Have just had an e-mail from Dr Eric Browne who has established a new Australian Blog on Health IT.
It is found here:
http://blog.healthbase.info/
Now Eric is way smarter than the average bear and will be well worth reading - not that I have any real idea just where he stands on all the issues I try to address. I am pretty sure his views will be solid, worthwhile and well considered.
David.
Thursday, August 26, 2010
This Discussion on Privacy Is Worth Following Closely. It Has Implications for OZ.
The following appeared a little while ago.
Health IT group drafts privacy recommendations
By Joseph Conn / HITS staff writer
Posted: August 19, 2010 - 12:30 pm ET
A federally chartered advisory work group charged in June with devising recommendations on privacy and security policies to support the government's electronic health-record system subsidy program presented today its near-final list of guidelines to the Health Information Technology Policy Committee.
The work group, known as the privacy and security tiger team, met Monday and released what amounts to a consensus report on its recommendations, said Deven McGraw, co-chair of the tiger team and director of the Health Privacy Project at the Center for Democracy and Technology, a Washington think tank. The Health IT Policy Committee advises the Office of the National Coordinator for Health Information Technology at HHS.
According to the tiger team's draft document posted on the HIT Policy Committee's website, the team's recommendations are based on "fair information practices," a now globally accepted set of privacy policy guidelines that stems from a 1973 report by the U.S. Department of Health, Education and Welfare.
"All entities involved in health information exchange—including providers and third-party service providers like Health Information Organizations (HIOs) and intermediaries—follow the full complement of fair information practices when handling personally identifiable health information," according to the tiger team proposal.
One fair-information practice incorporated by the tiger team in its recommendations is the requirement that there should be "openness and transparency about policies, procedures and technologies that directly affect individuals and/or their individually identifiable health information."
Another fair-information practice cited in the tiger team recommendations involves individual choice: Individuals, it notes, "should be provided a reasonable opportunity and capability to make informed decisions about the collection, use and disclosure of their individually identifiable health information." (This is commonly referred to as the individual's right to identifiable health information exchange.)
But the tiger team, while pronouncing that patients should have a choice, also made recommendations that either did not support or limited patient choice under an array of common healthcare scenarios.
For example, the tiger team recommended that healthcare providers—as they do now with paper records—bear the responsibility of maintaining the privacy and security of EHRs. Providers that exchange identifiable patient information "should be required to comply with applicable state and federal privacy and security rules," the team wrote. But for what the tiger team members define as "direct exchange" between a patient's treating providers, the tiger team recommended that patient consent not be required, just as it is no longer required under the privacy rule pursuant to the Health Insurance Portability and Accountability Act of 1996.
Nor should a patient consent requirement be triggered by the direct exchange of particularly sensitive healthcare information.
Lots more here:
http://www.modernhealthcare.com/article/20100819/NEWS/100819905/1029
Now consider what we have from NEHTA – From their 2009 Privacy Fact Sheet.
Six privacy tenets for e-health
1. Commitment to privacy
A commitment to privacy is the starting point for NEHTA initiatives involving the collection and handling of personal/health information.
NEHTA recognises that:
• Privacy is an integral component of a secure and interoperable e-health environment;
• It must be embedded in the design process;
• It must comply with all legal requirements; and
• It should promote privacy-positive approaches.
2. Health-specific focus
All NEHTA initiatives involving the collection and handling of personal/health information are focused on obtaining measurable benefits for individual health consumers and health providers as well as ensuring the improvement of public health outcomes.
3. Individual participation
All relevant NEHTA initiatives will seek to maximise the degree of control individuals may exercise over the collection and handling of their personal/health information.
4. Clarity & transparency of purpose
All NEHTA initiatives involving the collection and handling of personal/health information will seek to articulate their intended purposes transparently and clearly.
5. Data quality, audit & security
All NEHTA initiatives involving the collection and handling of personal/health information will ensure that robust data quality, audit and security measures are put in place.
6. Governance arrangements
All NEHTA initiatives involving the collection and handling of personal/health information will be subject to appropriate governance arrangements designed to ensure, amongst other things, that these privacy tenets are supported and progressed into, and beyond, the implementation phase of each initiative.
----- End Extract.
I don’t know about you but there seems to be a lot of ‘will seek to’, focusing on’ and ‘subject to appropriate’ rather that hard edged precision about what is actually going to be done.
In the past NEHTA has argued that it might just be a bit ‘too hard’ to provide the degree of control over their personal information at least a substantial minority of the population really want.
Just what will be done and how it will work needs to be fully clarified and properly consulted before any technical designs are developed or tenders issued.
David.
Wednesday, August 25, 2010
Is This A Credible Study or a Bit of Spin? You Be the Judge.
We had an interesting release appear just before the election.
Wednesday, August 18, 2010
Another study boosting broadband
Actually it doesn't even mention the NBN, but that's the impression you are meant to get..
Minister for Broadband, communications and the digital economy
TELEHEALTH BENEFITS BETWEEN $2BN - $4BN PER YEAR
Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy said a new report by Access Economics estimated the benefits of telehealth to Australia could be between $2 billion and $4 billion a year.
The report, Financial and externality impacts of high speed broadband for telehealth, found telehealth offers the potential for significant benefits to Australia’s population, especially for people who are elderly or who live in rural or remote communities.
“Telehealth including online consultations, electronic health records, in-home care, and online health education will not only open up new possibilities in health care delivery, but will have significant savings on the health budget,” said Senator Conroy.
The report found one of the reasons telehealth in Australia has been held back is the lack of high-speed broadband, particularly in rural areas.
The report noted that even where high-speed broadband was available, it often had slow upload speeds and reliability could be patchy.
“The National Broadband Network will fix these issues once and for all,” Senator Conroy said...
More here (including a neat display of the 30 page report)
http://petermartin.blogspot.com/2010/08/anther-study-boosting-broadband.html
Nice one Peter Martin!
The report is headed as follows:
Financial and externality impacts of high-speed broadband for telehealth
June 2010
The Executive Summary makes for some very interesting reading.
Executive Summary
The Department of Broadband, Communications and the Digital Economy (DBCDE) requested Access Economics to report on the financial and externality impacts of ubiquitous high-speed broadband in relation to health and aged care costs, in particular the impacts that would result from increased use of:
- tele-medicine for remote consultations;
- remote home-based monitoring of chronic-disease patients and the aged; and
- remote training of medical professionals (using haptics); while
- excluding the benefits of personalised electronic health records (EHRs).
The report was required to:
- identify and articulate the nature of the impacts;
- determine a methodology to estimate these impacts, both on a net present value (NPV) and an annualised cash basis; and
- provide high-level estimates of the impacts.
Tele-health offers the potential for significant gains to Australia’s population, especially for people who are elderly or who live in rural or remote communities. Unfortunately, however, despite a myriad of tele-health studies, it is difficult to measure such benefits. Tele-health studies to date have been constrained by poor economic and health data and methods.
Most studies have, however, shown that tele-health is cheaper and faster (and at least equally effective) compared to transporting patients or health care providers over large distances.
Thus, it should be possible to estimate time and money savings at a national level, if not health gains.
- There does not appear to be sufficient data to estimate the benefits of online training for rural / remote medical professionals.
Using a combination of a national level United States (US) study into one aspect of tele-health (tele-consulting) and a national level Australian study that was mostly based on EHRs but had tele-health components, Access Economics estimates that steady state benefits to Australia from wide scale implementation of tele-health may be in the vicinity of $2 billion to $4 billion dollars per annum.
----- End Extract
It would have to be said that this is one of the most vague, assumption laden and non coherent pieces of work I have ever seen. Access Economics themselves admit that, and make it clear without a lot more work, their rather vague set of figures should be treated as ‘guesstimates’, if that.
A close reading makes on think this is little more than a proposal to do a lot more detailed modelling while admitting that comparable useable information from Australia is essentially non-existent and only slightly better in the US.
It is also clear that even if the benefits were accurately assessed, which they clearly can’t be on the basis of what is offered in this report, then the impact of more or less bandwidth being available is utterly unknown and totally unpredictable.
For Senator Conroy to claim the proposed National Broadband Network (NBN) is an answer to all the issues identified here and to claim these findings in anyway justify the $43B investment in the NBN is clearly, in my view, laughable. It is this type of nonsense generalised political claim that undermines the case to sensible e-health implementations which have a strong supportive evidence base – including aspects of much that is mentioned in this report as well as EHRs.
Of course, one also wonders why a report completed in June, 2010 suddenly appears a day or so before an election?
Telehealth can be wonderful, for example there is little doubt tele-psychiatry, referring doctor to specialist telemedicine and remote home monitoring are valuable useful technologies! However none are cost free and all need to have serious investment and planning to succeed,
I really wish there was more rigour in the debate in the e-Health space.
David.
Tuesday, August 24, 2010
This Looks Like Desperate Pre-Election Promising To Me! How Credible Is It?
The following leapt out just before we all went to the polls
First places in Australia to get E-Health
Brisbane, the Hunter Valley and Melbourne’s eastern suburbs will be at the cutting edge of cyber health advances as the first areas in Australia to use electronic health records.
These three sites will lead Australia as the Gillard Labor Government takes the health system into the 21st Century by building an electronic health record system that improves patient care and the safety and efficiency of the health system.
“This is an important step forward in allowing online access to health records for each Australian that chooses to,” Minister for Health Nicola Roxon said.
“Patients will control what goes onto their record and who can access their information.
“Brisbane, Melbourne and Hunter Valley residents who agree to participate at one of these sites will be at the forefront of this exciting new initiative.”
“This builds on the Prime Minister’s announcement yesterday that Medicare rebates will be provided for online consultations across a range of specialities for the first time,” Ms Roxon said.
Each of the e-health sites announced today – GPpartners (QLD), GP Access (NSW) and Melbourne East GP Network (Victoria) – was chosen because they already have strong e-health capability and support within their communities.
In addition to e-health records, these three sites will use health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.
These sites will help lead the way in developing and informing future planning of the system, improving technology and identifying what works well and what could work better. The two year investment in the three sites will be up to $12.5 million in total.
The state governments of the three states will also join this partnership to drive e-health forward in these communities. The Queensland Government has committed $1.2 million of in-kind support to GP Partners. The NSW Government has also committed $1.2 million to support the initiative and will work with the National E-Health Transition Authority to integrate their Healthelink pilot program with the national rollout.
If re-elected, the Gillard Labor Government will call for expressions of interest to identify further lead implementation sites in the near future, and significant funding will be available to support this process.
The e-health system will also benefit from the roll out of the National Broadband Network.
More here:
http://alp.org.au/federal-government/news/first-places-in-australia-to-get-e-health/
There is coverage here:
Online trial of e-health records has begun
- Karen Dearne
- From: The Australian
- August 17, 2010
HEALTH Minister Nicola Roxon is preparing to announce the first sites for her $466.7 million personally controlled e-health records program.
"The government will soon make an announcement on where in Australia patients will be first to have access to PCEHRs," she said yesterday.
"This is an exciting next step as the Gillard Labor government builds the health system we need for the future."
The Australian can reveal the Health Department signed contracts with three GP divisions -- Hunter Urban in NSW, Melbourne East in Victoria and GP Partners in Brisbane -- to "develop lead implementation site" proposals in mid-July.
These divisions all have expertise in health IT, and each received $100,000 for the work.
The National E-Health Transition Authority has a $300,000 one-year contract to co-ordinate the project.
More here:
and here:
Labor launches e-health records
$12.5 million of funding provided over two years to three GP communities in Queensland, NSW and Victoria
- James Hutchinson (Computerworld)
- 17 August, 2010 12:15
Sites in Brisbane, the Hunter Valley and Melbourne's eastern suburbs will receive $12.5 million over two years as the starting point for the Labor party’s proposed $466.7 million e-health records policy.
Three general practitioner networks - GPpartners in Brisbane, GP Access in the Hunter Valley and the Melbourne East GP Network - will receive the funding to implement both the e-health records and unique health care identifiers for patients, providers and hospitals, as well as electronic discharge summary and referrals systems.
Funding for the e-health project was earmarked in the 2010/2011 Federal Budget, but thus far no details have been released as to how that money would be spent, or what standards would be adopted for inter-compatibility of e-health record systems, confusing industry groups and healthcare providers. The government organisation charged with implementing the systems, the National eHealth Transition Authority (NeHTA) has largely remained silent on the topic.
Health minister, Nicola Roxon, has suggested that under Labor’s plan, Medicare Australia may be considered to host the e-health record data in addition to the unique identifiers it has already implemented and assigned to 97 per cent of Australians.
It is also known that the e-health records will be voluntary and personally controlled by the patient, allowing them to determine what information is visible to healthcare providers, and which providers have access to the record. The records are also likely to tie into a new $392.3 million initiative that would see the Government issue Medicare rebates for medical consultations conducted online over the National Broadband Network (NBN).
Of the three clinics chosen, the Brisbane-based GPpartners has been the most active in the e-health arena, implementing its Health Record eXchange (HRX) in 400 providers including Queensland’s Metro North Health Service District over the last five years. As at February this year, the implementation had seen a 26 per cent reduction in the cost of administering patients, with 1320 patients having been registered on the system by June 2008.
In a letter to local newspaper, Northside Chronicle, GPpartners chair, Dr Henry Brian, dismissed the privacy concerns that have dogged the rollout of e-health records nationally, saying that a system would simply save lives.
GP Access in the Hunter Valley provides internal administrative services to general practitioners in its network. The Melbourne East GP Network currently runs an e-health Practice Incentives Program (PIP) using the NeHTA-compliant Argus secure messaging protocol.
In addition to the $12.5 provided by the Federal Government, the Queensland and NSW State Governments will each commit $1.2 million to support their respective GP communities, with NSW pledged to integrate its Healthelink pilot program with the national rollout through NeHTA.
More here:
http://www.computerworld.com.au/article/357235/labor_launches_e-health_records/
and here:
Labor announces first e-health record sites
By Josh Taylor, ZDNet.com.au on August 17th, 2010
Residents of Brisbane, Melbourne and the Hunter Valley will be the very first to get electronic health records, Health Minister Nicola Roxon has announced today.
"This is an important step forward in allowing online access to health records for each Australian that chooses to," Roxon said in a statement. "Patients will control what goes onto their record and who can access their information."
"This builds on the Prime Minister's announcement yesterday that Medicare rebates will be provided for online consultations across a range of specialities for the first time," she added.
According to Roxon, GPpartners in Queensland, GP Access in New South Wales, and Melbourne East GP Network in Victoria were chosen for the roll-out, as they already had e-health technology available.
The government has outlined $12.5 million in funding for the three sites, which comes from the $466.7 million investment the Federal Government outlined in this year's budget.
The Queensland Government has also committed to providing GPpartners with $1.2 million in funding, while the New South Wales Government has promised to chip in $1.2 million to the roll-out. NSW will work to integrate its Healthelink pilot program with the National E-Health Transition Authority's national roll-out.
More here:
http://www.zdnet.com.au/labor-announces-first-e-health-record-sites-339305266.htm
as well as here:
E-Health records become a reality
Three sites across Australia to take part in GP network trial
- Renai LeMay (CIO)
- 17 August, 2010 17:51
The Federal Government's $466.7 million e-health records scheme will shortly start to surface in patients’ lives in the real world, with Health Minister Nicola Roxon announcing three trial general practitioner networks that will start to implement the technology.
Labor allocated the money in the last Federal Budget after years of the health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients' records and achieve clinical outcomes.
The Opposition, however, has pledged to cancel the scheme.
The three GP networks will be GPpartners in Brisbane, GP Access in the Hunter Vally in New South Wales and the Melbourne East GP Network in Victoria.
"This is an important step forward in allowing online access to health records for each Australian that chooses to," said Roxon in a statement, noting the networks were chosen because they already have strong e-health capability within their communities.
More here:
http://www.cio.com.au/article/357267/e-health_records_become_reality/?eid=-601
and last here:
Labor unveils e-health records trial sites
- Karen Dearne
- From: Australian IT
- August 17, 2010
LABOR will rely on a Howard government e-health project to kickstart its $467 million personally controlled e-health records strategy.
Health Minister Nicola Roxon has confirmed GP Partners in Brisbane, GP Access in the NSW Hunter Valley and Melbourne East will receive $12.5 million in total funding to act as pilot sites over the next two years.
The Australian today revealed the three GP divisions had been selected as lead implementation sites, under a project led by the National E-Health Transition Authority.
Ms Roxon said the three lead sites "will be at the cutting edge of cyber-health advances".
They will also trial the new healthcare identifiers regime, and will be first to electronically send hospital discharge summaries and referrals using national specifications, she said.
The Queensland government has already committed $1.2m in in-kind support to GP Partners, while NSW will commit the same amount for the Hunter trial.
More here:
So suddenly by giving $100,000 to 3 divisions and having NEHTA co-ordinate for $300,000 we can have e-health records up and being piloted!
I am sure there are all fully standardised, data and content interoperable implementations that have just suddenly sprung into existence fully functional, fully privacy complaint and so on!
If only it was so easy, why was it not done years ago?
I look forward to the independent evaluations of what has been obtained for the total $12.5M and the matching State contributions. I would be willing to bet they never reach the public domain, just like the evaluation reports of most of the HealthConnect expenditure – and yes I do know there was an obfuscatory summary report released ages ago!
From this report it hardly looks like we have a co-ordinated strategic set of projects. Much more like an emergency political fix to me!
E-health measures progress as minority government looms
Announced funding for e-health trial sites will yield a proposal by the end of September, though the fate of the program remains uncertain
- James Hutchinson (Computerworld)
- 24 August, 2010 08:0
Election analysts predict that it could take as much as two weeks to decide the fate of the Australian Government, but planned e-health measures are expected to progress in as little as a month.
The $12.5 million provided by the Labor party during the election campaign to three pilot sites in Queensland, Victoria, New South Wales, is expected to yield a proposal for the implementation of voluntary, personally controlled e-health records on a national scale by the end of September.
NSW and Queensland state governments each committed a further $1.2 million in funding to the program, amounting to $14.9 million for the implementation of records.
The three sites - GPpartners in Brisbane, GP Access in the Hunter Valley and the Melbourne East GP Network - are in the process of collaborating on the proposal, which will see each provide specialised technologies and technical support to stakeholders.
GPpartners in Brisbane, for example, has been trialing its Health Record eXchange (HRX) software in 400 providers over the last five years, putting it in the best place to provide the software itself as well as the web-based interface required by both clinicians and patients to control the records.
GP Access, which provides services to 400 clinics on NSW’s Central Coast, has rolled out generic secure messaging software to 98 per cent of clinics in the area, allowing different systems to communicate and send referrals between practitioners and specialists. The GP network was a finalist in the Australian Telecommunications User Group’s (ATUG) national awards in 2006 for the proliferation of managed broadband services to GP clinics across the region and has aided some clinics in going completely paperless.
The Melbourne East GP Network has also facilitated the roll out of a secure messaging system based on Argus, as well as a shared referrals and health records system.
GP Access IT team leader, Jason Ruminek, told Computerworld Australia that the organisation was in a “holding pattern at this stage” over the funding, but that the project was still progressing.
Lots more here:
Is anyone else surprised that the flagship Shared EHR in the Northern Territory did not get some funds?
David.
Monday, August 23, 2010
NEHTA’s Blueprint – Do We Learn Anything New or Useful?
The following appeared on the RSS feed a few days ago
NEHTA Blueprint
The NEHTA Blueprint is a reference document intended to familiarise readers with major e-health capabilities that NEHTA is promoting for national adoption.
The Blueprint brings together and summarises the key design documents from across the NEHTA work program into a single document, explains how they fit together and how they fit within the broader strategic direction.
The Blueprint covers a range of capabilities including identifiers for individuals, providers and organisations, authentication, secure messaging, clinical terminologies, supply chain, pathology requests and reports, diagnostic imaging requests and reports, medication management, referrals and discharge summaries. The Blueprint is a living document and will be periodically updated as the NEHTA work program evolves.
This Blueprint is intended for an audience that is actively working in e-health. Potential readers include executives, policy officers, clinicians and technical staff.
If you have any comments or questions about the Blueprint, please direct your questions or feedback to: architecture@nehta.gov.au .
Blueprint
Download here: NEHTA Blueprint (20.87 MB)
Blueprint Sections
The Blueprint is a large document. Readers who wish to download the document in separate parts, a set of links have been provided
- Blueprint Part 1 (3 MB) (Chapters 1 and 2 - Introduction and Blueprint Overview)
- Blueprint Part 2 (6.81 MB) (Chapter 3 - Foundations)
- Blueprint Part 3 (8.26 MB) (Chapter 4 - Solutions)
- Blueprint Part 4 (3.34 MB) (Chapter 5, 6, 7, 8 - Future Capabilities, Architecture, Change and Adoption, Risks and Challenges)
Frequently Asked Questions
A set of frequently asked questions can be found here: Blueprint FAQs (63.98 kB).
The announcement is here:
http://www.nehta.gov.au/about-us/nehta-blueprint
As you would expect the there has been an enthusiastic welcome from at least one quarter!
NEHTA Blueprint online
Not quite sure what’s happening with ehealth? NEHTA has just published its Blueprint - “a reference document intended to familiarise readers with major ehealth capabilities NEHTA is promoting for national adoption”.
.....
Recommended for people writing in The Australian in particular!
More enthusiasm and excitement here!
http://www.ehealthcentral.com.au/2010/08/nehta-blueprint-online/
Well where does this all get us?
First we need to be clear that this document is first a listing of the “major ehealth capabilities NEHTA is promoting for national adoption”. It is not a list of current outcomes it is what is being promoted!
Second there are some interesting comments in the draft Frequently Asked Questions (FAQ).
Examples are:
“Q: Who should read the Blueprint?
A: This document is intended for an audience that is actively working in the e-health area within Australia. It is designed to be a reference document used to promote understanding of all elements making up the current NEHTA e-health work program, and provide guidance to more detailed documentation. Potential readers include executives, policy officers, clinicians, reference group members and technical staff.”
It is a big stretch to imagine any executives digesting a 200+ page document – despite all the pictures
“Q: When will the e-health products in the Blueprint be rolled out?
A: NEHTA is currently collaborating with all States, Territories, the Federal government and the private sector to find opportunities for early adoption of ehealth capabilities that align both the national strategy and with local priorities and programs of work.
In these collaborations, ownership and priorities for implementation always remains in control of the local project sponsor(s). NEHTA’s role is to work with local project teams and facilitate access to specialist knowledge about NEHTA specifications and national infrastructure.
The majority of change and adoption activities will be undertaken and managed at local and regional levels across the Australian health system. There is a need, however, for national strategies to accelerate the adoption of e-health in Australia to a tipping point as quickly as possible. Once a tipping point level of participation has been successfully achieved, other mechanisms will be considered to sustain continued growth in participation by healthcare providers.”
Translation – we are looking around for local areas of activity we can help with but don’t actually have money etc to contribute.
Also we need national adoption strategies but we are not doing it ourselves and need to consider mechanisms to have this happen!
“Q: What about personally controlled electronic health records?
A: As part of the 2010/11 federal budget, in May 2010, the current government announced a $466.7 million investment over two years in to a Personally Controlled Electronic Health Record system to support the National Health and Hospitals Network. Personally Controlled Electronic Health Records (PCEHR) are discussed briefly in the Blueprint and the section will be updated once more information is available.”
We know little more than we read in the NHHRC Reports and the press about this. Amazing the most lavishly funded e-Health initiative ever seen in Australia and NEHTA is not really seriously engaged or involved months after the announcements. One might a hoped DoHA and NEHTA might be actually talking from the get-go on all this. Seems not!
I don’t plan to comment on the whole document – but this section really stood out (Page 8 of consolidated document)
“The implementation of this strategy (The NHHRC Strategy) will require:
• Making sure the appropriate drivers are in place to support widespread adoption of e-health. This includes setting up a trusted approach to governance to deliver a shared vision based on a common strategy, thus ensuring that the benefits and outcomes are aligned with a mix of policy and regulatory drivers, such as claims and incentives and accreditation requirements;
• Collaboration with a wide range of primary/community based care organisations, acute/post acute care organisations, and other bodies that promote better self managed care of individuals;
• Development of national infrastructure services to support healthcare identifiers, security, location and other services (e.g. supply chain), as well as standards and solutions for key healthcare processes in care coordination, medications management and diagnostic services;
• Collaboration with a range of IT vendors who support healthcare; and
• Collaboration with government and privately operated online service providers, such as messaging solution providers, prescribing solution providers and imaging services.”
From where I sit and what I am told from all sides each of these points could do with a very substantial greater effort!
There also seem to be no clear dates for achievement of anything – just vague discussions of tipping points for adoption.
A classic example of this is the National Authentication Service for Health (NASH) Here we are told we are up to the design phase – and then, after a few pages – told no more information is available! What is going on here we can only wonder?
Overall, reading through I am left with two major impressions. First because of a lack of clear national leadership and governance of e-Health, NEHTA actually has no clear idea of how the get there (their future states) from here (the present states).
Second this document is much more a list of ‘gunna’s rather than actual blue-prints for steady progress. There is still so much in this document that is ‘will deliver.’ The classic is here (Page 15).
“Over the next three years, the National E-Health Transition Authority (NEHTA) will deliver key components of the National E-Health Strategy, endorsed by Australian Health Ministers in late 2008.”
Is it another 3 years we have to wait for delivery?
I do note in passing this is meant to be a ‘Draft for Consultation’ but that no date is given to get back to them. Additionally it surprising just how slow the development of the document was (took over a year – see page 7). Does NEHTA have no urgency for any of this?
David.
Note many of the comments on this post – and the post itself also bear directly on this document.
See here:
http://aushealthit.blogspot.com/2010/08/dr-andrew-mcintyre-blogs-on-future-for.html
D.
Sunday, August 22, 2010
Dr Andrew McIntyre Blogs on The Future For NEHTA in A New Political World.
This has just been posted on the Medical Objects Web Site:
e-Health in Australia – Time to actually move forward!
Well we have had the election and there is no clear winner but it appears that the Rudd/Gillard government is the loser. eHealth is up for some reassessment and it certainly needs some.
From all reports $5 Billion of taxpayers money has been spent over the last 10 years and we have little to show for it. 10 years is long enough for any reasonable plan to bear fruit and there is clearly some fundamental flaw in the methodology.
The decision to purchase a SNOMED-CT license, and a Certificate Authority is the only positive I can find. We do have a Secure messaging standard, but it is flawed by the fact that it really depends on Nehta “NASH” service for suitable certificates rather than working with the existing Medicare certificates. (and NASH is vapour ware) Virtually every general practice has Medicare certificates as part of the PIP program and the reason that the secure messaging standard was not designed to work with them lies with the dysfunctional relationship between Nehta and Medicare.
Dysfunctional organisations seem to be at the heart of the matter. We have not had one organisation for 10 years, but about 4 or 5 each of which has been rebadged and restarted only to repeat the same mistakes. That mistake, or the core of it is the idea that they have to “solve” the problem and produce software. Government is hopeless at doing this, indeed most large organisations are hopeless at producing software and large projects tend to fail. What we need is government to provide governance to move the industry forward rather than trying to do the heavy lifting. After 10 years the things that were working at the start are still working and all the things that are working are based on consensus standards. What we need is governance to comply with those standards and progress the standards in an incremental way. Currently we see much talk of Nehta inventing standards and despite some very capable people inside Nehta this is doomed to failure. Standards have to be created by consensus, as then the industry will engage with the painful standards process in order to prevent silly ideas becoming a standard and to fix errors where they occur. They will only engage when they know they have a duty to comply with the standards and this is where the lack of governance is failing us.
The standards process has become orphaned because Nehta have said they will be dictating the path, and they have failed to produce any clear path. More recently they have tried to steam roll standards and this is also likely to fail as without adequate review the standards will be poor.
Out there is the real world, which is the world that Medical-Objects inhabits, we see significant advances in communication with the number one obstacle being poor standards compliance. Because of a lack of governance large vendors feel that they can flout the standard and dictate the formats though sheer market size. Because of a lack of compliance anything that does work is fragile because it is never quite right, but has to be wrong in exactly the right way in order for it to work.
The dreams of the connected health landscape are often formulated by people with no knowledge of the importance of the lower levels. We can connect to the whole world of internet services because of compliance with the invisible things like tcp/ip and http standards and not because some middle manager dreamed of the internet. The dreams of a connected eHealth world rely on applications supporting the creation and consumption of high quality, standards compliant messages and not on the glossy pdfs produced by Nehta.
I don’t think we need Nehta, the states are not the eHealth leaders in this country and Nehta was setup as an uneasy alliance of the states, many of whom ignore Nehta anyway. What we need is good governance and a focus of standards compliance of all the applications that make up the landscape. There does need to be funding of the standards process and there needs to be a mechanism for providers of healthcare to pay to buy standards compliant software, which is built properly will be more expensive than they are paying now. However, the money they are saving is working against the big picture of a connected landscape and this is where governance and some well directed funding could make a huge difference. If every health application was required to be standards compliant we would see an enormous spike in interest in the standards process and the consensus process could be resuscitated for its premature death and we could start moving forward one level at a time.
The big bang process has failed, as it was bound to do and we need a return to proven paths. The cost would be a fraction of what was planned and the results, though slow would be much more solid. The tortoise is still in the race, it’s time to stop trying to follow the scatterbrain hare!
The blog is found here and is cross posted with permisson:
http://blog.medical-objects.com.au/?p=65
It will be fun to watch the apoplexy over on the NEHTA Sponsored blog!
Enjoy.
David.
Weekly Australian Health IT Links – 22 August, 2010.
Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
General Comment:
Well all I can say is that bigger forces are now in play and we will now simply need to see how it plays out before any possible impact on e-Health in OZ becomes apparent.
Those in the know say it will be a week or so before things become clear – so for now I think we will just wrap up the news and await events! The fate of the promises from both sides now seem to be in limbo.
I just checked out the policy from the Greens – and as far as I can tell no mention at all of e-Health. (The site lacks a search function I can find)
http://greens.org.au/policies/care-for-people/health
I wonder what that might mean?
I popped in a non e-Health article at the bottom just to allow us all to keep some perspective on things.
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Reality of national e-health moves fall short of promises
- Karen Dearne
- From: The Australian
- August 17, 2010
LABOR came into office with Health Minister Nicola Roxon promising to put e-health back on the agenda. She has failed.
What we have got is a healthcare identity number for every resident, but it will be years before doctors can even access the number, except by phone, let alone use it in any meaningful way.
Ms Roxon may have learned you can't make software work by waving a ministerial direction, but there's not much else to show for $98 million.
Medicare has assigned a 16-digit unique identifier against every record in its database -- surely a very straightforward IT task -- and as a result may, over time, clean up its dirty data.
Failure to consult means software developers are only now beginning to build interfaces with the system -- which has never been tested in the real world.
The twin healthcare provider identifier system is in meltdown -- with the process reportedly plagued with errors -- long before it expands to capture the details of some 500,000 never-before registered allied providers.
Right now, it can't even deal with the smaller number of GPs and specialists who are well-known through professional processes. Work hasn't even begun on the separate identifier for health IT service providers -- cobbled together because existing services had been overlooked in the regulations.
The key control system, the National Authentication Service for Health, is yet to appear on the starting blocks.
Note: This is a long article that is well worth a read – I would be interested in reactions to what is being said – now we are post election and in limbo!
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Telemedicine gets a healthy prognosis
- Adam Cresswell, Health Editor
- From: The Australian
- August 17, 2010
DOCTORS are providing about 2200 online consultations a year through the University of Queensland's Centre for Online Health in Brisbane.
The centre, which uses video to link specialists to patients thousands of kilometres away, is one of a handful in the country that have the facilities, and its services are only possible because the doctors at the centre and with the patient are paid a salary by Queensland Health, which also funds the technology involved.
The centre's deputy director, Anthony Smith, predicts the number of online consultations will jump if Labor wins the election and releases its promised funding for online consultations from July 1 next year.
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Labor unveils e-health records trial sites
- Karen Dearne
- From: Australian IT
- August 17, 2010
LABOR will rely on a Howard government e-health project to kickstart its $467 million personally controlled e-health records strategy.
Health Minister Nicola Roxon has confirmed GP Partners in Brisbane, GP Access in the NSW Hunter Valley and Melbourne East will receive $12.5 million in total funding to act as pilot sites over the next two years.
The Australian today revealed the three GP divisions had been selected as lead implementation sites, under a project led by the National E-Health Transition Authority.
Ms Roxon said the three lead sites "will be at the cutting edge of cyber-health advances".
They will also trial the new healthcare identifiers regime, and will be first to electronically send hospital discharge summaries and referrals using national specifications, she said.
The Queensland government has already committed $1.2m in in-kind support to GP Partners, while NSW will commit the same amount for the Hunter trial.
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http://www.6minutes.com.au/articles/z1/view.asp?id=522275
Immunisation register and incentives needed
by Jared Reed
The costs of creating and maintaining a whole of life immunisation register would be made more affordable by the move towards e-health, and should therefore proceed, says the AMA.
The register would allow GPs and other health professionals to know for certain which vaccines a patient had received over their lifetime, and would avoid wastage by duplication. It would also provide important data about herd immunity, says AMA vice president Dr Steve Hambleton.
“What GPs are missing ... is a mechanism for confirming immunisation status for anyone over the age of eight,” he told the National Immunisation Conference from the Public Health Association of Australia in Adelaide today.
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http://blogs.crikey.com.au/croakey/2010/08/19/some-clever-ideas-we-should-steal-from-the-us/
Some clever ideas we should steal from the US
August 19, 2010 – 9:28 am
I’ve written an analysis of health election debate and policy, which has been published today at ABC’s The Drum. It draws upon some of the discussion that Croakey has been hosting in recent weeks. Thanks to all those who have been contributing.
Also a particular thanks to Associate Professor Mavis Duncanson at Notre Dame University in Sydney, who suggested that this election manifesto from the Public Health Association of NZ might be a useful starting point for such an analysis.
Meanwhile, in part 13 of our election series, health policy analyst Dr Lesley Russell, looks at where Australia can learn from the US on health reform. This post is from a speech given at the Australian Financial Review’s national health conference on August 17.
This post is considerably longer than Croakey’s usual offerings but I thought it worth leaving in all the detail. I hope you find it informative…
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http://www.nehta.gov.au/e-communications-in-practice/epathology
e-Pathology
e-Pathology
e-Pathology aims to enable a nationally endorsed consistent and secure exchange of pathology information across the healthcare sector in an agreed approach using standardised formats.
Approach
NEHTA is working with the healthcare sector to understand current technologies, business processes and standards to develop agreed specifications or guidelines to align systems across the sector.
Benefits
e-Pathology facilitates the development of a national approach to pathology services creating more effective, efficient and safer patient care. This national approach will also promote greater continuity of care and enable increased responsiveness across the pathology sector.
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http://www.computerworld.com.au/article/357264/medtech_scores_nz_e-health_project/
Medtech scores NZ e-health project
- James Hutchinson (Computerworld)
- 17 August, 2010 16:36
ASX-listed e-health provider Medtech Global Limited (ASX:MDG) has secured a $1 million deal to provide software for an “important national health project” for New Zealand's Ministry of Health.
The tender, the details of which have remained commercial-in-confidence, would see Medtech’s New Zealand subsidiary and New Zealand Post subsidiary, Datam, jointly provide software and services for a minimum seven years with a potential three year extension. Datam will provide support, maintenance and development throughout the project.
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http://www.zdnet.com.au/e-health-just-like-online-banking-roxon-339305362.htm
e-health just like online banking: Roxon
By Josh Taylor, ZDNet.com.au on August 19th, 2010
Accessing your personal electronic health record via an online portal in 2012 will be just like using online banking, according to Health Minister Nicola Roxon.
"The actual design is still to be developed but the easiest way to think of this is to think about online banking, with clear information like allergies and medications upfront," she said during an online chat on The Australian's website this afternoon. "But you control access and information is very secure."
Labor has allocated $466.7 million in this year's Federal budget to deliver e-health over the next two years. Earlier this year Roxon set the deadline for the portal to be ready by July 2012. She said today that a patient portal used by GP partners in Brisbane could be the prototype for the national system.
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Live Q&A with Nicola Roxon
- Fran Foo
- From: Australian IT
- August 18, 2010
FEDERAL Health Minister Nicola Roxon has been driving Labor's e-health agenda as part of the government's wider health reform ambitions.
In December 2006, the Labor member for Gellibrand became opposition health spokeswoman and retained the portfolio when Labor won office in 2007.
She's backing a personally controlled e-health records framework expected to come to fruition by 2012 at a cost of $467 million.
Read the Q&A from this link.
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Coalition eyes 'ID card'
- Karen Dearne
- From: Australian IT
- August 20, 2010
THE loathed Coalition health and welfare Access Card is suddenly back on the agenda.
Opposition treasury spokesman Joe Hockey is proposing to use the mandatory new healthcare identifiers to monitor people on benefits.
A spokeswoman for Mr Hockey said the idea was not Coalition policy, but would be considered by an Abbott government.
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http://www.zdnet.com.au/coalition-confused-over-national-id-card-339305384.htm
Coalition confused over national ID card
By Darren Pauli, ZDNet.com.au on August 20th, 2010
The Liberal Party is in a state of confusion over whether it would deploy national identifiers to keep tabs on people receiving health and welfare benefits, should it win government.
Shadow Treasurer Joe Hockey told The Age today that the failure of the Howard Government's Access Card had been his biggest political regret and that he would "absolutely" re-introduce a similar scheme should his party win the election. The scheme would require "fair dinkum consolidation" of government IT agencies.
"Whether you go a card or not, I don't know. Everyone has a Medicare card already, but that's old technology. We're spending $140 billion to $150 billion a year on health and welfare, but what productivity improvements have there been in service delivery? None," Hockey told The Age.
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Surgically enhanced screensaver: telemedicine
- Karen Dearne, IT writer
- From: The Australian
- August 21, 2010
FOR some stroke victims it really does matter if you're in a big city or out bush.
That's because doctors have a short three-hour window to determine if a stroke was caused by a blood clot blocking an artery or a bleed into brain tissue.
If it's a blockage, they can administer a clot-dissolving drug, improving the odds of a good recovery.
Clearly, patients arriving in a metropolitan hospital have a good chance of getting a prompt diagnosis and on-time medication. But patients in regional and rural hospitals face a different outcome.
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http://www.bjhcim.co.uk/news/2010/n1008006.htm
iSOFT launches eprescribing system in UK
16 August 2010
iSOFT Group has launched an eprescribing and medicines administration (ePMA) system in the UK
The system is already in use at ten hospitals in Australia and across six district health boards in New Zealand and has been adapted for the UK market with drug database provider First DataBank.
iSOFT says it is close to finalising deals with a number of NHS trusts to become early adopters.
The system offers a drug formulary and decision-support rules engine to stop drugs being wrongly prescribed and so shorten hospital stays. It will also streamline processes such as discharge, reduce re-admission rates, and cut costs.
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'Ample' rebates offset by savings
- Adam Cresswell, Health editor
- From: The Australian
- August 19, 2010
THE federal government has defended the cost-effectiveness of its "generous" new rebates for video consultations due to start next year.
It says the program's near $400 million cost will be partly offset by patients being kept healthier.
Payments for doctors taking part in the online consultations, which have not been covered previously by Medicare except in a few areas such as psychiatry, are likely to be two to three times the value of rebates for face-to-face encounters.
Under the $392.3m package, announced by Julia Gillard on Monday, $250m is allocated for online consultations for Australians living in rural and outer metropolitan areas.
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Doctors wary about online house calls
Jacob Saulwick and Mark Metherell
August 17, 2010
GENERAL practice leader Rob Walters says he has been able to diagnose the skin ailments of far-flung relatives with the help of images sent by Skype or mobile phone - which he says highlights the potential of telemedicine.
But Dr Walters, the former chairman of the Australian Divisions of General Practice, and the e-health advocate Dr Mukesh Haikerwal, says Labor's plan to support online consultations and video-conferencing covered by Medicare within two years is ambitious, given the technical and privacy snags which have impeded e-health in Australia. The $392 million announcement, the centrepiece of Labor's campaign launch yesterday, brings to more than $800 million the amount Labor is pledging to spend over four years on new health technology and personal electronic health records.
''It is disturbing to me, it is unacceptable to me, it is offensive to me that if you live in rural or regional Australia you are three times more likely to die within five years if you are diagnosed with cancer than other Australians,'' the Prime Minister, Julia Gillard, told the Labor campaign launch yesterday.
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http://www.australiandoctor.com.au/articles/48/0c06bc48.asp
Online consult plan a big ask: Haikerwal
17-Aug-2010
By Michael East
Labor’s plan to introduce Medicare rebates for online consultations from July next year will require a “mammoth effort” to iron out privacy and security issues, e-health expert Dr Mukesh Haikerwal warns.
Labor yesterday outlined the $392.3 million package which will provide financial incentives for GPs to deliver online services and introduce Medicare rebates for online consultations in rural and remote areas from July next year.
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http://www.theage.com.au/federal-election/labor-ties-ehealth-to-broadband-20100816-126y7.html
Labor ties e-health to broadband
Jacob Saulwick
August 17, 2010
PATIENTS in rural and regional areas will have greater access to online consultations with specialists under a re-elected Gillard government, which has promised $392.3 million for a package of e-health policies.
The policies, the only ones announced by either Labor or the Coalition at their respective campaign launches, make a strong link between two issues the government is eager to campaign on: health and the national broadband network.
''It is disturbing to me, it is unacceptable to me, it is offensive to me that if you live in rural or regional Australia you are three times more likely to die within five years if you are diagnosed with cancer than other Australians,'' Prime Minister Julia Gillard said at Labor's campaign launch yesterday.
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Industry welcomes $400m spending for e-health
- Karen Dearne
- From: The Australian
- August 17, 2010
JULIA Gillard has pedged $400 million to reform Medicare payments and build capacity to provide medical services over the internet.
Labor hopes GPs, nurses and specialists will begin offering online consultations from next July and has allocated $250m in new Medicare rebates.
It estimates this sum will fund nearly 500,000 telehealth sessions in areas with poor access to healthcare over the next three years. There is also $57m in incentives for equipment purchases, to encourage take-up by practitioners.
Ms Gillard says Labor will expand its GP after-hours phone helpline, with $50m for online triage by doctors and nurses using videoconferencing.
Another $35m will go to an online training fund.
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Health agencies back Julia Gillard's online consult plan
- UPDATED Joe Kelly
- From: The Australian
- August 16, 2010
LEADING health organisations have endorsed Julia Gillard's plan to give rural and regional Australians access to online specialist consultations.
AMA President, Dr Andrew Pesce, said in a statement that the $392.3 million investment would help doctors use technology to provide services to patients who would otherwise have limited or no access to them.
"This is a recognition of the need to embrace communications technology to modernise our health system," Dr Pesce said.
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ELECTION 2010: Labor commits to rural e-health measures
By Angela Dorizas
Prime Minister Julia Gillard has promised to expand Medicare rebates to cover e-health consultations, particularly in rural and regional Australia.
Launching the ALP campaign in Brisbane on Monday, Ms Gillard said the National Broadband Network would transform the delivery of healthcare in regional and rural Australia.
“It is disturbing to me, it’s unacceptable to me, it’s offensive to me, that if you live in rural and regional Australia you are up to three times more likely to die within five years if you are diagnosed with cancer than other Australians,” she said.
“Well, I want to transform that. I want to transform it soon and I want to transform it for the future, relying on the National Broadband Network.”
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Updated: NBN to deliver online consultations: Gillard
Fibre-to-the-home network essential in delivering healthcare to regional and rural Australia, PM claims
- Tim Lohman (Computerworld)
- 16 August, 2010 13:05
Prime Minister, Julia Gillard, has used the Labor Party’s official campaign launch to link the future health of Australians with the National Broadband Network (NBN).
Speaking in Queensland, Gillard said the Government would use the speed and connectivity of the NBN to facilitate online consultations between patients and doctors via videoconferencing.
The $392.3 million initiative would see Medicare rebates issued from 1 July 2012 for some 495,000 online consultation services over four years to rural, remote and outer metropolitan areas.
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Gillard stakes political future on broadband and health at Labor launch
- Patricia Karvelas, Political Correspondent
- From: The Australian
- August 16, 2010
JULIA Gillard has vowed to transform the health system by allowing rural and regional Australians to see specialists using videoconferencing and online consultations.
Linking her national broadband network to the health of Australians, the Prime Minister said that from July 1 2012 Australians would have access to rebates to see doctors through the internet as part of a $392.3 million investment.
Ms Gillard said in the middle of the night a parent with a child with swelling or rash would be able to get help through the power of broadband access to the internet.
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http://www.computerworld.com.au/article/357036/nsw_health_moving_single_payroll/?eid=-255
NSW Health moving to single payroll
Web-based salary packaging solution will replace multiple manual and electronic health sector systems
- Tim Lohman (Computerworld)
- 16 August, 2010 07:39
NSW Health is considering the consolidation of its multiple salary packaging solutions into a standard state-wide salary packaging solution.
The new salary system will be hosted by a vendor partner and accessible by NSW Health staff from a Web browser for a period up to five years.
According to NSW Government documents, various health services within the NSW Health system provide a salary packaging service to employees either internally by the Health Service or by an external vendor.
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Lastly to keep things in perspective we have:
http://www.smh.com.au/world/no-stopping-universes-expansion-20100820-138xk.html
No stopping universe's expansion
August 21, 2010
LONDON: The universe will continue to expand forever, scientists have concluded in a new study that sheds light on one of the greatest astronomical mysteries, dark energy.
The international team of scientists, led by NASA's Jet Propulsion Laboratory in Pasadena, California, used the Hubble Space Telescope and the European Space Observatory's Very Large Telescope to narrow in on what they believe comprises dark energy, which pushes the universe apart at an ever-increasing speed. Astronomers are unable to say what the mysterious force, discovered in 1998, is, except that it is invisible and makes up 72 per cent of the universe.
About 24 per cent of the universe is thought to be dark matter - also mysterious but easier to study than dark energy because of its gravitational influence.
The rest, a mere 4 per cent, is made of the material that makes up planets, stars and everything made up of atoms.
The scientists concluded the distribution of dark energy would mean the universe would never stop growing. Their research, published in the journal Science, also found the universe would eventually become a dead and cold wasteland.
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Enjoy!
David.
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