Where Does ‘Big Data’ Fit In the Health IT Story? It Looks To Be Evolving Rapidly!

Over last weekend Radio National had a segment on ‘Big Data’

The ethics of using Big Data

listen now      download audio

Big Data is the abundance of information now available online, it includes everything from medical results, to your buying patterns, to your social media interactions. It's the latest, greatest thing in the tech world, but is Big Data all it's cracked up to be? And should we be asking serious questions about the ethics involved in accessing this information?

Guests

Karalee Evans
Senior Director and Digital Strategist with Text100

Kate Crawford
Associate Professor at the Journalism and Media Research Centre at the University of NSW

Co-author with Danah Boyd of 6 Provocations for Big Data

Further Information

6 Provocations for Big Data

Here is the link to the story and the comments.

http://www.abc.net.au/rn/saturdayextra/stories/2011/3345229.htm

The link provided points to this abstract:

Six Provocations for Big Data

September 14, 2011

by Danah Boyd

The era of “Big Data” has begun. Computer scientists, physicists, economists, mathematicians, political scientists, bio-informaticists, sociologists, and many others are clamoring for access to the massive quantities of information produced by and about people, things, and their interactions. Diverse groups argue about the potential benefits and costs of analyzing information from Twitter, Google, Verizon, 23andMe, Facebook, Wikipedia, and every space where large groups of people leave digital traces and deposit data. Significant questions emerge. Will large-scale analysis of DNA help cure diseases? Or will it usher in a new wave of medical inequality? Will data analytics help make people’s access to information more efficient and effective? Or will it be used to track protesters in the streets of major cities? Will it transform how we study human communication and culture, or narrow the palette of research options and alter what ‘research’ means? Some or all of the above?

Kate Crawford and I decided to sit down and interrogate some of the assumptions and biases embedded into the rhetoric surrounding “Big Data.” The resulting piece – “Six Provocations for Big Data” – offers a multi-discplinary social analysis of the phenomenon with the goal of sparking a conversation. This paper is intended to be presented as a keynote address at the Oxford Internet Institute’s 10th Anniversary “A Decade in Internet Time” Symposium.

Here is the link to the page

http://socialmediacollective.org/2011/09/14/six-provocations-for-big-data/

The discussion reminded me of an editorial I had seen a day or two earlier:

Is more data always better?

October 19, 2011 | Jeff Rowe, HITECH Watch

If you had to choose the one idea driving the HIT transition, it would probably be along the lines of, “Information is good, and more information is better.”

But is that always true?

This regular observer takes on that question in the context of what she calls “Big Data”, which, roughly, is the move by big-name companies to get in the game of collecting, storing and sharing health information.

On the plus, she notes the potential savings that could be realized from the digitization of health data. Specifically, she points to a recent McKinsey report that “is predicting $300 billion per year in savings due to utilization of Big Data to drive the execution of strategies proposed by health care experts. In the area of clinical operations, the report lists projected savings from Comparative Effectiveness Research (CER) when tied to insurance coverage, Clinical Decision Support (CDS) savings derived from delegating work to lower paid resources and from reductions in adverse events, transparency for consumers in the form of quality reports for physicians and hospitals, home monitoring devices including pills that report back when they are ingested, and profiling patients for managed care interventions. Administrative savings are projected from automated systems to detect and reduce fraud and from shifting to outcomes based reimbursement for providers and, interestingly, for drug manufacturers through collective bargaining by insurers.”

More here:

http://www.healthcareitnews.com/blog/more-data-always-better

The blog entry referred to is here:

The Rise of Big Data

By MARGALIT GUR-ARIE

Health care is in the process of getting itself computerized. Fashionably late to the party, health care is making a big entrance into the information age, because health care is well positioned to become a big player in the ongoing Big Data game. In case you haven’t noticed computerized health care, which used to be the realm of obscure and mostly small companies, is now attracting interest from household names such as IBM, Google, AT&T, Verizon and Microsoft, just to name a few. The amount and quality of Big Data that health care can bring to the table is tremendous and it complements the business activities of many large technology players. We all know about paper charts currently being transformed via electronic medical records to computerized data, but what exactly is Big Data? Is it lots and lots of data? Yes, but that’s not all it is.

Americans live for approximately 78 years. They see a doctor about 4 times per year and spend on average 0.6 days each year in a hospital.

To keep a life time record of blood pressure readings for all Americans, including metadata (date/time of reading, who recorded the measure and where, etc.) takes approximately 6 TB (terabytes) of storage space, or about 12 laptops with standard 600 GB hard drives. Not too big. What if we start using mobile wearable devices to quantify ourselves, as some folks already do, and we record blood pressure, say, every hour? We will require 1460 TB of storage, or almost 3000 laptops, or the equivalent of 6 times the digitized contents of the Library of Congress, and this is for blood pressure monitoring only.

Vastly more of the post here:

http://thehealthcareblog.com/blog/2011/10/10/the-rise-of-big-data/

Overall, what comes from this discussion are a number of points:

First there is a huge amount of data being collected and health systems are increasingly going to be collecting more.

Second a range of technologies now exist to analyse and attempt to interpret these micro pieces of information - i.e. the raw data.

Third the evidence is not in as to just how reliable such approaches are in getting to the truth of what the data is revealing - and so there needs to be caution in interpretation until we are sure we know what we are doing.

Fourth it is possible some data sets may be used for less than ‘above-board’ purposes.

This paragraph certainly lays out these risks clearly.

“As she puts it, Are all those petabytes of minute details about everything and everybody really useful, or are we just mixing a little wheat with a lot of chaff? There are various opinions on this, but the prevailing wisdom seems to be that the more data you have, the more likely you are to be able to extract something useful out of it. . . . There is much power in Big Data, but there is also danger. As big as Big Data may be, it does not guarantee that it is complete or accurate, which may lead to equally incomplete and inaccurate observations. Big Data is not available to all and is not created by all in equal amounts, which may lead to undue power for Big Data holders and misrepresentation of interests for those who do not generate enough Big Data. Collection and analysis of Big Data has obvious implications to privacy and human rights. But the biggest danger of all, in my opinion, is the forthcoming relaxations in the rigors of accepted scientific methods, and none seems bigger than the temptation to infer causality from correlation.”

It seems to me both as a society that is being marketed to and as those interested in where the use of technology can go in the health sector we need to pay close attention as things evolve.

David.

An Interesting Little Report from a Regional Newspaper In the UK!

The following report appeared a few days ago.

NHS rejects fears over roll out of medical database

Published on Saturday 22 October 2011 22:00

THE NHS in North Yorkshire has begun transferring medical records on to an electronic database to help boost life-saving treatment for hundreds of thousands of patients.

But health chiefs have maintained strict procedures will be in place to protect patients’ confidential records, which can be accessed by doctors anywhere in the country.

Angela Wood, NHS North Yorkshire and York’s assistant director of informatics, said: “Anything that can be done to save vital minutes in the treatment of patients can only be a good thing.

“When the new database starts to save lives, hopefully the concerns about the new procedures will diminish.

.....

Only authorised staff with a chip-and-pin NHS smartcard who are involved in a patient’s treatment will be able to access the information stored on the database. Unlike the existing paper records, an audit trail is generated when a patient’s details are viewed on the computer database.

Patients have been given the chance to opt out of the new system, and a mail-shot was sent to residents across North Yorkshire to make them aware of the choices they had. Figures show just 0.9 per cent of the county’s patients have opted out, although Mrs Wood stressed every effort was being made to raise awareness of the new procedures.

.....

The full article is here:

http://www.ripongazette.co.uk/community/your-community/nhs_rejects_fears_over_roll_out_of_medical_database_1_3896999

There are two interesting elements of this report.

The first relates to the remarkably low opt-out rate among the general population despite a media campaign - including letterboxing every home - explaining what was planned and its implications.

We have had a poll on the issue here:

http://aushealthit.blogspot.com/2011/10/aushealthit-poll-number-91-results-10th.html

and a discussion of the issue here:

http://aushealthit.blogspot.com/2011/08/consent-model-for-pcehr-needs-to-be.html

A range of links are found there.

The second is the obviously routine use of smartcard based security to manage and audit access to the sensitive health databases.

As I pointed out a few days ago - until we have a system of this type strength and robustness fully implemented across the health system before the claims regarding a provider access audit trail will be true.

Of course just how individual user ID’s will be managed through issues like separation, divorce etc. are also matter of considerable uncertainty. The ConOps does not seem to have a use case on how that is actually handled in terms of access revocation etc.etc.

Amazing how a little regional article from the North of England can have relevance in the Antipodes!

David.

The Spin From DoHA Just Goes On and On. They Make It Up As They Go Along!

In response to the Royal Australian College of GP suggestion that additional financial incentives would be needed to compensate for the additional costs in time and effort there was an amazing response as far as I am concerned.

I discussed the statement from the College identifying the requirement here:

http://aushealthit.blogspot.com/2011/10/common-sense-descends-on-royal.html

This prompted a response from the Office of the Minister (among a fair few others):

Spokesperson, Office of the Hon Nicola Roxon MP Minister for Health and Ageing

21 October 2011 at 9:13

The RACGP's media release ignores many of the facts and underlying principles of personally controlled eHealth records. GPs are heavily involved in the development of eHealth records, and we are confident our system will help provide better care, save lives and save money.

On consultation with GPs: Over a third of the health professionals advising the development of eHealth records are GPs. This recognises our commitment to consult extensively with GPs. Significantly, the head of the eHealth Clinical Leaders group is Dr Mukesh Haikerwal, a GP, and past president of the AMA. Joining Dr Haikerwal in the group, is Dr Chris Mitchell, a past President of the RACGP.

On GP additional workload: The Government already has incentives in place to encourage GPs to keep up to date with the latest developments in eHealth. Our eHealth Practice Incentives Program provides up to $50,000 per year to practices and we would expect these funds to assist with their adoption of the PCEHR.

On education and adoption: The Government is well aware of the need to encourage patient uptake of eHealth records and, in particular, older Australians, Aboriginal People and Torres Strait Islanders, and mother and their new-born children. That's why many of our eHealth implementation sites focus on these groups. Further, we are investing almost $30 million to encourage the adoption and uptake of eHealth records by the public and the healthcare sector. See this release for further details: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr138.htm

On personal control: The Government does not apologise for creating a personally controlled ehealth system. Right now, it is completely up to a patient what they tell their doctor and this will continue with eHealth records. Importantly, only clinicians will be able to create or alter eHealth records.

The initial article and this and all the other comments are found here:

http://www.6minutes.com.au/news/four-fixes-needed-for-pcehr

While there are potential issues with all these 4 points it is point 2 about the PIP being a source of funds to compensate for the time and effort to maintain the PCEHR that deserves a little scrutiny.

The eHealth Incentive Guidelines - found on the Medicare Web Site - and dated August 2011 explains what the PIP payment is for:

“To be eligible for the PIP eHealth Incentive, practices must:

1. have a secure messaging capability, which is provided by an eligible supplier as listed on the  NEHTA website

2. have (or have applied for) a location/site Public Key Infrastructure (PKI) certificate for the practice and each practice branch, and make sure that each practice GP has (or has applied for) an individual PKI certificate (excluding locums)

3. provide practice GPs with access to a range of key electronic clinical resources.”

Further detail is provided in the short document which is found here:

http://www.medicareaustralia.gov.au/provider/incentives/pip/files/2709-7-eh-guidelines.pdf

Note that there is no mention of the PCEHR at all. These payments are for getting a secure messaging capable GP system in place (you don’t seem to have to be using it!)

All you need is to have a system from the list which was last updated 18 months ago!

The list is here:

http://pip.nehta.gov.au/component/docman/doc_download/4-nehta-eligible-suppliers-for-pip-ehealth-incentive

Equally you need to have - but not necessarily be using PKI certificates (not NASH provided ones).

The electronic resources are easily available and integrated into at least some GP systems.

The payment is approximately $6,500 for a solo General Practice a quarter and capped at a maximum of twice that no matter the size of the practice.

For a 5 man practice (40% of all practices) this amounts to $10,000 per practitioner per annum which, while reasonable is not a huge amount.

Compare this with the impact of spending 2 minutes of each consultation on ensuring PCEHR currency and reliability. The average GP probably sees six patients per working hour or say 40 patients per day. If we assume say a conservative 30 minutes per day on PCEHR related activities (consent, checking, uploading, reviewing) we are looking at a net loss of say 3 patient consultations per day. Doing the math that is say $300 / week in lost income - i.e. approx. $15,000 a year (very conservatively) in lost income.

Thus - unless there are real productivity and workflow benefit from the PCEHR this is a real looser for the GPs.

Be assured it is maths like this the AMA and the RACGP are doing that has them alarmed and resistant. They know this is going to cost them and they are not happy!

What the DoHA spokesperson is saying just makes no economic sense as does a good deal else in the overall PCEHR proposal despite all the claims to the contrary!

David.

Here is the AusHealthIT Blog Agenda Just So You Know! Ignore Any Other Rubbish You Read About This Blog and Its Perspective!

There has been a lot of nonsense being sprouted in some quarters about this blog. So I thought I would just make it clear where I stand on Australian E-Health and the present Government plans.

First I think that the use of terms like ‘e-Health’ and saying people are pro or con ‘e-Health’ is semantic nonsense. For what it’s worth I believe you can only form such opinions of particular individual initiatives and not the aggregate. In that context I think better secure e-Health messaging is good, supporting practitioner IT use is good, providing a consumer and professional portal is good and the PCEHR is an ill-conceived and wasteful initiative which has a very high chance of failing and which lacks any evidence to support its deployment.

People who talk of ‘e-health haters’ and ‘e-health lovers’ are frankly talking arrant nonsense and are clearly beyond rational debate.

Second I think that, on the basis of evidence from many, many sources inside and outside NEHTA that the organisation is in some significant degree of distress, is expecting too much of some hard working staff and has manifestly not delivered on most of its agenda. The latest evidence for this is the eleventh hour ‘pussy cat teams’ being formed to solve issues that should have been sorted ages ago. I do not blame NEHTA and most especially its staff. I blame Government and NEHTA senior management for failing to provide the appropriate governance frameworks and mechanisms that could have much better joined NEHTA with those who needed its help (jurisdictions, vendors, the private sector etc.)  and avoided the mess with which we now seem to be stuck.

Third I think most who are not, nor ever have been, practitioners in the e-Health domain really struggle to understand just how difficult and complex it is, and how naïve ill-considered initiatives can lead to disaster. We only need to see how badly the well-funded and pretty well considered UK National Program for Health IT went to be put on our guard regarding the risks of failure.

Fourth, as has also been found in the UK, large national programs have a propensity to stifle local innovation and damage emerging players in virtually any industry. We are seeing this right now with DoHA and NEHTA choosing winners and losers and the long term consequences of this I do not believe will be good.

Fifth we seem to have a situation where the tolerance of any form of dissent from a Government position can be commercially and personally exceptionally damaging as paid spruikers and lobbyists push the party line. I know of many competent people who have been cut out of employment and work for having the impertinence to suggest there might be another way to the to proceed different from the NEHTA tablets handed down from mountain of e-health truth!

Sixth I think it is just fraudulent for DoHA and NEHTA to be claiming they are implementing the 2008 National E-Health Strategy when nothing could be further from the truth. They have done what policy incompetents often do - cherry picked the recommendations and ignored much that was crucially important.

Seventh I am still amazed how such large sums of money and effort can be expended without a business case that explains the cost and benefits - with evidence - of proceeding down the present path.

Enough said - I want to see ‘e-Health’ progress, based on evidence of improved health outcomes and evidence of improvement in the whole health system being facilitated and enabled.

Also, on the positive side I aim to provide information and perspectives I find in my research in bite-sized chunks and allow those who want to comment and contribute.

Just doing ‘e-Health’ on an emotion, guess or a whim is nonsense but sadly there is a lot of this going around lately. I plan to continue to suggest we try to do things with a little more scientific and socio-technical rigor. Using technology to improve health outcomes and reduce risks is not easy but there are some who seem to think all you need is some spin and a populist plan and all will be well. Nothing could be further from the truth in my view.

I write this blog because I do actually care that we get value for money for the e-Health dollar and actually make a clinical difference. Right now I do not believe either of these goals are being reached as quickly as they might - by a very, very long way!

On a related matter I was asked by someone who is pretty close to the PCEHR what should be funded for 2012/2013 and on with the PCEHR Program.

My view was - in 2 minutes off the top of the head was:

If the PCEHR is to be ever useful the issues are investment is needed in:

1. Improving the information quality and sourcing of the health summaries.

2. Improving secure clinical messaging - using proven approaches.

3. Providing full integration with GP systems

4. Addressing and Fixing workflow issues and providing incentives for those who will lose out financially.

5. Sorting out the non-existent - as a practitioner - audit trails.

6. Actually doing some full function trials to show what works and what doesn't

7. Stop pretending a national implementation of anything is possible in 8 months

8. Stop all the pretence and actually tell the truth and consult honestly!

9. Work to stop the ‘hollowing out’ of the Health IT Vendor Community by the dominance of NEHTA and DoHA in the e-Health space.

10. Actually invest in some proper Project Governance and Management and develop real rather than political project plans!

The implication of this list is that the PCEHR Program needs to be fundamentally re-designed to actually work and deliver I believe! It seems a pity that there has to be an implosion, as seems inevitable, before anything is actually done.

This comment a few days from a NEHTA insider said it all - and confirms there are some very smart people in NEHTA who would like to do good - but who are just dreadfully managed!

Lagrimas de Luna said... (October 20, 2011)

David,

You are right to posit that Nehta is in considerable trouble. The scale of work required by next July is immense, and cannot be accomplished by anything other than a well-led, highly motivated and content group of people.

Instead of having a dedicated focus on delivery, the architecture office instead comes up with the monstrous work programme for which you posted a diagram on this site a few weeks ago. That work programme requires even more Enterprise Architects than they already have. It is a program of job creation for EAs, ensuring that the senior managers can write "I managed this many EAs" on their CVs. When Nehta is finally abolished, these cockroaches will pop up in the next incarnation of Nehta, or at Qld Health, as bureaucrats tend to do. Does anyone remember HealthConnect? I rest my case. Professional ambition motivates these people, not any genuine interest in delivering value to the community.

I learned some very painful lessons at Nehta about accountability and hostile work environments. If you are bullied, victimised or marginalised there is only one thing to do: RESIGN. If you complain, your managers shuffle their feet and can't maintain eye-contact, the HR department circles the wagons, defending the most blatant bullies. Worksafe is equally impotent, and at least one attempt to bring legal action against Nehta has foundered because the company has the resources to bring the full force of its taxpayer-funded war chest against those it perceives as its enemies.

What we are dealing with here goes well beyond incompetence. Nehta may have started with good intentions, but has become a malevolent organisation, whose leaders dismiss criticism as lunatic raving. The sad irony is that all of the "lunatics" are powerless to derail this train, which will crush its opponents, damage careers, waste taxpayer money, and fail to deliver meaningful benefits to health care.

I exhort the "little people" who are actually doing the work, to heed Monty Python: FLEE !

There is no one who could doubt the frustration, sadness, devotion to cause, intelligence and insight provided here!

This blog exists as a forum to allow discuss how we can do better in the e-Health domain in OZ and that is it!

David.

Another Expert Points Out How NEHTA is Off The Rails and Not Getting The Basics Right - Worth A Close Read!

Dr Andrew McIntyre posted this a few days ago. (Reposted with Permission)

Extreme e-Health – what’s gone wrong?

Extreme failure in e-Health programs is in the news and Australia, as it usually does, appears destined to repeat the mistakes of others.

There is clearly a fundamental error in the approach to the problem and like the global financial crisis, I would postulate the error is ignoring the lessons of history and the folly of “generic management”, who do not have a deep understanding of what they are managing. Large IT projects fail frequently and this is well established in the IT world. Top down centralised management by persons without a deep understanding of IT or Medicine virtually assures failure and Australia has large doses of both.

You cannot build a complex system on poor foundations and that is what is attempted time after time. Just like getting a building out of the ground is an important milestone when building a physical structure, having reliable, well tested base level functionality is an important foundation for a working e-Health system. Instead we describe castles in the air, like the PCEHR (Person Controlled Electronic Health Record). I am yet to be convinced that it is the right castle, but to build it, inter-provider messaging needs to be in place first and the lessons learned and infrastructure reused. Instead we have an array of unproven, and in most cases non-existent “proto-standards” proposed as the foundations. In software engineering circles the term “code smell” is often used to describe something in the code that is clearly wrong, even if it appears to be working at the moment. To most in the medical software industry the code smell of the PCEHR is overpowering.

We have no solid standards based messaging, with the SMD specification created with a dependency on a non-existent NASH (National Authentication Service for Health) and a non-existent ELS (Endpoint location Service) and a dependency on the recently hacked and over complex WS-Security. Despite having a working and costly Certificate authority with most GPs having Medicare location certificates the wheel has to be reinvented to satisfy someone’s love of xml based web services.

The AMT (Australian Medications Terminology) is brain dead, with no ability to do proper allergy checking or drug disease interactions. We have a license for SNOMED-CT but minimal market uptake of any quality usage of it and scant localization.

Our Unique patient identifiers have no published quality measures or risk assessment and yet all the risk has been hoisted on the users. Our provider identifiers have had no real use, no freely published API and are fundamentally flawed because they are not location specific and cannot easily be used for pathology messaging because of this. We need location identifiers badly, but this is optional in the plans!

We will continue to use HL7 V2 for pathology (and clinical messaging) but no attempt has been made to ensure basic patient safety is protected with many non-compliant implementations and an inability be confident that data will be reliably read at the endpoint. Instead we are to introduce new standards without fixing what is in use and will continue to be used for a long time.

To build a complex system you need all these building blocks functioning reliably, with compliance expectations on both the sending and receiving sides. This is obviously not sexy enough for the politicians, but we have spent several billions on e-Health in Australia with little return so hopefully at some point someone will try a different approach and spend a couple of million on program to mandate compliance with existing proven standards.

We appear to be able to insist that new drugs have trials, but can continue to hoist unproven standards and systems on users without any proper trial. The potential effects of bad e-Health are just as bad as any other unproven treatment and it’s time to take patient safety seriously and use proven standards with an expectation of compliance by all players, including the government sector. It would be costly for many non-compliant systems to become compliant, but this would be money well spent, money that has to be spent and it would have long lasting benefits. The returns on our current castles in the air will be non-existent.

So what would a good strategy look like? Simply mandate compliance with existing standards and as a result create vendor interest in participating in the standards process. The users need to pay the costs of this compliance and funding could be directed to that end, but the focus of the industry needs to be on quality, compliance and creation of standards. If that was mandated then end users would have no choice but to pay the increased costs initially, but over time the free flow of reliable clinical data would result in increased efficiency and patient safety would be ensured. The privacy issues of provider to provider messaging are also already known and solved. A base of high quality implementations would also allow for gradual enhancement of the semantics of the content. Without basic compliance and quality in place the grand plans are a pipe dream.

This entry was posted on Sunday, October 23rd, 2011 at 1:41 pm

The blog is found here:

http://blog.medical-objects.com.au/?p=84

Andrew’s message on patient safety is an important one - and ought not be ignored!

Agree totally!

David.

It Seems The NEHTA Pussy Cat Teams Are Actually A Bit of a Farce! It Is Not Clear Just Where They Fit and What the Rush Is.

The following appeared today:

http://www.theaustralian.com.au/australian-it/new-body-to-manage-risk-in-e-health-record-system/story-e6frgakx-1226175593129

New body to manage risk in e-health record system

• by: Karen Dearne
• From: The Australian
• October 25, 2011 12:00AM

RISKS to patient safety arising from new clinical systems being installed as part of the national e-health records rollout will be managed by a new oversight body.

Health department chief information officer Paul Madden said a project governance group was needed to flag errors, and it should be able to assess and mitigate clinical risks detected by users or software makers.

Mr Madden said some technical specifications for the $500 million personally controlled e-health record system should be "signed off as ready to build" from October 31, with the rest finalised by November 30.

These specifications are being drafted by fast-track "tiger teams" set up by the National e-Health Transition Authority in response to pressure to meet Health Minister Nicola Roxon's deadline for a July 1 start.

"At this stage, the tiger teams are confident those dates will be met, but we're not going to put out a shoddy product on the basis we're out of time," Mr Madden said. "We do have to make sure we've got quality to the right level.

"But we are looking to make these specifications available so that vendors at least have the opportunity to start reading and to understand how this whole thing fits together.

"Wrapping that up in a change control process will give software makers certainty and stability.

"We'll support the specification as if it were a standard for a two-year period." Last week, Mr Madden told a Senate estimates hearing that the technical specifications "would be guaranteed not to change" in the short term, except in the case of system errors.

He later told The Australian: "If applications are thought to have a newly discovered patient safety risk when they are being built into clinical systems, then we would flag that as an immediate change.

"We're looking at an implementation governance body that can determine the intensity of a risk and assess how quickly we need to resolve it. There have been times where we've said, we'll have to stop this (application) because there's a clinical risk, but when you do a full assessment some of those risks are not found or they're considered to be easily mitigated."

More here:

http://www.theaustralian.com.au/australian-it/new-body-to-manage-risk-in-e-health-record-system/story-e6frgakx-1226175593129

The most important bit - from the perspective of what is being done in Australia is the last five paragraphs.

“Mr Madden expected these (tiger team) specifications would complete the Standards Australia publication process by the middle of next year.

But the entire national e-health record infrastructure build -- outsourced under contract to an Accenture-led consortium -- has been ruled out of scope.

Asked if the consortium would deliver its version of a core infrastructure based on existing and available standards in the marketplace, Mr Madden replied: "Correct.

"There is a review process for the Accenture specifications and design involving people external to Accenture, and external to Nehta as well," he said.

"But there's no intention to turn PCEHR specifications for the portal, the call centre systems, the B2B gateways, the core services and templates, into Australian standards."

So what is being delivered by Accenture is a US product based on current US standards. Given the Wave 1 and 2 sites are working to the still to be finalised NEHTA specifications I leave it as an exercise for the reader to work out how the US Standards based core - which does not seem to be changing - and the newly developed Wave products will integrate. Also it seems what is going into the PCEHR sites are not to become Australian Standards, if I read what was said correctly. This is all pretty confusing!

One also needs to ask just what all the carry on and rush is all about. That will become clear I guess in due course!

Of course having some clinical risk monitoring function is a very good idea. I wonder who will serve, how the function will work and what teeth the function will have to make sure its advice is followed? That needs to be publicly released and explained and fast!

Late Update - Just confirms what a mess all this is!

E-health 'tiger teams' yet to meet

• by: Karen Dearne
• From: Australian IT
• October 25, 2011 3:46PM

THE so-called tiger teams expected to draft and complete new technical specifications for the $500 million personally controlled e-health system by November 30 are yet to hold their first meetings.

The National e-Health Transition Authority established the plan to fast-track delivery of critical standards needed for the PCEHR infrastructure build and by the lead implementation sites, ahead of next year's July 1 start date.

Health department chief executive Paul Madden has told The Australian the tiger teams are confident they can sign-off the first round of specs "as ready to build" by October 31, and have the rest finalised and reviewed by the end of next month.

But a leaked document calling for participation by members of Standards Australia's expert IT-014 committees shows only three teams have been established to date - Repository Services, e-Health Interoperability Architecture and Consolidated View.

A second View team is expected to be operational by the third week in November, according to an updated list of PCEHR tiger teams released on Monday.

The Repository team has its first meeting on Friday, Interoperability will meet next Monday while the View team has listed November 7 for its first session.

More here:

http://www.theaustralian.com.au/australian-it/government/e-health-tiger-teams-yet-to-meet/story-fn4htb9o-1226176402276

Just amazing!

David.

Weekly Australian Health IT Links – 24th October, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Quite a busy week with Senate Estimates unearthing a little more information on what is going on behind the scenes.

Other than that we have had some changes in the attitude of the RACGP to the PCEHR and some results from the Wave 1 and 2 sites, and some more discussion on e-Health Standards and NEHTA’s treatment of its staff.

Lastly the father of Unix has died. His contribution was pretty awesome and his work led to operating systems (Linux, iOS etc) which are serving all of us and will for a very long time into the future.

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http://www.medicalobserver.com.au/news/personally-controlled-ehealth-records-up-and-ready-for-testing

Personally controlled e-health records up and ready for testing

17th Oct 2011 Danny Rose

MO test-drives the government’s personally controlled e-health record

UPDATING a personally controlled electronic health record (PCEHR) will be a “single button” process integrated with existing clinical software and “won’t be onerous”, National E-Health Transition Authority (NEHTA) clinical lead Dr Rob Hosking has assured GPs.

Dr Hosking last week gave MO a tour of an operational early build of the technology that, from July 2012, will enable patients to have a secure online medical file.

The process is initiated by the patient, who must activate their own record online before seeking the cooperation of a ‘nominated provider’ – typically their GP – to help populate it with their relevant medical information.

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http://www.itwire.com/it-policy-news/government-tech-policy/50522-gps-demand-pcehr-payment

GPs demand PCEHR payment

By Beverley Head

Wednesday, 19 October 2011 16:08

The Royal Australian College of GPs has stepped up its demands for GPs to receive incentives to use, and contribute data to, the Personally Controlled Electronic Health Records that are to be introduced from next July.

In August the RACGP issued its qualified support for the PCEHR but noted at the time that there was a need for more than one off investment in information technology, instead calling for ongoing, and properly funded, investment in data management to ensure that the information stored in PCEHRs is accurate.

But it has today warned that unless GPs are properly compensated for their efforts in using and maintaining the PCEHR it may prove to be as much of a white elephant as the UK’s National Programme for IT system which is now being dismantled by the British Government.

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http://www.theaustralian.com.au/australian-it/government/gps-should-be-compensated-for-e-health-says-royal-australian-college-of-general-practitioners/story-fn4htb9o-1226170972459

GPs should be compensated for e-health, says Royal Australian College of General Practitioners

• by: Karen Dearne
• From: Australian IT
• October 20, 2011 5:00AM

THE Royal Australian College of General Practitioners wants GPs to be reimbursed for the work of creating and maintaining personal e-health records.

RACGP chair Claire Jackson has called for new payments under the Medical Benefits Schedule in recognition of the extra workload GPs "will undertake in consultations (including updating) the patient’s shared health summary" and other elements of the Gillard government’s $500 million personally controlled e-health record system.

"We are concerned that the current plan does not offer any incentives for general practice to create and maintain documents for indexing in the PCEHR, such as shared health summaries," Professor Jackson said in a statement on Wednesday.

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http://www.theaustralian.com.au/australian-it/government/no-e-health-rebates-for-gps/story-fn4htb9o-1226171925879

No e-health rebates for GPs

• by: Karen Dearne
• From: Australian IT
• October 20, 2011 3:13PM

THE Health department has rebuffed calls to reimburse GPs for creating and managing e-health records for patients, saying doctors will spend less time chasing paper.

The Royal Australian College of General Practitioners yesterday called for new Medicare rebates in recognition of the extra workload GPs will undertake in consultations to initiate and update patients' shared health summaries and other elements of the Gillard government’s $500 million personally controlled e-health record system.

"The RACGP is concerned that the current plan does not offer any incentives for general practice to create and maintain documents for indexing in the PCEHR, such as shared health summaries," RACGP president Claire Jackson said in a statement on Wednesday.

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http://www.medicalobserver.com.au/news/ehealth-security-may-cost-government-10m

E-health security may cost government $10m

17th Oct 2011 Mark O’Brien

THE government may be forced to subsidise medical software vendors with contributions of up to $10 million a year in order to provide security for electronic patient records.

According to industry experts, there is still no clear value for GPs in the personally controlled e-health records (PCEHR) system.

MediSecure CEO Phillip Shepherd said if GPs didn’t see value in the system, they would be reluctant to pay enough for clinical software to allow vendors to provide ongoing security upgrades and protect patient information.

“You have to create an environment where stakeholders other than the government see the PCEHR as a value proposition,” Mr Shepherd said.

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http://www.theaustralian.com.au/australian-it/government/nehta-faces-high-staff-turnover/story-fn4htb9o-1226172342675

NEHTA faces high staff turnover

• by: Karen Dearne
• From: Australian IT
• October 21, 2011 12:00AM

STAFF turnover at the National e-Health Transition Authority is "high" at 30 per cent per annum, its chief executive Peter Fleming has conceded, prompting "research" into the reasons.

Mr Fleming said employees were talented and working long and hard towards establishing the nation's e-health record infrastucture for the benefit of all Australians, but it was difficult for him to have an opinion on morale.

"Turnover is reasonably high, yes. We've actually commissioned researchers to talk to our staff and understand the drivers behind that," he told a late night sitting of Senate estimates this week.

"The research is in relation to the type of organisation - a transitional authority - and how it compares to other consulting groups, and in those terms it's actually on par with what we see in the consulting industry.

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http://www.zdnet.com.au/nehta-investigated-for-workplace-bullying-339324628.htm

NEHTA investigated for workplace bullying

By Josh Taylor, ZDNet.com.au on October 20th, 2011

The National E-Health Transition Authority (NEHTA) has been investigated by WorkCover over bullying within the organisation, while reporting an annual staff turnover rate of 30 per cent, a senate estimates hearing has heard.

The company is charged with managing and supporting the delivery of personally controlled e-health records (PCEHR) as part of the Federal Government's $466.7 million investment in e-health. Speaking at an estimates hearing last night, NEHTA CEO Peter Fleming confirmed that WorkCover had been brought into the NEHTA offices in Sydney to investigate a staff complaint over bullying.

"There was, just recently, a very brief investigation. I believe a WorkCover officer came and had a talk to our head of personnel, and I believe that issue was dealt with to their satisfaction," he told the committee.

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http://theotcinvestor.com/visiinc-plc-vzj-research-shows-australian-support-of-e-health-personal-records-1249/

VisiInc PLC (VZJ) Research Shows Australian Support of E-Health Personal Records

By Justin Kuepper · Wednesday, October 19th, 2011

VisiInc PLC (ETR: VZJ), a provider of revolutionary collaboration tools for online conferences that enable real-time sharing of complex data in its native format, similar to companies like Cisco Systems Inc.’s (NASDAQ: CSCO) WebEx and j2 Global Communications Inc. (NASDAQ: JCOM), recently released a national Australian survey highlighting support for E-Health technologies.

VisiInc PLC (VZJ) (http://www.deutsche-boerse.com) have released a National Australian survey showing public confidence in security will boost E-health uptake, just days after VisiInc announced their acquisition of VIA3.

The USD$16 million scrip deal to acquire USA company VIA3 will deliver a powerful combined technology of 3D real time collaboration, voice and video conferencing, an ultra-secure platform and marks a major push into Australian E-health market. The acquisition is timely with a national Australian opinion survey revealing that the uptake of E-health could be considerably higher if security issues are addressed.

In June 2011 VisiInc PLC entered into an agreement to launch MMRGlobal’s patented consumer and professional health IT products and services, including MMRPro for healthcare professionals (http://www.mmrprovideos.com) and the MyMedicalRecords Personal Health Record (PHR) (http://www.mmrvideos.com), on the Visi™ platform utilizing the Vistime product.

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http://www.computerworld.com.au/article/402643/how_do_they_do_it_ehealth_bleeding_edge_part_1/

How do they do IT? eHealth’s bleeding edge part 1

The NBN has being touted as a cure-all for eHealth across the nation but hospitals, medical schools and medical professionals show eHealth is fighting fit

• Chloe Herrick and Lisa Banks (Computerworld)

Ever since the Federal Government announced its plan to construct a National Broadband Network (NBN) much time and talk has been dedicated to the endless possibilities of the fibre network. In few sectors has this been more the case than healthcare.

Indeed, the potential for ultra-fast broadband to transform the health sector and make the electronic health, or e-health, a reality has often been touted as the raison d'être for the network.

However this excitement — spurred on by the promise of specialist consultations via video conferencing and GPs being able to access digital health records — has cast a shadow over the many layers and limitations of day-to-day technology already embedded in healthcare, whether it be hospitals, specialist clinics, nursing or medical schools.

The fact is, despite the government’s hype about the NBN, hospitals, medical schools, nurses and doctors are already achieving advances in health through the use of information technology.

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http://www.computerworld.com.au/article/402644/how_do_they_do_it_ehealth_bleeding_edge_part_2

How do they do IT? eHealth’s bleeding edge part 2

The NBN has being touted as a cure-all for eHealth across the nation but hospitals, medical schools and medical professionals show eHealth is fighting fit

• Chloe Herrick and Lisa Banks (Computerworld)
• 18 October, 2011 01:01

Telehealth

With an ageing population and a shortage of nurses placing a strain on the healthcare system, RDNS' Ironside points to video conferencing technology as an area of increasing activity.

The not-for-profit healthcare provider has embedded video conferencing across its business in an effort to help nursing staff treat as many people as possible.

“The primary focus for us in IT here at RDNS is around delivering a better quality of care to our clients through using technology and we do this by driving innovation and using the technology available,” Ironside says.

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http://www.stuff.co.nz/business/industries/5796344/Orion-Health-snaps-up-Microsoft-e-health-unit

Orion Health snaps up Microsoft e-health unit

CLAIRE ROGERS

Last updated 08:32 17/10/2011

New Zealand's largest software exporter Auckland-based Orion Health has purchased Microsoft's hospital information software assets in Asia Pacific for an undisclosed sum.

The two companies will also work together to provide solutions for the global electronic health market.

Orion Health chief executive Ian McCrae has said the acquisition would see it take on 50 staff.

Orion, which employs more than 400 staff, turned over almost $100 million last year.

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http://www.healthdatamanagement.com/news/acquisition-orion-health-microsoft-hospitals-43403-1.html

Orion Health Teams with Microsoft for Expansion

Joseph Goedert

HDM Breaking News, October 17, 2011

Health information exchange software vendor Orion Health has acquired Microsoft Corp.'s hospital information system and RIS/PACS that are marketed in Southeast Asia.

The vendors also will jointly market Orion Health's HIE product and Microsoft's Amalga data aggregation, analysis and reporting software to public and private HIEs, as well as accountable care organizations.

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http://www.6minutes.com.au/news/e-health-record-failure-blamed-on-top-down-approac

E-health record failure blamed on top-down approach

• By Gemma Collins on  18 October 2011

The failure of the UK’s e-health program has been blamed on rushed implementation, failure to engage clinicians and a top-down government-driven partnership with private contractors. 

A review of the UK’s program, similar to the $500 million PCEHR planned in Australia, concluded that it was “time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients.”

Researchers who reviewed five areas where the IT system was implemented through partners such as Cerner and iSoft, blamed the program’s ‘top down’ approach which led to an “unrealistic, politically driven timeline from the outset”, with “multiple tensions” between the creators and NHS staff.

In their review (link) the authors suggest there needs to be a clear vision and realistic timescale from the start with more “user involvement” of local clinicians and health staff in decision making.

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http://www.theaustralian.com.au/australian-it/government/health-cio-paul-madden-clears-air-on-pcehr-standards-debate/story-fn4htb9o-1226171804245

Health CIO Paul Madden clears air on PCEHR standards debate

• by: Karen Dearne
• From: Australian IT
• October 20, 2011 1:48PM

Health department chief information officer Paul Madden says draft specifications will be "guaranteed not to change" - except in the case of system errors - during the first two years of operation of the $500 million personally controlled e-health record system.

The technical specs are urgently needed as Health Minister Nicola Roxon has committed to a July 1, 2012 starting date for the nationwide patient information-sharing program.

Rollout is proceeding, despite concerns primarily from the software industry that a lack of standards risks massive future costs in fixing non-compliant systems. 

Mr Madden rejected the IT industry's criticism over a "tiger team" approach intended to fast-track technical specifications, saying the department and the National e-Health Transition Authority were not departing from the normal standards-setting process. 

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http://www.theaustralian.com.au/australian-it/bionic-eye-team-looks-to-catch-up-despite-burning-through-the-cash/story-e6frgakx-1226169112223

Bionic eye team looks to catch up despite burning through the cash

• by: Andrew Colley
• From: The Australian
• October 18, 2011 12:00AM

THE consortium behind Australia's bid to be a force in bionic eyes has burned through more than half its $42 million war chest, with clinical trials still at least 18 months away.

University of NSW Biomedical Engineering Professor and Bionic Vision Australia acting director Nigel Lovell said the consortium had enough remaining funds to meet its milestones and start clinical trials of a bionic eye by mid-2013.

"This is very much milestone-driven with a whole lot of performance indicators along the way. It will get done," Professor Lovell said.

"We're not halfway through yet. We're progressing towards our human trials in 2013 and things are looking very solid."

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http://www.smh.com.au/national/pharmacists-paid-by-drug-company-for-patient-details-20111018-1lypd.html

Pharmacists paid by drug company for patient details

Kate Hagan

October 19, 2011

ONE of the world's biggest drug companies has been accused of paying Australian pharmacists to promote some of its best-selling drugs, in a controversial deal that has divided the profession.

Pfizer pays pharmacies a $7 ''administration fee'' for each patient signed up to so-called support programs that involve the drug company providing information directly to patients about nine of its drugs.

Pharmacists say the deal, which Pfizer struck with the Pharmacy Guild of Australia in July, is similar to the one dumped this month for them to market dietary supplements with prescription medicines.

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http://www.theage.com.au/national/health-groups-challenge-ethics-of-pfizer-deal-20111019-1m86s.html

Health groups challenge ethics of Pfizer deal

Kate Hagan

October 20, 2011

A COALITION of 60 health groups has described a deal for pharmacists to promote Pfizer branded drugs as ''highly questionable'', saying it could cost patients more.

The Consumer Health Forum's chief executive, Carol Bennett, said the deal - under which Pfizer pays pharmacies $7 for every patient they sign up to ''support programs'' for nine of its drugs - was another example of the Pharmacy Guild of Australia trying to maximise profits at the expense of consumers.

The support programs involve Pfizer sending regular emails and text messages to patients about their medication and condition, in what some people say is thinly disguised marketing.

Pfizer Australia's managing director, John Latham, yesterday told Pharmacy News that more than 11,000 patients had signed up, but it was unclear if they were all referred by pharmacists.

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http://theconversation.edu.au/one-wrong-foot-after-another-the-ethics-of-the-pharmacy-guilds-deals-3939

20 October 2011, 5.39pm AEST

One wrong foot after another: the ethics of the Pharmacy Guild’s deals

Dr Ken Harvey

First it was the Pharmacy Guild’s deal with Blackmores that raised ethical concerns. Now it’s the Guild and Pfizer.

Both deals involve undisclosed payments from drug companies to Guild subsidiaries to ensure that dispensing software identifies certain prescriptions on which pharmacists are prompted to take action.

In the Blackmores case, to on-sell Blackmores “companion” complementary medicines with prescription drugs; in the Pfizer case to sign up patients prescribed nine Pfizer brand name drugs to the company’s “support” programs.

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http://www.smh.com.au/it-pro/security-it/super-sloppy-first-state-customers-kept-in-the-dark-20111019-1m7g6.html

Super sloppy: First State customers kept in the dark

Asher Moses

October 19, 2011 - 5:34PM

Update 5:30pm: First State Super has just updated its website with a statement on the issue - the first time it is notifying its broader customer base since the breach.

Update 4pm: The Federal Privacy Commissioner, Timothy Pilgrim, announced today he was opening an "own motion investigation" into First State Super.

First State Super customers have been left in the dark over a serious security breach at the company, saying they only learned through media reports that hundreds of thousands of accounts may have been exposed.

Acting NSW Privacy Commissioner John McAteer says the apparent decision to notify just a small portion of its customers rather than the entire database was not acceptable.

Yesterday it was revealed that First State Super, which has over $30 billion in funds under management, called the police on private security consultant Patrick Webster after he informed them of a flaw that opened up access to the company's database of sensitive customer details. All identity thieves would need to do to gain access was change numbers in the URL bar.

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http://www.firststatesuper.com.au/SecurityOfMemberInformationUpdate

Security of member information update

There has recently been some media coverage about unauthorised access to our members’ online benefit statements. The statements were in PDF format and were viewed by the person responsible but he did not gain direct access to other account details nor did he conduct any transactions.

Only 568 member statements were viewed out of a total membership of some 770,000. The members whose statements were viewed have been notified.   

The fault in our security was also rectified immediately, and a comprehensive IT security review is now underway.

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http://www.theage.com.au/national/defence-checks-fake-id-data-20111019-1m833.html

Defence checks fake ID data

Dan Oakes

October 20, 2011

TENS of thousands of security clearances are being urgently investigated after fake information was entered to speed up the process, Defence officials revealed yesterday.

The opposition has also claimed that four government MPs were told of the security issues months before they were investigated, but did not act on them.

Under questioning at a Senate committee hearing, a senior Defence Department official also admitted that 5000 of those clearances were classified as ''top secret''. It is the first indication of exactly how widespread the problems are.

Claims that Defence employees were forced to enter fake data at the initial stages of the clearances were aired earlier this year. Whistleblowers said the fake information was designed to fill gaps in personal histories, speeding up the processing of clearances, which were passed on to ASIO for further evaluation.

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http://www.computerworld.com.au/article/404088/dennis_ritchie_father_unix_c_programming_language_dead_70

Dennis Ritchie, Father of Unix and C programming language, dead at 70

• Bob Brown (Network World)
• 14 October, 2011 02:45

Dennis Ritchie, the software developer who brought the world the C programming language and Unix operating system, has died at the age of 70. 

Ritchie (known by the username "dmr") was part of a dynamic software development duo with Ken Thompson at Bell Labs, which they joined in 1967 and 1966, respectively. Ritchie created the C programming language, which replaced the B programming language Thompson invented. 

The two later went on to create Unix, initially for minicomputers and written in assembly language, in 1969, and written in C in 1973. Unix went on to become key software for critical computing infrastructure around the world, though wasn't for everyone. 

Ritchie once said: "UNIX is very simple, it just needs a genius to understand its simplicity." Unix , of course, became the inspiration for newer operating systems including Linux and Apple's iOS. 

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http://www.technologyreview.com/blog/guest/27263/?nlid=nldly&nld=2011-10-20

Kurzweil Responds: Don't Underestimate the Singularity

Last week, Paul Allen and a colleague challenged the prediction that computers will soon exceed human intelligence. Now Ray Kurzweil, the leading proponent of the "Singularity," offers a rebuttal.

By Ray Kurzweil

Although Paul Allen paraphrases my 2005 book, The Singularity Is Near, in the title of his essay (cowritten with his colleague Mark Greaves), it appears that he has not actually read the book. His only citation is to an essay I wrote in 2001 ("The Law of Accelerating Returns") and his article does not acknowledge or respond to arguments I actually make in the book.

When my 1999 book, The Age of Spiritual Machines, was published, and augmented a couple of years later by the 2001 essay, it generated several lines of criticism, such as Moore's law will come to an end, hardware capability may be expanding exponentially but software is stuck in the mud, the brain is too complicated, there are capabilities in the brain that inherently cannot be replicated in software, and several others. I specifically wrote The Singularity Is Near to respond to those critiques.

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Enjoy!

David.