Washington Post article -- that HIMSS helped push in the halls of Congress and the White House the notion that a lot of money would help spark much more rapid adoption," Findlay said, adding, "I agree with them -- that more money was needed. Surely more money than the Bush policies provided."

More here:

http://www.ihealthbeat.org/Features/2009/Spotlight-on-HIMSS-Welcomed-But-Shaded-by-Perspective.aspx

MORE ON THE WEB (Here)

Continuing discussion of the lobbying process around the decisions in the US to promote Health IT.

Eighth we have:

Device Monitors Home Medications

HDM Breaking News, June 15, 2009

American Medical Alert Corp. has introduced a medication dispensing and adherence verification system for use in patient's homes.

The MedSmart system, a clam-shell shaped device, activates visual and audio alarms at the time medication is to be taken, according to the Oceanside, N.Y.-based vendor.

.....

More information is available at healthyagingsolutions.com.

--Joseph Goedert

Full article here:

http://www.healthdatamanagement.com/news/home_health-38477-1.html?ET=healthdatamanagement:e908:100325a:&st=email

Sounds like a useful service for selected patients.

Ninth we have:

U.S. Health Departments Using Orion Health Technology for Disease Tracking

By Calvin Azuri, TMCnet Contributor

More than 45 health departments in the U.S. use technology from reputed software developer Orion Health to identify at an early stage, and react quickly to, contagious and potentially hazardous diseases and other public health exigencies.

The Center for Disease Control and Prevention (CDC) and other central authorities are now persuading more and more state health agencies to enhance their crisis management, response and health monitoring mechanisms to give access to vital information in an emergency reaction or in analyzing any spikes in health issues.

Orion’s ready to use software, the Rhapsody Integration Engine, available on counters of most software stores, has been instrumental in easing off some of the burden from the shoulders of healthcare enterprises by enabling a smooth framework for making sense of hundreds and thousands of bits of medical information.

The software helps compile medical data about a broad range of medical conditions, including recent outbreaks like the swine flu, from a wide cross-section of patients on a daily basis. The collection process, often carried out by several scattered healthcare organizations from unorganized sources, is streamlined to a precise and quicker one by Rhapsody. Rhapsody processes thousands of feeds from these organizations everyday and then it safely provides the data to public health decision makers using their PHINMS (Public Health Information Messaging Service).

More here:

http://healthcare.tmcnet.com/topics/healthcare/articles/57919-us-health-departments-using-orion-health-technology-disease.htm

Certainly one piece of software that suits the times !

Tenth we have:

European hospitals share real-time videos

12 Jun 2009

Hospitals in Norway, Italy and Spain have been linked together using an advanced video conferencing system enabling them to share real-time images of surgery for training and diagnosis.

The systems were linked as part of a demonstration at the Terena Networking Conference in Malaga this week, intended to show how similar telemedicine systems could improve healthcare across Europe

St Olav’s Hospital in Norway, Monaldi Hospital in Italy and the Hospital Clinica in Barcelona, Spain, were connected to each other via their hosts and the pan-European GÉANT academic network to the conference.

Staff at each of the hospitals provided a virtual tour of how endoscopic surgery can be transmitted for training across the GÉANT network, operated by the Dante research organisation.

Dai Davies, general manager of Dante, said: “Telemedicine has the power to improve medical training and patient care across Europe.

More here:

http://www.ehealtheurope.net/news/4931/european_hospitals_share_real-time_videos

Obviously a good way to share skills and expertise for less cost overall that air-travel etc.

Eleventh for the week we have:

AMA to set policy on electronic security breaches

By Andis Robeznieks / HITS staff writer

Posted: June 15, 2009 - 11:00 am EDT

The American Medical Association is set to decide policy on a physician's obligations in the event of a computer security breach, whether the federal incentives and subsidies to buy electronic health records constituted a pay-for-performance scheme, and several other information technology issues over the next three days at its annual House of Delegates meeting being held in Chicago.

Split into eight reference committees, delegates on Sunday considered more than 200 reports and resolutions including one on supporting the use of open-source software and others on opposing penalizing physicians who don't use IT.

The reference committees will draft reports on each item and include recommendations to either support, oppose, support or oppose with amendments, or refer them back to the board of trustees for further study. The recommendations will then be voted on by the 500-plus members of the entire House of Delegates over the next three days.

More here (registration required):

http://www.modernhealthcare.com/article/20090617/REG/306179993

This is certainly an area where clear policy will be needed.

Twelfth we have:

Intermountain, Geisinger share the spotlight in Obama talk

June 12, 2009 | Bernie Monegain, Editor

GREEN BAY, WI – President Barack Obama on Thursday turned the spotlight on healthcare IT leaders Intermountain Healthcare in Salt Lake City and Geisinger Health in rural Philadlephia.

"We have to ask why places like the Geisinger Health system in rural Pennsylvania, Intermountain Health in Salt Lake City or communities like Green Bay can offer high-quality care at costs well below average, but other places in America can't," Obama told a packed gymnasium at Green Bay Southwest High School.

"We need to identify the best practices across the country, learn from the success and replicate that success elsewhere," he said. "And we should change the warped incentives that reward doctors and hospitals based on how many tests or procedures they prescribe, even if those tests or procedures aren't necessary or result from medical mistakes. Doctors across this country did not get into the medical profession to be bean counters or paper pushers, to be lawyers or business executives. They became doctors to heal people. And that's what we must free them to do."

More here:

http://www.healthcareitnews.com/news/intermountain-geisinger-share-spotlight-obama-talk

This is a major question indeed. We can only hope our NHHRC will have some accurate answers when it reports in a week or two.

Thirteenth we have:

Health care records should be user-friendly, patients say

Patients want health technology rules to give them more access to their data

Dave deBronkart has a rather unique perspective on the health information technology debate: He's a cancer survivor, “e-Patient Dave” blogger and a believer in the power of technology to improve health care for patients, providers and the government.

“I am a high-tech guy," he said. "And I see what is happening in technology as a big opportunity to benefit patients and reduce costs.”

DeBronkart is one of the founders of a movement to put patients and consumers in the center of health care reform and health IT. He and other advocates are trying to get patient-centric principles into the Obama administration’s upcoming regulations for spending $19 billion in incentives for health information technology. The question is: Is giving more power to patients too big a pill to swallow?

The goals of patient-centric approaches are to give patients a more active role in their care including giving them greater access to their medical data in digital form. Vendors are applying patient-centric ideas to electronic personal health records, systems that store someone’s health history in one place in digitized form. Those systems could eventually be involved in regional and national health information exchanges.

Personal health records, which patients create and use voluntarily, would seem to complement the Health and Human Services Department’s development of standards and policies for certified electronic health records, patient records created and shared by doctors and hospitals. In May, HHS’ Office of the National Coordinator for Health IT (ONCHIT) began drafting regulations to reward providers who show "meaningful use" of health IT.

More here:

http://fcw.com/articles/2009/06/15/topic-a-patient-centric-health-record.aspx

An obviously important perspective I believe.

Fourteenth we have:

Is That A Cloud On Healthcare's Horizon?

Posted by Marianne Kolbasuk McGee @ 01:39:PM | Jun,16, 2009

Cloud models are starting to provide an attractive option for large and influential regional medical centers to get lots of small, local, laggard doctor offices trading in their paper patient files for electronic medical records. Are there clouds in your forecast?

Beth Israel Deaconess Medical Center (BIDMC), together with its Beth Israel Deaconess Physicians Organization (BIDPO), is just one of a handful of large and prestigious health care organizations in the country helping small doctor offices in their region (in this case, the Boston area) to deploy e-medical record systems.

A cloud model allows these doctor offices to use software to manage their practices and patient data, but the servers are located remotely and supported by BIDMC and Concordant, a services provider. BIDMC is covering about 85% of the non-hardware expenses for the practices to deploy the eClinicalWorks software, and the doctor offices pay a monthly subscription fee of between $500 and $600 for support.

A similar cloud plan is also being used by University Health System of Eastern Carolina to get small doctor practices in rural North Carolina using 21st century technology, says CIO Stuart James. "Most providers can't afford to hire IT people to keep these systems running," he says. "This keeps the costs down."

The loosening nearly two years ago of federal Stark anti-kickback regulations allows hospitals to donate e-health record software and services to doctors.

More here:

http://www.informationweek.com/cloud-computing/blog/archives/2009/06/is_that_a_cloud.html

It will be interesting to see how this plays out – especially given the possibly privacy and security implications.

Fifteenth we have:

Obama: Current Costs Unsustainable

HDM Breaking News, June 15, 2009

Labeling the current healthcare system a "ticking time bomb," President Barack Obama assured some 4000 physicians and their staff attending the American Medical Association's annual meeting in Chicago that he would not let it explode in their faces.

In an hour-long speech describing his administration's intentions to reform health care, Obama drew multiple bursts of applause punctuated by a few moments of awkward silence.

On the one hand, Obama went to great lengths to debunk the idea that he is single-payer, big-government advocate. "If you like your doctor, you will be able to keep your doctor. Period." Yet, he also made it clear that the industry needs to clean up its act, that the country can no longer tolerate a fee-for-service system that rewards quantity more than quality.

"A lot of people in this room know what I am talking about," he said, shifting into a tone suggesting a stern parent scolding an errant child. "It is a model that rewards the quantity of care rather than the quality of care. It is a model that has taken the pursuit of medicine from a profession--a calling--to a business."

More here:

http://www.healthdatamanagement.com/news/AMA-38484-1.html?ET=healthdatamanagement:e909:100325a:&st=email

Never was a truer word spoken!

There is more on this here:

Obama's reform plan to start with EHRs

By Andis Robeznieks / HITS staff writer

Posted: June 16, 2009 - 11:00 am EDT

Fixing the nation's healthcare system will begin with implementing electronic health records, President Barack Obama told the American Medical Association's House of Delegates yesterday.

"How do we permanently bring down costs and make quality affordable healthcare available to every single American?" Obama asked. "First, we need to upgrade our medical records by switching from a paper to an electronic system of record-keeping. We've already begun to do this with an investment we made as part of our recovery act. It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out—and I don't quote Newt Gingrich that often—we do a better job tracking a Fed Ex package in this country than we do tracking patients' health records.

Right click to download a podcast of President Barack Obama's address to the AMA. (55MB file, 60-minute audio)

See here:

http://www.modernhealthcare.com/article/20090616/REG/306169993

Again registration required.

Sixteenth we have:

CCHIT hosts 'town call' on certification concerns

By Joseph Conn / HITS staff writer

Posted: June 16, 2009 - 11:00 am EDT

Members of a newly formed not-for-profit organization to promote free and open-source software development in the healthcare industry will likely join in the discussion today during a "town call" hosted by the Certification Commission for Healthcare Information Technology.

The virtual and physical meeting of CCHIT, the first of two scheduled on successive days in Washington, is specifically aimed at addressing the open-source community’s concerns regarding CCHIT certification of their software products in the new IT era of the American Recovery and Reinvestment Act of 2009.

Open-source community members and leaders of CCHIT, which is a federally supported organization testing and certifying electronic health-record systems, first met in April in Chicago. Among complaints aired by the open-source members were that CCHIT is dominated by and favored developers of proprietary healthcare IT systems, it is too expensive, and its testing procedures and criteria are incompatible with open-source methods of software development.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090616/REG/306169994

I understand these meetings went pretty well and that the OS community is feeling happier.

Fourth last we have:

Cedars-Sinai worker gets prison for stealing patient records

4:28 PM | June 15, 2009

A former Cedars-Sinai Medical Center employee was sentenced to four years, eight months in prison after pleading guilty today to stealing patient information to defraud insurance companies of $354,000.

The hospital had sent letters in December to more than 1,000 patients, warning them that their personal information had been found during a search of the home of James Allen Wilson, who worked in the billing department between 2003 and 2007.

Much more here:

http://latimesblogs.latimes.com/lanow/2009/06/cedarsinai-worker-gets-prison-for-stealing-patient-records.html

Well I am sure that will focus the minds of those involved in things like this.

Third last we have:

HealthSpace expansion plans shelved

16 Jun 2009

The Department of Health has shelved plans for a massive expansion of its personal health record project, HealthSpace.

HealthSpace was conceived as a way to allow people to access and eventually add to a version of their Summary Care Records. But like the national SCR project, it has suffered from lengthy delays.

An £80m-plus business case, that was due to be submitted to the Treasury, now appears to have been kicked into the long grass. Most of the team working on HealthSpace has been stood down and released for other work, with just a skeleton crew retained.

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.

Plans for HealthSpace were based on making it a hub for transactional services, so patients could book nurse or GP appointment, manage long-term conditions, order repeat prescriptions or medication reviews and complete pre-registration assessments online.

Other planned services included access to letters and test results and access to data sent through telehealth devices.

Low take-up of the services currently offered by HealthSpace has done little to promote the portal’s cause.

Figures released to GP Dr Neil Bhatia under the Freedom of Information Act show that out of more than 250,000 records created, just 812 people had activated an advanced HealthSpace account and only 437 had accessed their SCR.

Much more here:

http://www.ehiprimarycare.com/news/4938/healthspace_expansion_plans_shelved

I think the NHHRC needs to look closely at this outcome for any implications for their stated PHR plans.

Second last for the week we have:

e-Health chairman fired

The Ottawa Citizen June 17, 2009

Dr. Alan Hudson is being replaced as chairman of eHealth Ontario.

The chairman of eHealth Ontario has been fired, Premier Dalton McGuinty was to announce Wednesday afternoon, according to a published report in Toronto.

A report at thestar.com said McGuinty, who was defending Hudson just last week, would make the news official at a mid-afternoon news conference.

More here:

http://www.ottawacitizen.com/news/Health+chairman+fired/1705766/story.html

The last act of the play it seems. I hope things can get back on the rails quickly and successfully.

Last, and very usefully, we have:

Health should be at the heart of health IT

By Carol Diamond and Josh Lemieux

12 June 2009

With billions of taxpayer dollars about to be invested, the stakes are indisputably high to set the right priorities for accelerating the benefits of health information technology. What should those priorities be?

It would be easy to assume that the main focus should be on technology-related issues—standards, software, hardware, technical support, and so forth. After all, isn’t “IT” what we are talking about? But technology-related goals often seduce and distract us from the heart of the matter.

And the heart of the matter is: “What is the IT for?”

Clay Shirky and I have written about the misconception that simply creating technical standards will magically lead to the rapid adoption of health IT.1 Ironically, one of the biggest obstacles to expanding the use of health IT may be a narrow focus on stimulating its adoption. Success is not how many doctors and hospitals use electronic medical records. Success is when clinical outcomes improve. Success is when everyone can learn which methods and treatments work and which don’t in days instead of decades.

Now that the federal government is investing upwards of $30 billion to help stimulate health IT adoption among providers and hospitals as part of the American Recovery and Reinvestment Act (ARRA), it’s critical that we define success in the right way.

Much more here:

http://whatmatters.mckinseydigital.com/health_care/health-should-be-at-the-heart-of-health-it

This is an important perspective that needs to be carefully thought through.

There is an amazing amount happening. Enjoy!

David.

Thursday, June 25, 2009

The Time Has Come for DoHA and NEHTA to Abandon Absurd Secrecy.

All over the country we are gradually seeing Governments respond to public pressure for a innocent public information to indeed become public and not held in the tight grasp of authoritarian bureaucrats.

Sadly, despite we pay them and the consultants they use, they seem to feel we are all to ignorant or unimportant to be let into their thought processes and to be allowed to maybe suggest where things could be done better. The arrogance of many of these people – not the staff, but their managers – is really breathtaking – especially their woeful track record of competence, delivery and implementation.

The need for change was made clear in a recent release (June 18, 2009) from the Australian Law Reform Commission.

Review of Secrecy Laws: Discussion Paper 74

Introduction

This briefing provides an overview of the ALRC’s Discussion Paper, Review of Secrecy Laws (DP 74, June 2009).

On 5 August 2008, the Attorney-General of Australia, the Hon Robert McClelland MP, asked the Australian Law Reform Commission (ALRC) to conduct an Inquiry into options for ensuring a consistent approach across government to the protection of Commonwealth information and, in particular, to review the secrecy laws currently on the federal statute book. The Terms of Reference for the Inquiry ask the ALRC to consider the balance between the need to protect some Commonwealth information and the need to maintain an open and accountable government through providing appropriate access to information.

The ALRC has identified and considered 507 secrecy provisions scattered across 175 pieces of legislation, including 358 distinct secrecy offences carrying a wide variety of criminal penalties. DP 74 indicates the Inquiry’s current thinking in the form of specific reform proposals. In trying to move towards a more open and ‘pro-disclosure culture’, the ALRC proposes a substantial decrease in the use of criminal sanctions—limiting prosecutions to those unauthorised disclosures in which it is alleged that harm has been caused, or was likely to be caused, to a compelling public interest. In most cases, however, the ALRC proposes that concerns about the protection of Commonwealth information should be addressed through better education and training, improved information handling practices, and public service disciplinary procedures.

The proposals contained in DP 74 do not represent the final recommendations of the Inquiry. The ALRC is seeking further submissions and is undertaking a further round of national consultations on the proposals in DP 74. It is not uncommon for there to be some significant changes of approach between a Discussion Paper and Final Report.

In recent times, the ALRC’s approach to law reform has involved a mix of strategies including: legislation and subordinate regulations, official standards and codes of practice, industry and professional guidelines, and education and training programs. Proposals—and, later, recommendations—may be directed to the Attorney-General, to whom the Report is presented, and also to other government and non-government agencies, associations and institutions.

Vastly more here:

http://www.alrc.gov.au/media/2009/mbp0618.html

The important bit for me is here:

In Chapter 7, the ALRC proposes that the new general secrecy offence should only impose criminal liability where a particular disclosure did, was reasonably likely to, or was intended to:

  • harm the national security, defence or international relations of the Commonwealth;
  • prejudice the prevention, detection, investigation, prosecution or punishment of criminal offences, breaches of a law imposing a penalty or sanction, the enforcement of laws relating to the confiscation of the proceeds of crime, or the protection of the public revenue;
  • endanger the life or physical safety of any person;
  • pose a serious threat to public health or public safety;
  • have a substantial adverse effect on personal privacy; or
  • have a substantial adverse effect on a person in respect of his or her lawful business or professional affairs or on the business, commercial or financial affairs of an organisation.

Staggeringly Crikey.com.au in an article on the 19th of June came up with this amazing statistic found in the report.

“At first glance it suggests some sensible changes to the current 537 separate secrecy provisions scattered through 175 pieces of Federal legislation that the Commission has identified.”

Those public servants have been very busy making sure we all “know nothing”!. This is to the great disadvantage of the future of our democracy I believe.

At the same time we have this from the ABC

http://www.abc.net.au/news/stories/2009/06/15/2597966.htm

'Systemic secrecy' hampering NSW health

The New South Wales Nationals' conference has heard claims of systemic secrecy in the state's health system.

The conference, which ended in Wagga Wagga on Saturday, called for public reporting of performance indicators such as efficiency, quality of care and infection rates.

The Parliamentary Secretary for Rural Health, Jenny Gardiner, says a culture of secrecy has developed in the hospital system and the performance of hospitals, particularly in regional areas, needs to be more transparent.

"We believe that that's in the interests of patients," she said.

"Patients and their families have the right to know about such information and so we believe that that should be a feature of any reforms of the health system across Australia.

"[We need] more accountability, more information to patients and communities."

More here:

http://www.abc.net.au/news/stories/2009/06/15/2597966.htm

The time has surely come for NEHTA, DoHA, and others, to stop commissioning consultants to do expensive reports on matters of more than some community interest and then refusing to share them with those who paid for them.

They could start with the various e-Health Strategy Documents and Business Cases that in no way fit the criteria above!

For those with a serious interest I provide the following:

“Further information

The full Discussion Paper can be downloaded from the ALRC’s website www.alrc.gov.au.

Hard copies and CDRoms are available from the ALRC.

Submissions on the ALRC’s proposals are due by 7th August. The final report and recommendations in this Inquiry are due to be provided to the Attorney-General by 30 October 2009.”

This issue with NEHTA has become even more important now we have discovered documents as important and non-commercial as Privacy Impact Assessments are being withheld. Just pathetic.

David.

Wednesday, June 24, 2009

NEHTA E-Health ID - Looking Like a Big Mess So Far.

NEHTA, with very considerable public funding, has now been developing the UHI service for almost 3 years, having initially been funded to undertake the work in around August 2006.

The following very interesting and carefully researched article appeared yesterday.

Medicare the base for e-health IDs

Karen Dearne | June 23, 2009

PATIENTS' medical records will be linked across health providers using the present Medicare number and card, under the $98 million Unique Healthcare Identifier (UHI) program being developed by the National E-Health Transition Authority.

Few details of the planned UHI service have been revealed to date, despite the January 2010 deadline for completion of the project's design and build. The work has been directed by the Australian Health Ministers' Council (AHMC) and funded by the Council of Australian Governments

Although healthcare providers - doctors, pharmacists, community clinics and hospital administrators, in both the public and private arenas - will be issued with highly secure smartcards using PKI-based identity verification, consumers' individual healthcare numbers (IHIs) will be accessed by linking through the old Medicare number.

The stronger credentials for medical professionals will be managed through the planned National Authentication Service for Health (NASH), an extension of Medicare's existing arrangements to securely identify doctors accessing the agency's systems for claiming or payment transactions.

Individual healthcare identifiers have been touted as a key building block in the nationwide shift to e-health systems, with the free-flowing exchange of people's health records set to revolutionise patient care through improved safety and quality outcomes, together with greater efficiencies, cost savings and a wealth of new opportunities through telemedicine, remote monitoring of chronic disease and public health surveillance.

Eventually, the plan is for each person to have an individual e-health record, which holds their personal details; a summary health profile that can be shared with the person's permission between treating doctors; event summaries such as hospital discharge reports, care plans and test results, and a self-care management record where people can add their own material.

But consumer and privacy groups may be disappointed by the barebones approach outlined to The Australian, in response to questions put to NEHTA, Medicare Australia - which is creating the UHI system under contract to NEHTA - and federal Health Minister Nicola Roxon.

It appears Ms Roxon has been mistaken in her recent comments that patients will access their health records through a smartcard.

Instead, doctors or staff members will have to call up a person's shared record via the Medicare number, together with the existing, additional family member number.

"The IHI is simply an identifier that will facilitate the secure transmission of health information," a NEHTA spokeswoman said. "The IHI will predominantly be retrieved using an individual's Medicare number as opposed to a 'look-up' system, but separate security and authentication processes will be put in place regarding the actual use of the IHI in relation to health records.

"If an individual does not have a Medicare card, their healthcare provider will be able to use demographic information to obtain an IHI from the service. A patient will normally be asked to provide only his or her name and date of birth."

This approach assumes Medicare's well-publicised difficulties with data quality - mailing out replacement cards to deceased persons, duplications and other errors, and fake cards circulating in the black market - have been fixed.

Another issue involves ensuring the proper separation of data in the new registration and record databases from Medicare's financial transactions and business operations.

Read much more detail here:

http://www.australianit.news.com.au/story/0,24897,25679209-15306,00.html

The way this whole project is being run reveals frankly an astonishing level of arrogance and failure of technical and public consultation.

NEHTA apparently believes Privacy Impact Assessments should be kept from the public. This is clearly an absurdity and deserves condemnation.

NEHTA has not even got to the stage of even the draftest of legislation which they admit will be needed. With the present government turmoil and hostile Senate what chance of legislation, which seems to be likely to be privacy invasive, getting through in other than geological time?

NEHTA apparently plans to have an operational service available at the beginning of 2010. What seems to be missing are the technical specifications that people who will use the service will need to develop to in order to use the service once it is operational. We have lots of business specifications but not much in the way of technical specifications.

See here for the presently available documents.

http://www.nehta.gov.au/connecting-australia/e-health-id

(Note in passing how most documents are nearly 2 years old!)

I wonder does NEHTA have a plan to pay software developers to interface with their service or is that another unexpected cost they plan to impose.

On the basis of what we all know about the data integrity of Medicare Identifiers who would trust this to be used to assemble and manage a clinical record. I certainly would not. The Medicare ID databases are just not ‘fit for purpose’ in this context (creating an aggregate trustworthy EHR). What is going on here is that we will very possibly wind up with a less than satisfactorily robust individual identifier and over time it will fall into disuse as it causes more misidentification and problems than it is worth.

I am sure additionally NEHTA has vastly underestimated the complexity and cost of issuance, maintenance and deletion of certificates and tokens to 500,000 health professionals. Frankly that is a huge task which is not done properly will also cause more problems than it is worth.

I also wonder who is going to pay to operate this service in the longer term and at what stage will the users be charged a fee for use to recover ‘costs’.

NEHTA needs to get the PIAs, Technical Specs and Draft Legislation out pronto so their plans can be reviewed and assessed publicly to prevent any continuing waste of money and effort. Sneaking around fobbing people off with vague details and timelines is really not good enough.

We need identifiers I believe to make patient records work optimally – but not developed in secret like this.

David.

Tuesday, June 23, 2009

Review of State Health IT Budgets – A Mixed Bag to Say the Least.

We have now seen pretty much all the State Budgets that matter.

First we have NSW.

NSW Health gets $63m IT injection

Karen Dearne | June 16, 2009

NSW Health Minister John Della Bosca has committed more than $603 million to building better health infrastructure this year, with around 10 per cent going to IT projects.

The IT funding falls far short of the $700 million urgently needed to upgrade IT systems across the state's public hospitals before July 2011, as ordered by Special Commissioner Peter Garling in his searing review of the acute care sector.

Mr Della Bosca said the delivery of major IT initiatives to enhance patient services was "also a Government priority over the next four years".

For the moment, however, he allocated $63.1 million in 2009-10 "to upgrade business information technology, including medical imaging and clinical systems across the state".

"The Government is boosting health funding right across NSW to ensure local communities continue to have access to high quality services closer to home now and into the future," he said.

Most of the $603 million will be spent on rebuilding hospitals and regional health centres.

A further $485 million has been allocated to "Caring Together" initiatives, previously announced in March, when the NSW Government made its formal response to the Garling Report.

Rather than spending money on new IT systems to reduce the administrative and planning burden on frontline doctors and nurses, the Government plans to employ 500 clinical support officers, at a cost of $44 million per year, to take over the paperwork.

It will also employ 64 new clinical pharmacists, at a cost of $8.6 million, to improve patient safety by monitoring the use of medications.

More here:

http://www.australianit.news.com.au/story/0,24897,25646141-15306,00.html

This seems to me to be a relatively poor effort from the Health IT perspective. The deployment of more staff rather than enabling technologies shows how little the present NSW government understands about making the system sustainable in the longer term.

The papers refer to “the introduction of state of the art information systems such as the First Net Emergency Department software program” in 2008/09 so this can only be a good thing. (Page 13-6).

Sadly as mentioned in the article the “Caring Together” programme does not seem to really have the Health IT Mr Garling was suggesting.

We also see the following as the only e-Health nominated funding:

E-Health

“As part of its continued commitment to e-Health, the Government will invest $35.7 million over the next three years to continue its support of the National E-Health Transition Authority. This investment will commence with the allocation of $9.4 million in 2009-10.” (Page 13-12)

Oddly there is also this which is not tagged as e-Health (Capital):

“commencement of new Information and Communication Technology programs including the implementation of a new Community Health and Outpatients Information System, the upgrade of infrastructure, and further development of the department’s corporate information systems. These projects will enhance clinical and corporate information management and deliver improved service” (Page 13-15)

All sounds a bit like a refresh rather than new capital!

What I can’t find is what the recurrent expenditure for Health IT is. I suspect that is buried in the Shared Services Area to maximise how opaque it is. Anyone who can provide the figures I would be grateful for a comment!

Next report we have was here:

Health IT gets mixed funding in state budgets

Karen Dearne | June 17, 2009

QUEENSLAND has dug deep to add $270 million to its Health IT spending in this year's budget, while South Australia has performed a surprise U-turn, ripping $42 million from its planned e-health infrastructure program over the next four years.

In the SA Budget, only $8.3 million has been committed to new health ICT projects in 2009-10, down from $12 million in 2008-09, although a further $8 million has been allocated to continue work on a new clinical nursing and midwifery system.

"Savings initiatives" have rubbed out planned expenditure of $9.2 million next year, and $10.9 million, $11.3 million and $10.6 million in the years to 2012-13.

SA Health portfolio details show the foundation IT program has been stripped to just $890,000 next year, from $7 million this year.

No money has been allocated for "minor" technology projects, compared with $890,000 last year; there is also no money for a SA ambulance IT project, compared with $410,000 last year.

Lots more here:

http://www.australianit.news.com.au/story/0,25197,25650119-15306,00.html

I have already commented on South Australia. See here:

http://aushealthit.blogspot.com/2009/06/south-australia-works-hard-to-be.html

The ACT Budget was pretty early and is covered here:

http://aushealthit.blogspot.com/2009/05/aus-health-it-gets-some-facts-wrong-on.html

So we can push on to Queensland.

The key capital parts are here (Budget Paper 3 – Page 83) :

“In 2009-10, $84.5 million will fund provision of health technology equipment that supports the efficient delivery of safe, quality health services.”

And here

“A total of $87.1 million will be invested in 2009-10 in projects across e-Health Clinical Systems and other health systems. These are a series of interlinked projects that will contribute to the objectives of the e-Health strategy in delivering an electronic medical record to support a patient-centric, networked model of care to ensure location-independent delivery of health services. Key highlights of this investment include:

- ongoing statewide rollout of a new Radiology Information System enabling a significant reduction in the time taken for radiologists to view, assess and diagnose medical problems;

- implementation of digital technology for breast screening that will enable faster communication of the results to patients and the potential for improved detection of breast cancer;

- ongoing implementation of an Enterprise Discharge Summary to provide a more accurate care record to consumers and improve communication to General Practitioners; and

- Information and Communication Technology projects to enable secured system access, integration of existing systems and manage reference datasets.

$86.2 million for information and communication technology equipment to replace, upgrade and provide future capacity/capability to support the e-Health strategy and clinical information solutions. This investment incorporates telephone system replacements, network and server upgrades.”

This is all encouraging but again there is a theme of refresh of systems rather than newer ones – allowing that there are a few new ones – The RIS for example.

At least, other than the RIS, most of the planned expenditure is for ongoing programs previously announced. In total there seems to be about $55M for ongoing actual clinical e-Health expenditure. (Page 87)

This level of investment, given the false starts in the past, is really not all that impressive.

For Victoria we had a rather disappointing e-Health outcome.

This was even noticed by the AMA.

AMA Victoria underwhelmed by Budget

5 May 2009.

AMA Victoria has labelled the Victorian Budget “underwhelming”, saying it misses an opportunity for real action.

....

AMA Victoria was particularly disappointed that the Budget fails again to invest in information technology. HealthSMART has been very disappointing, and doctors are still lacking the basic IT tools needed to provide best possible care to patients.

“What’s missing from this Budget is a plan for health. There is no vision of how to care for a growing state’s health needs now and into the future. We need to invest more in training, in capacity, in IT and the drivers of reform.”

.....

“This Budget will see the Victorian health system continue to limp along rather than make great strides in caring for our sick.”

Full commentary here:

http://www.amavic.com.au/page/Media/News/AMA_Victoria_underwhelmed_by_Budget/

I must say the word ‘HealthSMART’ does not seem to appear in the budget papers at all – which I find very odd indeed! Seems like there is a plan to have it just ‘fade away’!

We do however find this:

The 2009-10 Budget also provides:

$27 million over three years for Victoria's contribution to the National E-health Transition Authority to enable it to continue its existing work program (Paper 3 – Page 27)

(7.1M, 9.1M and 10.1M over the next 3 years) Page 315

On Page 323 we find.

National E-Health Transition Authority’s Core Operations

Funding is provided to support Victoria’s contribution to the National E-Health Transition Authority (NEHTA) for foundation work agreed to by the Council of Australian Governments. Funding will support identifier and authentication services to allow the development of a National Individual Electronic Health Record (IEHR) system.

This initiative contributes to the Department of Human Services’ Acute Health Services outputs.

This compares with this from 2007/08

“The hospital sector is an information intense sector increasingly dependent on reliable and up-to-date Information and Communications Technology (ICT) to support delivery of high quality, efficient and patient focused care. The government is investing $77 million over four years and $27 million TEI for new and upgraded ICT equipment to support the HealthSMART system.”

There appears to be about $26M pa for 4 years here but odd it is not mentioned this year.

Now we also have to move on to Western Australia and their eHealthWA programme:

Health Information

“• In 2006, WA Health commenced a 10 year program to implement eHealthWA, a major reform initiative designed to provide a modern, integrated platform to facilitate the delivery of world-class health services. The program aligns with the national eHealth program which aims to provide a national approach and framework for the delivery of information and the way it is used to deliver health services across Australia. In 2009-10, work will be progressed on the implementation of the pharmacy module, the planning and early implementation of a replacement Patient Administration System, and hardware and software technology to support eHealth.

• Currently, health information in Western Australia consists of many discrete ‘islands of Information’. eHealthWA will allow health information to flow regardless of where you interact with the system. It will provide access to information and clinical evidence at the point of care to support effective decision-making. That is, having the right information available to the right person at the right time in the right place. It will also allow information to be collected and analysed to guide management, funding and policy decision-making. Consumers, care providers and health care managers will all benefit from the introduction of eHealthWA.”

What is a bit of a worry is that this section does not mention any figures!

There is also some funds to keep NEHTA going.

It seems last year’s budget had some specific funds:

“This is 4yrs too late, and perhaps longer for many Western Australians. Why not ask the Minister and the IT Executive why the eHealthWA Program penned for 600m over 10yrs some 4 years ago has only just been kicked off? and at that with no more than 5% of the original allocation! This program addresses systems that are some 20yrs old, multiple point systems across hospitals with no way of seeing a holistic summary of service utilisation, no shared health records, no single patient ID, no effective medication management cycle management, a die'ing PC fleet, multiple information portals, some of the worst IT management practices in Australia, the list goes on. Health is very much Information Centric, beds are critical, emergency department spend is important, but we are some 10 to 15yrs behind any modern Hospital environment from an ICT perspective, and this is a significant contributor to enhance health delivery across the state.

Posted by: Bobby of Perth 7:55pm December 29, 2008”

http://www.news.com.au/perthnow/comments/0,21590,24852391-948,00.html

There is a recent presentation from the CIO here:

http://www.aiia.com.au/docs/states/wa/Richard%20McFadden%20Presentation.pdf

Sadly no dollars mentioned!

The whole things gets very high points for vagueness in my view.

Second last we have Tasmania.

From the health budget commentary we find:

“$12.9M over the next three years – including $5.3M in 2009-10 – for information technology advancements to support reform of service delivery. Funded projects include new patient/client administration systems for hospitals and mental health services.”

See here:

http://www.budget.tas.gov.au/ministers-on-the-budget/lara-giddings

This is the detail.

Health Information Technology

Funding of $18.5 million has been allocated over four years from the Infrastructure Tasmania Fund to support the development of integrated health information systems and related infrastructure in the Department to enable and support reform in health service delivery. Funding of $5.5 million is allocated in 2009-10 for the implementation of information technology projects including: a patient administration system ($1.5 million); messaging and identifier systems ($500 000); Mental Health Services Electronic Client Management and Reporting System ($750 000); LAN and Infrastructure Upgrade ($1.0 million); Enterprise Storage Solution ($500 000); Child Protection Information Systems Phase Two ($200 000); and Medical Imaging Project ($1.0 million).

Better than nothing I guess and at least some detail provided.

Interestingly no special mention of NEHTA I could spot.

Last we have the Northern Territory.

Here we find and under the Health and Families Department Budget Highlights.

-> Additional funding of $2 million for continued implementation of eHealthNT initiatives.

Not much really given the budget for the Department was just over $1 Billion.

All in all not a great set of figures for e-Health. Sadly it is virtually impossible to understand what level of recurrent investment is being made. This really would be useful for Governments to provide.

Maybe when we actually start to implement a national E-Health Strategy we can get proper information and co-ordination.

David.