Weekly Australian Health IT Links - 02-02-2010

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.

General Comment:

Clearly the biggest news of the week was the focus the Prime Minister was bringing to bear on the health sector with his early January speeches.

Also pretty big was the suggestion that there might be a major injection of funds for e-Health via the COAG process sometime in the next few months.

See here:

http://aushealthit.blogspot.com/2010/01/another-false-dawn.html

What seems to be missing in all this is the making of the link between e-Health and supporting the sustainability of the health system. Other countries get it but somehow it does not seem to have got through to those of our political elite. Blowed if I know why?

Interestingly the Defence Department seems to get it – see article below – and is funding a new e-Health system for our service people!

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http://www.theage.com.au/national/states-face-health-cost-avalanche-20100124-msl7.html

States face health cost avalanche

MICHELLE GRATTAN AND LORNA EDWARDS

January 25, 2010

FEDERAL Government spending per person on health will rise in real terms from $2290 today to $7210 in 2050, with state governments at risk of being overwhelmed by rising costs, Prime Minister Kevin Rudd has said.

Treasury projects that, on present trends, the total health spending of all states will exceed all of their tax revenues, excluding the GST, by 2045-46, and possibly earlier in some states.

This year the Australian Government is spending the equivalent of 4 per cent of GDP on health, but the third Intergenerational Report, prepared by Treasury with projections to 2050, forecasts this will increase to 7.1 per cent in 2050.

That is an increase of more than $200 billion by then. Forty years ago, federal spending on health was only 1.2 per cent of GDP.

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http://www.smh.com.au/national/health-spending-to-swamp-budgets-20100124-msls.html

Health spending to swamp budgets

JONATHAN PEARLMAN AND LINTON BESSER

January 25, 2010

KEVIN RUDD has warned that the states are being ''overwhelmed'' by rising health costs as he gears up for an election fight over an overhaul of hospital funding.

Citing figures from the coming third intergenerational report, the Prime Minister said yesterday health spending was set to swamp the public purse and he sought to pave the way for a battle with the states over control of funding.

He singled out NSW, where the Treasury estimates spending will more than double over 22 years to 55 per cent of the budget.

''Rapidly rising health costs create a real risk - absent [of] major policy change - state governments will be overwhelmed by their rising health spending obligations,'' he said in a speech in Sydney. ''Without reform, states' ability to provide the services they currently provide will be significantly strained. That is why 2010 must be and will be a year of major health reform.''

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http://www.smh.com.au/opinion/politics/rudds-options-on-health-costs-are-alarmist-and-misleading-20100126-mw8a.html

Rudd's options on health costs are alarmist and misleading

January 27, 2010

Welcome to another year of media manipulation by our political leaders. Don't you love it? The Rudd Government is sitting on two major economic reports - from the Henry review on tax reform and Treasury's third intergenerational report - and some day soon it will let us see them. Meanwhile, it's leaking to journalists or dropping into speeches bits and pieces from them.

In the week leading up to Australia Day, Kevin Rudd gave a series of speeches in each capital city purporting to outline the findings of the intergenerational report on the implications of our ageing population. His version was both debatable and - I think we'll find - quite misleading.

In ''sounding the alarm bells'' on the effects of ageing, his first point was that it will lead to much slower growth in our material standard of living. Whereas average real income per person grew by 1.9 per cent a year over the past 40 years, Treasury's projections show it growing by only 1.5 per cent a year over the next 40.

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http://www.psnews.com.au/Page_psn2017.html

Defence battles health problems

New medical services that improve the treatment of wounded servicemen and women in the Australian Defence Force have been announced by the Minister for Defence Personnel, Greg Combet.

Mr Combet said the health and wellbeing of Defence personnel was a top priority for the Government.

“That is why we are putting considerable funding into new and improved Defence health initiatives,” he said.

.....

“We will continue to provide our personnel with world class health care, that is why we are also funding a comprehensive e-health system to improve the maintenance of ADF health records,” he said.

http://www.smh.com.au/technology/enterprise/computers-under-constant-attack-20100128-n1s0.html

Computers under constant attack

CONRAD WALTERS

January 29, 2010

THIRTY per cent of computer systems for the nation's essential services such as banks, government and utilities are repeatedly attacked by hackers every month, according to an international report released today. More than half of those targets are hit multiple times a week or even multiple times a day, and the situation could get worse.

Forty per cent of the Australian experts surveyed for the report believed the nation would sustain a ''major cyber incident'' against its key services in the next 12 months. Given a two-year timeframe, the figure jumped to 53 per cent, and 76 per cent expected a major digital strike against the nation's critical infrastructure within five years.

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http://www.pharmacynews.com.au/article/nps-drug-information-hotline-shelved/510137.aspx

NPS drug information hotline shelved

28 January 2010 | by Mark Gertskis

A drug information telephone hotline used by pharmacists will be shut down in the middle of the year because of rising costs and limited reach.

The National Prescribing Service (NPS) has confirmed that it would stop funding the Therapeutic Advice and Information Service (TAIS) on 30 June.

Staffed by specialist pharmacists, the service provides information on new drugs, side effects and drug interactions.

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http://www.6minutes.com.au/articles/z1/view.asp?id=510128

GPs lack email for discharge summaries

by Jared Reed

A fax is the GP’s preferred method of receiving a hospital discharge summary because many practices do not have an email address, despite high levels of computerisation.

In a study that pitted fax, email, post and patient hand delivery against each other, fax and email were found to be the most reliable method of a GP receiving their patient’s discharge summary, in randomised controlled trial of 196 geriatric patients at a Sydney teaching hospital.

The researchers found that most practices stored their information electronically, and almost 90% used medical prescribing software - but most still preferred to receive information by fax, meaning staff would need to manually scan documents to the patient’s file.

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http://www.computerworld.com.au/article/334165/gaming_tech_spurs_development_hyperfast_medical_imaging_systems/?eid=-255

Gaming tech spurs development of hyperfast medical imaging systems

University, hospital team to build tools to boost medical image processing by 1,000 times.

• Lucas Mearian (Computerworld (US))
• 28 January, 2010 08:34
• Comments

University and hospital researchers have taken a cue from the gaming industry by using 3D video graphics chips to develop a parallel software platform that can speed the processing times, in this case for medical digital imaging, by 10 to 1,000 times.

Northeastern University in Boston and Massachusetts General Hospital (MGH) were jointly awarded a $1.3 million grant from the National Science Foundation in December to develop the technology and use it to enhance several biomedical imaging applications, including software designed for breast and brain imaging.

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http://www.psnews.com.au/Page_psn20116.html

Agencies plug into eHealth systems

The Minister for Health, Nicola Roxon, has visited the offices of Medicare Australia in Canberra to see for herself how a new, secure eHealth system would work for health care patients and professionals.

Ms Roxon said her visit showed how useful tools such as electronic health records, medications-management systems and electronic discharge, referrals and prescriptions would be. She said the new e-health system would improve patient care and efficiency.

She said unique healthcare identifiers would be assigned to all health consumers and professionals by the middle of the year, following the passage of the Healthcare Identifiers Bill 2010 and would be provided in addition to Medicare numbers to ensure security.

Ms Roxon said the Government was “committed to continuing implementation of eHealth to support a more effective health system.”

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http://www.thefreelibrary.com/A+new+era+in+clinical+communications:+a+report+on+the+past+year%27s...-a0216961585

A new era in clinical communications: a report on the past year's work at NEHTA.

Introduction

The development of a national electronic health system for Australia goes hand in hand with consultation and collaboration with government, industry and health sector stakeholders. Meeting the needs of the Australian public and ensuring that e-health systems meet consumer expectations of safety, quality and security is paramount to the success of e-health for Australia. To this end, the National E-Health Transition Authority (NEHTA NEHTA National E-Health Transition Authority (Australia) ) has spent the past year interacting with stakeholders and understanding both technical and social requirements to advance the e-health agenda. Following on from an independent review conducted by the Boston Consulting Group late in 2008, NEHTA launched an Action Plan for Adoption Success (1) to further develop our collaboration and engagement with industry, the healthcare sector, consumers and the state, territory and federal governments. The Action Plan flows directly from NEHTA's acceptance of all the recommendations in the review and resulted in a multifaceted program of stakeholder engagement. This took the form of NEHTA-hosted events, seminars and consultation forums; external conferences and presentations; informal briefings; face-to-face meetings; and NEHTA produced publications.

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http://www.computerworld.com.au/article/334035/telstra_separation_bill_delayed_again/?eid=-6787

Telstra separation bill delayed again

Federal Government's efforts to force separation upon the telco will be sidelined due to "more pressing considerations"

• Darren Pauli (Computerworld)
• 27 January, 2010 12:53

The Federal Government's proposed legislation for the separation of Telstra (ASX:TLS) has been delayed again thanks to big ticket items to be discussed in the Senate hearings starting on February 2.

A spokesperson for Communications Minister Stephen Conroy said the senator plans to have the bill heard "this year" but could not make the next sitting in the first week of February because of "more pressing considerations".

The spokesperson would not provide any further details on the situation.

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http://www.theaustralian.com.au/australian-it/windows-70-upgrade-closes-off-an-upgrade-option/story-e6frgakx-1225823429974

Windows 7.0 upgrade closes off an upgrade option

• Fran Foo
• From: The Australian
• January 26, 2010 12:00AM

A LONG-TIME Microsoft user is furious at the loss of basic back-up functions after upgrading to Windows 7 Family Pack.

But Microsoft says users should visit its website and research products before buying.

Former Australian Computer Society president Philip Argy had PCs at home running various versions of Windows: XP Professional 32-bit, Vista Ultimate 64-bit, and Windows 7 Home Premium.

He had never had any problem manually backing up files to a Linksys external storage system, and late last year Microsoft began offering a "family version" of Windows 7, which allows upgrades to three PCs for the single price of about $280.

Mr Argy bought the family edition, on which the packaging states that all editions of Windows XP and Windows Vista can upgrade to Windows 7.

On the back of the box is a statement that automatic backup is possible for Professional and Ultimate versions, but not Home Premium. It says: "Recover your data easily with an automatic backup to your home or business network".

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http://news.smh.com.au/breaking-news-world/nasa-ends-effort-to-free-rover-spirit-20100127-mwt4.html

NASA ends effort to free rover Spirit

January 27, 2010 - 8:09AM

AFP

NASA says efforts to free the Spirit rover bogged down by Martian sand are over and instead the plucky robot is hunkering down to brave the harsh Mars winter.

"Spirit is not dead; it has just entered another phase of its long life," said Doug McCuistion, director of the Mars Exploration Program at NASA headquarters in Washington.

"It looks like Spirit's current location on Mars will be its final resting place," he said on Tuesday

Earlier this month NASA, celebrated Spirit's bountiful, six-year stint on the Red Planet, much longer than the three months it was forecast to last.

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Pretty sad after such a great effort!

Enjoy!

David.

NEHTA is Leaking Like A Sieve – A Symptom The Organisation is in Deep Trouble I Suspect.

The following just dropped over the fence into my lap today.

Document Title.

Unique Health Indicator Project

Project Health Check

National eHealth Transition Authority

Date: 13 March 2009

The authors of the document are SMS Management and Technology – a listed technology consulting firm.

I think quoting from the Executive Summary says all that is needed.

Executive Summary

Review Approach

This report details the results of a project health check undertaken of the Unique Health Identifier (UHI) project at nehta. The project review was undertaken over 10 days and involved in-depth interviews of project team members, suppliers and senior managers and a review of key project artefacts. The report assesses the UHI project’s health in 14 key elements, notes any exceptions to these findings and makes recommendations for improving the health of the project. Annex A outlines the approach to interviews and questionnaires used in the review.

Using the intelligence gathered through the project health check (scored in Annex B), an assessment has been made of the project’s ability to deliver. Overall, the Unique Health Identifier project is rated as RED. Unless significant changes are implemented, this project will not deliver agreed scope within timeline or quality tolerances. There are critical issues and concerns that exist within the project that require management intervention by the project sponsor, programme management and other senior management.

Summary of Key Findings

• There is a lack of organisational project management and delivery competencies

• Dysfunctional Project team environment

o UHI team communication is intermittent, piecemeal, reactive and selective

o UHI team lacks clarity as to team and individual deliverables

o No clear critical path or project plan and supporting roadmap for the Pilot

o Management of scope definition and scope creep has been a major cause of project delay

• UHI team members are confused as to the role and accountabilities of the UHI team and nehta

. There is confusion between the following roles:

o governance oversight

o policy concept development

o delivery and design

o stakeholder marketer or advocate

Medicare team members also have some confusion as to nehta’s role in relation to the project

• Lack of clarity on all aspects of the Pilot

o There is no documented description of the deliverable, no critical path, no comprehensive allocation of responsibilities for team members, or current risks and issues log

o There may be contractual changes required to enable delivery and operation of the December Pilot

o Some team members lack confidence in the team’s ability to deliver to the December 2009 deadline

· Medicare working relationship at the non-executive level is fractured

· Project governance structure is not clear and has been ineffective

· Lack of effective private sector stakeholder engagement

Summary of Key Recommendations

H.1. Immediate focus on scoping and planning for the December 2009 pilot

H.2. Lock down scope to ensure no more scope creep

H.3. Invest in addressing the UHI team’s morale issues

H.4. Improve team communications on the critical path and team accountabilities

H.5. Establish a streamlined governance structure for December 2009 delivery

H.6. More actively manage risks and issues at all levels within the UHI project

H.7. Maintain joint Medicare and nehta executive sponsorship with a focus on improving the working relationship between nehta and Medicare

H.8. Engage key internal and external stakeholders on the December 2009 Pilot

H.9. Build organisational project management competencies

H.10. Implement a structured project methodology immediately

----- End Extract.

That less than 12 months ago the HI project was in this state reflects pretty badly on all concerned – one can only hope it is much, much better now!

At a broader level it seems to me that so much arriving in just a day or so just shows how dysfunctional NEHTA has become and how a much broader review of all that is going on is really warranted.

I am sure there is enough information here for an FOI request for the full document to have the desired effect now we are told NEHTA is subject to FOI. See here for details.

Peter West (in a comment found here)

http://aushealthit.blogspot.com/2010/01/has-time-come-to-just-ignore-nehta-and.html

told us:

Where does this idea that NEHTA is not subject to FOI come from?

I have an email from Jim Claremont, Department of the Prime Minister and Cabinet to the effect that NEHTA has been identified as an agency for the purposes of the Freedom of Information Act 1982 (Cth).

FOI requests for NEHTA documents can be lodged with
Department of Health and Ageing
GPO Box 9848
CANBERRA ACT 2601
FOI Contact Officer is on 02 6289 1718.

Go for it!

----- End Comment.

I am also told there have been a large number of staff also leaving in the last few months and that this is, in part, due to the rather poor organisational culture. Looking today NEHTA has 17 jobs advertised which seems high for an organisation with of the order of 150 people.

The sooner a formal review is undertaken the better in my humble opinion.

David.

Request to Take Files Off Line

I have just had a call from NEHTA. They claim the documents are draft and so may mislead. On that basis I will agree to remove them.

NEHTA has agreed, with me, to make the finalised document public - so we will see if that happens.

Sorry to all those who are curious but were not quick enough.

David.

What Fun - NEHTA Lets its Health Identifier Communications Strategy Out!

All of us who did not fall down in the last day or two are aware of the media management and spin NEHTA is prone to.

Well, for the first time we are now able to provide interested readers with the ‘communications strategies’ (read spin crib sheets) NEHTA is planning to use to sell the Health Identifier Service to consumers and health care providers.

The documents are very current – being dated 29 Jan, 2010

There is little doubt that there is a substantial ‘spin’ component when we read.

“Communication Objectives

The objectives of this strategy is to:

· Increase the national awareness of e-health and its associated benefits to all Australians – this is in conjunction with specific campaigns focused on the introduction of healthcare identifiers to the Australian public.

· Foreground the introduction identifiers as a fundamental component to enabling e-health.

· Articulate strategies and tactics to manage media issues and unfavourable and inaccurate messages about the HI Service and e-health.

· Shape public ‘consumer’ opinion to support and embrace the concept of e-health and the introduction of identifiers to the Australian public.”

The talk for shaping opinion says it all.

We learn of all sorts of things we are going to be subjected to.

First and most amusingly we read that your inoffensive blogger is to have paid for competition!

“E-health Blog

NEHTA is sponsoring an e-health blog that is being established and managed by blogger Charles Wright. The purpose of the blog is to give consumers with an interest in technology factual information about e-health and the HI Service and to combat other sources of misinformation.”

Could that be little old me?

Next a new website is about to be launched in a few days.

“e-health website

www.ehealthinfo.gov.au is a jurisdiction (federal and state health departments) owned website to serve as the primary internet gateway to e-health information and knowledge. This website will be the focal point for sharing the combined activities and knowledge of e-health stakeholders, delivering information and knowledge to healthcare managers and providers, as well as providing healthcare consumers with an authoritative information source.

The site will serve to raise awareness of e-health and provide general information in addition to information that’s specific to particular industry audiences.

This site will have a soft launch on February 5th with a large public launch by the end of February.”

Third we are going to muck about with Google to get more attention.

“Search Engine Optimisation

Google Searches/ Search Engine Optimization – leveraging key word searches and tactics to place targeted content online. An online and search engine strategy is being developed to drive traffic to the blog and ehealthinfo.gov.au including other online material we need to highlight.”

Fourth there seems to might be a bit of secret influence peddling going on.

“RACGP Co sponsorship

NEHTA and the RACGP have entered into an agreement whereby NEHTA will assist the RACGP as they prepare the next version of the RACGP Standards for General Practices which is the foundation for Practice Accreditation. NEHTA will also be the major sponsor of the RACGP National Conference in 2010. As part of this sponsorship, 12 topics that relate to the Standards will be developed as topics to promote e-health to consumers. One topic is being developed each month and a news release is being distributed to media outlets with a view to them picking up the story. This is mainly a mainstream print media campaign.”

I wonder how the membership would see this? An assault on College independence maybe? I sure would.

Fifth it seems there are some really expensive heavy spinners involved.

“E-health Promotion

To increase the national awareness of e-health and its associated benefits to all Australians, in conjunction with specific campaigns focused on the introduction of identifiers, we have engaged integrated marketing and communications agency The Campaign Palace.

The Campaign Palace will leverage our communications messages around wellness, personal empowerment, health, positive lifestyle experiences and preventive care in a variety of online and offline media.

To counterpoint the work of the Campaign Palace, international public relations firm Hill and Knowlton will implement a mainstream media campaign that involves engaging e-health champions to be the expert and trusted “voice” to present credibility of our messages to the Australian public.”

The experts who they seem to indicate they may use are a diverse bunch from Delta Goodrem to Professor Kerryn Phelps and Ita Buttrose. I wonder have they all agreed?

We are also to be Issues Managed.

“Issues Management

To manage media issues and unfavourable and inaccurate messages about the HI Service and e-health we have employed the services of specialist Canberra public relations firm McManus, Skotnicki and Associates to assist with proactive and reactive issues. Principals Gerard McManus and Tom Skotnicki have strong connections with the Canberra press gallery and Canberra political media and understand the process of government. They have notable experience in issues management and dealing with contentious media issues.

Issues are managed proactively and potential issues that may negatively impact on the progress of e-health are responded to quickly.”

Last we are to be subjected to paid articles in the medical press – advertorials!

“Advertorial

This is a paid form of editorial and provides an effective means of conveying information in a controlled and strategic manner. NEHTA will explore opportunities to promote key developments through advertorial in specialist publications such as Australian Doctor and Medical Observer. Consideration will have to be given to MCGC processes if this is undertaken.”

Enough – read the gory details for yourself!

The files can be downloaded here:

Removed at NEHTA Request

and here:

Removed At NEHTA Request

Enjoy reading and as they say forewarned is forearmed!

I will note in passing – as free advice to NEHTA – their case for fostering provider adoption looks flimsy at best.

David.

Treasury Releases the 2010 Intergenerational Report.

Just a short post to note the report has been released.

The report can be downloaded from this page.

http://treasury.gov.au/igr/igr2010/

I have to say this report is quite pathetic in my view. It is alarmist – describing us as ‘hot, crowded, ailing and ageing’.

The modelling seems to me to have been done on assumptions that are not really explicit and while the negative impact of technology on costs is mentioned the beneficial effects on productivity and so on are just ignored.

Sure it will cost a bit more to care for our population as we all age, but where is the modelling of the offsets and the positive things we might do to make things less difficult for all of us.

As for mentioning e-health in assisting health sector not anywhere to be found.

Hopeless, technically inadequate and hysterical while offering no list of offsets that might be possible. A purely political document in my view.

David.

Some Amazing Figures from the eRx E-Prescribing System’s Operators.

A very interesting article appeared in Pharmacy Daily in mid January. Two paragraphs especially caught my attention.

Pharmacy Daily Monday 18th January 2010

eRx welcomes funds

.....

eRx has also confirmed that it will continue to provide a free e-prescription service to eRx users via the current Guild funding for 10.6 million transactions and AFSPA funding for 500,000 membership transactions.

More than 3700 pharmacies, general practitioners and medical specialists have registered to use eRx since its Apr 09 launch, with 7.5 million electronic prescriptions already sent to the exchange, of which 1.7m have been dispensed.

.....

The full issue is downloadable from here:

http://www.pharmacydaily.com.au/getattachment/cca1def7-f248-4816-aee0-474ac25c7625/1-18-2010-12-00-00-AM.aspx

A few things struck me.

The first thing that struck me was that the penetration of registration for the service has clearly reached a real ‘critical mass’

The second was that the ‘free use’ of the system was soon going to run out.

I was also rather confused by the huge number of prescriptions that had been sent to the exchange (7.5M) and that only 23% of those had been dispensed.

What on earth is going on here? Surely more than that proportion or patients actually go and get their medicine from the chemist?

Is it that people are turning up to pharmacies who are not connected to eRx?

Or is it that the meaning of the barcode on the prescription is not being recognised and used for what it is.

I think it would be very interesting to know what is actually happening that these figures are reached. It would be also interesting to know what happens after the prescriptions expire. Right now seems a lot of unloved prescriptions are sloshing around eRx.

Clearly we will need to get the linkage between prescriber, pharmacist and patient working better than this at some point in the future!

David.

AusHealthIT Man Poll Number 7 – Results - 01 February, 2010

The question was:

What is Your View of the Quality of Leadership in E-Health Being Provided By NEHTA?

Results:

Fabulous

- 2 (4%)

Pretty Good

- 7 (15%)

Needs Some Work

- 2 (4%)

Needs Much Work

- 16 (34%)

Non-Existent

- 19 (41%)

Votes : 46

Comment:

This must be the closest poll yet! A whole 25% of readers thought NEHTA’s leadership was OK or only needed a little work.

75% of readers thought a bit more than that was needed!

Thanks again to all who voted.

David.

The Reality of a Fully Operational HI Service is Years Away. Let’s Stop The Spin and See the Actual Implementation Plan!

The following appeared a few days ago.

Thursday, 28 January 2010

e-Health: something's rotten in the State of Kevin

"The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care.

In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.

The security controls and awareness levels found in these assessments have been varied."

{NEHTA - HI Service Security and Access Framework 13/11/09 PUBLIC}

For the rest of the blog drop in here:

http://northcoastvoices.blogspot.com/2010/01/e-health-somethings-rotten-in-state-of.html

This got me to start thinking just where the Nation Authentication Service for Health (NASH) was up to, as it is needed for the HI Service.

I found this page:

http://www.nehta.gov.au/component/docman/cat_view/49-publications/48-connecting-australia/54-nash

NASH

As significant amounts of sensitive and personal information is being sent electronically around the globe, there is a need to guarantee the authenticity and validity of the information that is being exchanged. In the case of your personal medical information, there is an even greater imperative to ensure that information is collected and securely electronically exchanged only by those authorised to do so.

The National Authentication Service for Health (NASH) project will deliver the first nationwide secure and authenticated service for healthcare organisations and personnel to exchange e-health information.

Together with clinical terminology, messaging standards and unique health identifiers, NASH will provide one of the fundamental building blocks for a national e-health system.

Categories

Nash Fact Sheets

Information Specification, Content & Requirements

However no joy. Both these are empty of any information at all!

The article referenced in the blog does provide some small help and raises more than one issue!.

See here:

http://www.nehta.gov.au/component/docman/doc_download/877-security-and-access-framework

For those who missed the release of the document initially there are some interesting things said.

This provides the first interesting section:

“2.2 End User Access - Threat and Risk Assessment

The potential user base of the HI Service is diverse. Once fully operational, it is expected that upwards of 500,000 Healthcare Provider Individuals (HPI-I’s) will participate in the HI Service. In addition, large numbers of HI Service Users will require access to the service to facilitate the delivery of healthcare services. The end user security assessment has allowed NEHTA to ascertain security vulnerabilities, risks and threats that an end user presents at a ‘typical’ healthcare setting, and gain an understanding of current security practices and awareness levels.

In order to obtain a cross section of the healthcare community in a diverse array of healthcare settings, a range of private and public health organisations were visited. Numerous staff members were interviewed, and practices and processes reviewed and evaluated.

The End User Security Reviews assessed the following:

• • A large city public hospital
• • A children’s public hospital
• • A private pathology and radiology service
• • A private hospital
• • A rural public hospital

The End User Security Reviews clearly found that there are instances in which particular users may share user credentials (whether they be passwords or tokens) to facilitate their obligation to patient care. In situations such as a hectic Emergency Department or a large onsite trauma situation, the adherence to business processes which promote unique identification and authentication of users of the HI Service may not be practically possible.

The security controls and awareness levels found in these assessments have been varied. These findings are invaluable as they provide a solid ‘real world’ understanding of security in a variety of healthcare settings. They will give primary input into appropriate baseline security controls that will need to be included in Participation Agreements, and security considerations that will need to be included in the design of third party health systems (such as Patient Administration Systems).

These reviews have ultimately assisted in designing and developing effective and usable controls for the HI Service.”

Now I am not sure how you read this, but what it says to me is the chance of having trustworthy provider identification – to reassure the public their records are secure – is not high at all. Too many people and too many situations where ID technology will get in the way – exactly as has been discovered with the provider smartcards in the UK!

I think you will find NEHTA has no clue about how to handle emergent and high volume situations - especially with many providers all needing computer access. Some explanation of how this was to be handled would have been good.

I could have told them had they asked!

This is also very interesting:

3.3.2.2 Healthcare Provider Individuals

Healthcare provider individuals (possessors of HPI-Is) will be identified through their professional registration process or other approved processes. Access will be either by identifying themselves to an HI Service officer by phone, person, fax or mail or by using a PKI certificate to electronically access the HI Service. Certificates will be available upon request using the National Authentication Service for Health (NASH).

As an individual healthcare provider they will be able to access their own provider information. However, they must provide evidence, either to a body acting as a Trusted Data Source to the HI Service, or directly to the HI Service Operator, that they are employed by a healthcare provider organisation, before being permitted to access the core HI Service. The core HI Service includes IHIs and associated healthcare individual information, and the healthcare provider directory services (which include the details of healthcare provider organisations and consenting healthcare provider individuals).”

I am not sure if I read this correctly, but it sounds like solo GPs and specialists who work for themselves are not going to have access without a lot of work and signing all sorts of documents – see below!

The other issue, of course, is that the National Registration System is not planned to start until mid 2010 – so there is not going to be much time to get providers into the system, issue all the PKI certificates and so on with the current planned live date of the HI service being the same! (July 2010)

Even more remarkable is this:

“4.3 Participation Agreements

Participation Agreements will be a necessary requirement for healthcare provider organisations to actively participate in HI Service. A Participation Agreement will be executed as part of an overall registration process. The Participation Agreement will form an integral part of the security framework, providing the foundation for best practice security. Participation Agreements will include enforceable terms and conditions, underpinned by legislation, and will address a broad range of fundamental areas of responsibility.

In order to access the HI Service, healthcare provider organisations will be required to address the following areas in relation to security:

• Comply to minimum baseline security requirements (including areas such as account creation, unique identification of users in interfacing systems to the HI Service, password management strategies, firewalls, anti-malware, audit trails);

• Participating organisations will be required to maintain any computer and other ancillary electronic equipment to meet a minimum standard of being technologically adequate for the purposes of the IHI and HPI services;

• Have mechanisms in place to manage risks and liabilities;

• Have policy and procedures that address information security and privacy; and

• Provide education and training to all HI Service authorised users so that they are aware of their responsibilities.”

Continued.

Showing characteristic understanding of the sector they seem to imagine all the providers are going to rush to take on all these extra-obligations, at their cost, to suit NEHTA. Just why would anyone bother?

They are clearly dreaming and have not thought through and worked out how to distinguish the perfect from the possible and then how they are going to even get to the possible.

The whole document also seems to identify a range of problems for which it has no answers – and this document is released about 2 months ago! What has changed I wonder?

Of course all this makes a joke of all the claims of how all access to the HI will have full reliable audit trails etc. They are really dreaming I believe.

The following provides the FAQ for healthcare providers.

http://www.nehta.gov.au/images/flipbooks/HI-Brochure-Providers-FAQs-NEH050/index.html

The one big question it does not answer is the obvious one. Why would I go to all this trouble and if I do what can you show is really in it for my patients and me?

Finally, it is clear from the FAQ that allocation of provider identifiers will be staged over who know how long – so I wonder if all the other issues are addressed just how long it will be before the actual HI Service is really operational nationwide. Let’s face it – it will be years!

As I have said before – let’s see a realistic implementation plan. As it is now we are all in the dark!

David.

An Offer You Can’t Refuse! And Certainly Shouldn’t.

The following announcement appeared from Health Affairs Journal (probably the best journal on Health Policy in the world) yesterday.

Top 20 Health Affairs Journal Articles for 2009

January 29th, 2010

by Jane Hiebert-White

We are pleased to announce the “most-read” Health Affairs journal articles published in 2009. The number 1 article published in 2009 was on “Annual Medical Spending Attributable To Obesity” by Eric Finkelstein and colleagues. All articles below are open to all readers for the next 2 weeks—through February 12, 2010.

Top-viewed articles published in 2009

1. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates
   by Eric A. Finkelstein, Justin G. Trogdon, Joel W. Cohen, and William Dietz
2. Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook
   by Andrea Sisko, Christopher Truffer, Sheila Smith, Sean Keehan, Jonathan Cylus, John A. Poisal, M. Kent Clemens, and Joseph Lizonitz
3. National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998
   by Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin, and the National Health Expenditure Accounts Team
4. What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist
   by Donald M. Berwick
5. The Recent Surge In Nurse Employment: Causes And Implications
   by Peter I. Buerhaus, David I. Auerbach, and Douglas O. Staiger
6. Building Organizational Capacity: A Cornerstone Of Health System Reform
   by Janet Corrigan and Dwight McNeill
7. Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care
   by Carleen Hawn
8. Fostering Accountable Health Care: Moving Forward In Medicare
   by Elliott S. Fisher, Mark B. McClellan, John Bertko, Steven M. Lieberman, Julie J. Lee, Julie L. Lewis, and Jonathan S. Skinner
9. Health Reform: A Bipartisan View
   by Jim Cooper and Michael Castle
10. Meeting Enrollees’ Needs: How Do Medicare And Employer Coverage Stack Up?
    by Karen Davis, Stuart Guterman, Michelle M. Doty, and Kristof M. Stremikis

Read about the next 10 and download those articles that interest you for the next week or two. Then it is over until next year!

Here is the link:

http://healthaffairs.org/blog/2010/01/29/top-20-health-affairs-journal-articles-for-2009/

Enjoy. I certainly plan to! The article on Kaiser Permanente (Number 16) is especially relevant!

David.

Lastly, as a special treat to weekend readers – go here for the ultimate in rouge’s galleries!

http://www.newspix.com.au/Search/SearchResults.aspx?keyword=e-health

Sorry!

D.

A Useful Review of Identity Issues in HealthIT.

The following interesting and quite long article appeared a few days ago.

Identity Crisis

The push to share data electronically - both inside and outside of the hospital walls - is forcing patient identification to the forefront.

By Kate Huvane Gamble

As healthcare organizations move further into an electronic environment, the need for an accurate system of patient identification is becoming increasingly evident. Errors resulting from duplicate patient records or incomplete information can incur significant costs, burden the administrative staff, and most importantly, compromise patient safety.

Smart CIOs are avoiding - or at least minimizing - these issues by establishing an enterprise master patient index (EMPI), a central repository of information that contains a unique identifier for every patient. And they are finding that having a clean patient index can play a key role in the success of data sharing initiatives. Not having one, on the other hand, can leave an organization out in the cold.

“The MPI and the EMPI function are absolutely critical to record integrity.”

“The MPI and the EMPI function are absolutely critical to record integrity,” says Mary Anne Leach, CIO at The Children's Hospital in Aurora, Colo. “All of the sophisticated tools on the planet aren't going to fix anything if the patient presents with different data.”

According to Kerry Kerlin, executive vice president at Stoltenberg Consulting (Bethel Park, Pa.), the market for patient authentication solutions is growing rapidly, with many CIOs turning to EMPI as either a stand-alone product or as part of an EMR suite. With all identification systems, he says, the goals are the same. First, data fields should be uniform, and the information should be accessible from any location within the hospital. “The second thing is to have enough detailed information associated with the patient - including address, social security number and birth date - that you can differentiate between similar records and verify a patient's identity,” he says. “You want the ability to do a quick search on your database to try to prevent mistakes.”

One of the most common mistakes, Kerlin says, is having multiple records for a single patient. Providence Hospital, a Mobile, Ala.-based facility that is part of Ascension Health (St. Louis), was seeing duplication rates as high as 14 percent before implementing Reston, Va.-based QuadraMed's Smart Identity Management solutions. Providence's IT team worked with the vendor to clean up the existing database and install a system that could be more easily managed, says Cynthia Hyde, CIO and assistant vice president of information services. “We needed to do something on the back-end, because we were spending so much in the way of resources managing the duplicates, and we knew that our EMPI was getting less data integrity day by day.”

So Providence implemented QuadraMed's tool that tracks activity by registrar and department to help determine where errors are occurring. Since going live with the software in 2008, Hyde says her 349-bed hospital has cut its duplication rate in half and maintained an average duplication creation rate of less than 2 percent. Reducing registration errors was critical at Providence, which has nearly 60 points of entry.

This, says Kerlin, is typical. Many hospitals admit patients at radiology, lab and cancer centers, and use systems that are not directly connected to the hospital's overall ADT system. “So what happens is you have a lot of different data files out there with patient demographics and insurance information,” he says. “With a true EMPI, data is available electronically and serves as the master record for all the activity of a patient within the hospital.” And that, he says, should extend beyond the administrative department and into the clinical units.

At Children's Hospital, Leach says, “strong partnership between registration and HIM” at her 284-bed facility has been paramount to achieving a clean MPI. “That relationship has been critical to registering people with the right identity to begin with, and then in working through duplicates and un-combines to make sure the data for each patient is correct,” she says.

In addition to the main campus, Children's includes two emergency hospitals, three urgent care locations and nine specialty care clinics, all of which use the EMR from Verona, Wis.-based Epic Systems. The hospital is also rolling out the EMR to its independent community providers as part of the PedsConnect program. With so many providers sharing one electronic record, Leach says it is critical that patient information is authentic.

To that end, Children's has implemented two patient index systems - Chicago-based Initiate Systems' Interoperable Health and Epic's Identity EMPI - which she says help maintain a low error rate. Although Leach says the two solutions “work well in concert,” she believes Initiate's product has evolved, and says she is looking at how Children's can further optimize its use. “What I look for in these tools is the ability to identify key data elements and be able to match on them using weighted criteria - at least that minimum level of sophistication.”

Very much more here:

http://healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=9F5580F1A53C4F43AB08E8B52AD935C9

This article makes for very interesting reading as it explores a range of approaches that may be adopted to maximise the accuracy of patient identification. Worth a read.

David.