Useful and Interesting Health IT Links from the Last Week – 27/07/2008

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Doctors, PHDs to edit new Wikipedia of medical information

Medpedia site is backed by health care heavies like the Harvard, Stanford medical schools

Heather Havenstein 24/07/2008 09:24:59

A project launched Wednesday aims to create what is in essence a medical Wikipedia, an online encyclopedia focused on explaining conditions, drugs, procedures, medical facilities and other medical topics written by physicians and PhDs.

The Medpedia Project launched a preview of the Medpedia site Wednesday with the support of medical heavyweights like Harvard Medical School, the Stanford School of Medicine, the University of Michigan Medial School and the University of California Berkeley School of Public Health.

These schools and other organizations have agreed to provide content and to urge their employees to sign up to be editors of the new site, which is scheduled to go live with 1,000 pages of information by the end of the year.

The site, which is built with the same open source software that runs Wikipedia, will be written and edited by volunteer medical doctors or experts with PhD degrees, noted James Currier, Medpedia's founder and chairman. The site will provide profiles of each of each editor, including their background and areas of expertise, he added.

More here:

http://www.computerworld.com.au/index.php?id=1238485857&eid=-6787

This seems like a very interesting and risk controlled initiative with some pretty smart people behind it. If the success of Wikipedia is any guide – this should be a very interesting site to visit once operational.

Second we have:

Bedside technology proves its worth

Technology can improve medical handovers, but implementing changes may prove challenging, writes Lynnette Hoffman | July 26, 2008

KEVIN Murphy, in the words of an Irish magistrate, "should not have died" from a highly treatable condition known as hypercalcaemia, where calcium levels in the blood are too high.

The 21-year-old had classic signs of an over-active parathyroid gland, but despite complications including bone pain, neurological problems and, ultimately, renal failure along with the hypercalcaemia, the link between the test results and the correct diagnosis was never made and the seriousness of the situation not recognised.

Vital information about the young patient was not communicated effectively between different health workers, and was never passed to the doctors who needed it. Case notes did not mention his deteriorating condition, and he never received surgery to remove the overactive parathyroid gland, which would have saved his life.

The magistrate's damning words came at a hearing five years after Murphy's death. Murphy's mother, Margaret, has since gone on to lobby for patients' rights for the World Health Organisation, which last May launched nine patient safety solutions aimed at reducing healthcare-related harm.

Improved communication during medical handovers, when one nursing or medical team goes off shift and another begins, ranked in at number three.

Though Murphy's case occurred years ago in Ireland, it could easily have happened here in Australia this week, says associate professor Steve Bolsin, a patient safety expert at Geelong Hospital. "Poor clinical handovers remain a major problem, and there is a huge opportunity to do it much better, particularly for patients who move between different components of care, such as from their GP or aged-care facility to hospital," Bolsin says.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24072261-23289,00.html

This is an interesting article that I feel somehow misses the point. Handover is best facilitated by having a reasonably complete set of current patient documentation regarding a patient available within a properly constructed Electronic Health Record that forms the basis of what is discussed as handover occurs. Much of what is discussed in this long articles are various short term interim approaches to try and make up for the lack of an EHR.

Third we have:

Medicare easy claim hard going

Frustration is rising over the roll-out of Medicare's Easyclaim system, reports Health editor Adam Cresswell | July 26, 2008

THE advent of the "push-button society" was supposed to make life easy.

Time-consuming tasks could be telescoped into seconds at the stroke of a finger, effort and hassle effectively removed, and bureaucracy tamed.

That has certainly been the vision behind various IT initiatives in health. Medical software programs have transformed racks of dusty patient files into instantly searchable, digitised data on doctors' computer servers; illegible scrawl on prescriptions is now crystal-clear printer type; and hope remains that electronic health records will improve care of patients, even if technical and privacy concerns have made progress slow on that to date.

Claiming of Medicare rebates, particularly when the doctor has charged a private fee rather than bulk-bill, is another area long recognised as overdue for revolution.

The appeal of Medicare Easyclaim -- an EFTPOS-based system intended to allow instant claiming of rebates at the doctor's surgery -- is obvious. It's just the reality that doctors and practice managers say is wanting.

The system uses an EFTPOS terminal to allow patients to pay their doctor's fee with a swipe of a bank card, and in the next step claim the rebate by then swiping their Medicare card.

The rebate is paid into their account almost immediately, reimbursing the patient sooner and obviating the need to go to Medicare.

Medicare itself also wins, by not having to process bundles of forms arriving from practices across the country.

It should be great, but uptake has been slow. Medicare Australia's website notes that of the 29 million services notified to it between July and December 2007, just 2.76 million were lodged electronically.

Of these, 2.67 million were lodged via a separate electronic method called Medicare Online, and just 88,000 were made using Easyclaim, first announced in August 2006.

This is despite the financial carrots on offer to tempt practices to make the switch. GPs can claim a $750 grant ($1000 in rural areas) to help them meet the costs of installing the new system. They also receive 18c for each transaction lodged electronically until December 2009, although this is also paid for systems using Medicare Online.

The Government committed yet more funds in this year's budget to encourage electronic claiming, earmarking a further $8.6 million over four years to make systems work better. At the time Human Services Minister Joe Ludwig said the Easyclaim system inherited from the Coalition "did little more than tie up (doctors) in red tape", which explained the 0.5 per cent take-up rates. The low take-up has been interpreted by some as medical bloody-mindedness. But the list of grievances against Easyclaim is lengthy and specific.

One GP told Weekend Health the system required a "huge amount of data entry" because it does not integrate with a practice's billing software -- every detail, from the amounts being charged and claimed, to the doctor's provider number (a unique identifying code used by Medicare to track doctors) has to be punched in manually all over again. This goes to a key AMA concern about Easyclaim, that it ties up receptionists at a time when even the Government acknowledges GP surgeries are being overrun with patients.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,24072278-23289,00.html

This is really an interesting article describing a Financial System black hole in the way the Health Sector works. Obviously the system needs to be offered in an integrated and very quick to use form – otherwise no adoption incentive is likely to ever work!

Fourth we have:

Therapy with the click of a mouse

Kate Benson Medical Reporter
July 23, 2008

TOO shy to venture out of the house or too sensitive to criticism to face up to therapy?

People with social phobias, anxiety and depression are being treated over the internet, answering online questionnaires and emailing their therapist with their darkest thoughts and fears.

Psychiatrists and lecturers who have been running the pilot programs through St Vincent's Hospital, in Darlinghurst, say the treatment has been as successful as face-to-face therapy even though the therapists and patients never meet. The program could help free up psychiatrists to see more needy patients with severe mental illness.

"It's the way of the future and it's fascinating," a professor in psychiatry at the University of NSW, Gavin Andrews, said yesterday. "We are treating people we never see and yet we are getting equivalent results to our world-standard anxiety clinic where we see people face-to-face. And these people are maintaining their wellness. If you grew up before the age of the internet, it seems a shock to think you can be treated without seeing a doctor, but it is working."

More here:

http://www.smh.com.au/news/technology/new-program-clicks-with-psychiatrists-and-patients/2008/07/23/1216492458705.html

Another report of continuing work in the e-psychiatry space. Good to see!

Fifth we have:

'Health delay' penalties looming

Siobhain Ryan | July 22, 2008

THE federal Government will be held to account for the first timeover patients' delays in seeing a GP or finding an aged care bed, under draft targets to gobefore Australia's health ministers today.

The long-awaited set of performance indicators, drawn up by the Australian Institute of Health and Welfare, will force the federal Government to measure its progress on honouring planned healthcare pacts, to be finalised with the states and territories by the end of the year.

But the Government is yet to say whether it will accept penalties for any areas where it underperforms, despite warning its state counterparts they risk a federal takeover if they fail to deliver improvements on health.

Health Minister Nicola Roxon yesterday recommitted to increased spending to fix the nation's hospitals - a key demand of the states in the current healthcare negotiations.

"But as well as delivering that money, we need to be able to measure improvement, to make sure our investments are delivering high-quality care for ... every Australian," Ms Roxon said.

The targets will, for the first time, extend beyond hospital waiting lists into doctors' waiting rooms, nursing homes and mental, dental and community health clinics, reflecting the wider range of services to be covered under the new five-year deals.

Public hospital funding has dominated previous agreements. This time, indicators will record patients' out-of-pocket costs and the number who postponed seeking help because they couldn't afford treatment. Others will publish data on potentially avoidable deaths and independent peer reviews of cases where patients die on the operating table.

The AIHW's list of 40 indicators, however, lacks the detail and ambition of an earlier proposal from the Government's chosen adviser on health reform, the National Health and Hospitals Reform Commission.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24057291-23289,00.html

This is an important – but apparently sadly watered down – approach to understanding what is going on with our health system. It is only by measuring real outcomes can we set priorities and make sure effort and investment is directed to solve real problems.

More coverage is found here:

http://www.news.com.au/story/0,23599,24058166-29277,00.html

States get new health benchmarks

And here:

http://www.theage.com.au/national/stricter-reporting-ahead-for-hospitals-20080721-3isv.html

Stricter reporting ahead for hospitals

Sixth we have:

Health IT research gets $20M boost

ICT aiming to improve healthcare industry

Rodney Gedda (Techworld Australia) 21/07/2008 14:43:50

The Australian e-Health Research Centre (AEHRC) became a national institution today with $20 million in funding from the federal and Queensland governments.

Established in 2003 as a joint venture between CSIRO and the Queensland government, the Brisbane-based AEHRC is used for ICT-related CSIRO health research.

Funding of $20 million will be provided to fund the centre's operations until 2012, CSIRO announced today.

The AEHRC has also relocated to new premises at the University of Queensland's Centre for Clinical Research at the Royal Brisbane and Women's Hospital.

More here:

http://www.computerworld.com.au/index.php?id=1399951529&eid=-180

On the face of it this is unequivocally good news. However I do wonder just in what context this money was made available and just where this work actually fits in the big picture?

A visit to the home page seems to me to be worthwhile to see for yourself what is planned and what is being achieved.

http://aehrc.com/

Additional coverage from the CSIRO is here:

http://www.csiro.au/partnerships/AEHRCPartnership.html

I guess success will be defined by how much of what is being developed here actually makes it into routine care over the next decade or so.

Last we have our slightly technical note for the week:

Study finds huge rise in malware this year

Malware has risen by 278 percent so far this year according to ScanSafe.

Tom Jowitt (Techworld.com) 21/07/2008 08:23:13

Malware has risen by a staggering 278 percent in the first half of 2008, thanks in part to the large number of websites comprised last month, so says a new study by ScanSafe. And it warns that things are only going to get worse, especially after Dan Kaminsky goes public with details about his 20 year-old DNS vulnerability.

The ScanSafe Global Threat report is a study of more than 60 billion web requests that ScanSafe has scanned, as well as 600 million web threats it has blocked from January through June 2008 on behalf of corporate customers worldwide.

The report found that web-based malware increased 278 percent during this period. This was in part due to large websites such as Wal-Mart, Business Week, Ralph Lauren Home, and Race for Life, being compromised in June by SQL Injection Attacks.

Less than a year ago, web surfers were more at risk from social engineering scams and rogue third-party advertisers, with the outright compromise of legitimate websites being relatively rare, and when they did happen, they were fairly obvious cases such as website defacements.

But now it seems that instead of attacks on the website itself, the target nowadays is the site visitor. ScanSafe says that unlike defacement, the signs of compromise are not readily apparent as the attacks are deliberately crafted to avoid casual observation.

"Today, compromises of legitimate websites are occurring en masse and in nearly all cases there are no readily visible signs of the attacks," the security expert warns.

Large number of these SQL Injection Attacks was detected back in March this year. Then in April, attacks on legitimate web domains, including some belonging to the United Nations, expanded dramatically. In June, ScanSafe found that SQL injection attacks accounted for 76 percent of all compromised sites.

More here:

http://www.computerworld.com.au/index.php?id=130781343&eid=-255

While one is always a little suspicious of alarmist reports on nasties out there on the Internet – the information on the changing nature of the attacks I found interesting. Worth noting.

More next week.

David.

Patients Googling their Doctor – A Coming Trend?

I came upon this interesting blog post the other day.

When Patients Googlestalk Their Doctors

Posted by Jacob Goldstein

Old doctors barely know what the Web is. Baby docs just out of residency would rather take a job in the Arctic than get rid of their Facebook page. And all of them are likely to get Googlestalked now and again by creepy patients.

That’s what a couple of Harvard psychiatrists say (albeit somewhat less glibly) in a commentary in this week’s JAMA.

“Many physicians over a certain age never envision their patients Web searching” for personal information about their doctor, write Tristan Gorrindo and James E. Groves. The older docs (naively) believe that “being absent from the Web is the surest way of avoiding disclosure of personal information on the Web.”

…..

Given how easy it is to go online and find housing records, divorces, bankruptcies and whatever pack of slanderous lies your bitter ex wrote on his/her blog, there’s only so much anybody — M.D. or otherwise — can do. Still, for the benefit of old and young alike, Gorrindo and Groves lay out a few common sense tips to help docs manage their online identity:

• Create your own Web page with basic information about your training and your practice.
• Search for yourself regularly. Use the form “John Q. Smith” or “John Smith, MD,” including quotation marks
• Go after sites that post slanderous material. (This WSJ story lists private companies that, for a fee, help deal with this sort of thing.)
• On social networking sites, use privacy controls to keep juicy bits out of sight of the general public.
• If you think a patient is searching for private information about you online, bring it up with the patient.

More here:

http://blogs.wsj.com/health/2008/07/08/when-patients-googlestalk-their-doctors/

This is a trend that may alarm clinicians.

While it seems perfectly reasonable to check if a clinician you plan to consult has any adverse commentary available on the Web it would seem very poor if patients start to abuse the information they find.

Potentially worse are sites the purport to rate clinician performance but which allow totally un-moderated and potentially damaging posting.

This is discussed further here.

Online Doctor Stalking: America’s New Pastime?

Kathryn Mackenzie, for HealthLeaders Media, July 15, 2008

We hear a lot about patient privacy and rights. With high-tech heavyweights like Google and Microsoft getting into the online personal health records game, it's likely that publishing medical information online will become the norm, rather than a futuristic pipe dream. Of course, patients will still want to know that their private information won't be accessed by the prying eyes of bosses, friends, neighbors, or relatives. And, through advertising pushes, test cases, and studies, the industry is working very hard to prove to patients that their medical data will remain private.

But what about the healthcare provider's right to privacy?

Many providers, especially those of a certain age, may not have any idea just how much of their personal information is easily accessible online to anybody—including their patients.

Anyone who comes into contact with patients, whether it be a physician or hospital executive, is accustomed to the dependency of patients in a clinical setting. Yes, we look to our doctors to cure what ails us, but we also want them to offer us comfort and support when we're feeling scared or sick. Some of us also want to know a little about our primary caregiver's history. Where did she graduate from, what do other patients think of her, where else does she practice? With the click of a mouse and few keystrokes, it's a breeze to get that information online at sites like ratemds.com and physicianreports.com. Unfortunately, it's also that easy to access far more personal information. Just by entering my doctor's name in Google or one of the dozens of other search sites, I can find out everything from where my doctor lives to her marital status to how much mortgage she pays.

More here:

I guess this issues is like all sorts of other relatively new technologies. There are often un-intended consequences which it takes time for an appropriate way of dealing with such problems to evolve. I suspect we are at the front of this curve!

David.

Data Security – A Pervasive and Difficult Problem.

In the last week or so the Poynter Review reported in the UK Treasury.

The background to the review is covered here.

The Poynter Review

On 20 November 2007, the Chancellor appointed Kieran Poynter, the Chairman and Senior Partner of PricewaterhouseCoopers, to investigate the circumstances that led to the significant loss of confidential personal data on Child Benefit recipients and other recent losses of confidential data and the lessons to be learnt. Kieran Poynter published his final report on 25 June 2008.

Media links

• Poynter Review final report, 25 June 2008 (PDF file 1.13MB)
• Poynter Review initial report, 17 December 2007 (PDF file 129KB)

After the review was published an opinion piece appeared in the London Financial Times.

Data security is not just a matter of technology

By Kieran Poynter

Published: July 15 2008 18:57 | Last updated: July 15 2008 18:57

The recent spate of high-profile data security breaches and the regulatory responses to them have once again thrust issues of data management into the limelight. I have spent the past few months looking at the issue and talking to leaders from the private and public sectors about data security issues. What has emerged is that there is a decided lack of ownership when it comes to data security, which cuts across all organis­ations.

There is a widespread perception that information security is an information technology issue and that produces a tendency to focus on security safeguards such as encrypting data on laptops, preventing use of USB memory sticks, password protection and so on. However, even in these areas experience shows that there is a long way to go.

Technological measures risk creating a false sense of security. Most breaches are the result of quite mundane physical factors and are essentially caused by process failures and/or people simply not knowing what to do.

Organisations can have all the policies and processes they like, but if their culture and values, management systems and scrutiny are not joined up in a clear governance framework, this lack of integration lends itself to data security exposures.

As the volume and depth of personal information that organisations hold on their customers, employees – indeed, on all of us – continue to grow, so do the potential regulatory, legal and reputation risks associated with failing to keep that data secure. While more and more businesses are taking data security seriously, the fact remains that serious breaches are on the rise, as is malicious activity by criminals seeking access to companies’ personal data.

Organisations with weak data security are generally also weak in terms of wider risk management and governance. So a failure adequately to manage information security risks is often symptomatic of broader risk issues or a fragmented governance framework.

More here (subscription required):

http://www.ft.com/cms/s/0/525bc6ec-526d-11dd-9ba7-000077b07658.html?nclick_check=1

Poynter review: HMRC has radically reduced security risks

Richard Thurston | Jun 27, 2008 10:25 AM

HMRC has radically improved its data security measures since the breach which caused it to lose 25 million child benefit records in October last year.

PwC chairman Kieran Poynter, the man tasked to investigate what happened in the catastrophic HMRC data breach, has revealed that significant progress has been made since the disastrous information leakage last October

Those are the thoughts of Kieran Poynter, chairman of Price Waterhouse Coopers, whose review into the data breach was published yesterday.

The positive statement was published as part of a largely critical report which said there were "serious institutional deficiencies" and "no visible management of data security at any level" of HMRC.

But Poynter did take the opportunity to outline HMRC's achievements since the breach.

Among the more important he picked out were:

- Creating a new post of director of data security;
- Issuing clearer at-a-glance data security guidance, which gives examples of what can be sent by what mechanism, and in what circumstances;
- Mandatory attendance at a half-day information security workshop for all staff;
- A review of post room processes and practice to identify high risk security issues;
- Locking down write access to removable drives, with reversal of that policy only able to be made by a small number of designated personnel;
- A ban on the use of unencrypted laptops outside secure premises;
- The introduction of new controls for bulk data transmissions;
- Progress on developing a mechanism for secure electronic transfer of information with external partners.

"I am pleased to say that HMRC has significantly reduced the risk of further data loss since the incident," said Poynter.

More coverage is available here.

http://www.securecomputing.net.au/News/115363,poynter-review-hmrc-has-radically-reduced-security-risks.aspx

The broader picture is revealed in the following from the BBC.

MoD admits loss of secret files

More than 100 USB memory sticks, some containing secret information, have been lost or stolen from the Ministry of Defence since 2004, it has emerged.

The department also admitted that more than 650 laptops had been stolen over the past four years - nearly double the figure previously claimed.

The Liberal Democrats condemned the latest security breaches as evidence of "shocking incompetence".

But the MoD insisted its policies were "generally fit for purpose".

Previously the MoD had confirmed that 347 laptops were stolen between 2004 and 2007.

The Mod said it has no idea on when, where and how the memory sticks were lost.

Defence Secretary Des Browne issued revised figures after "anomalies in the reporting process" were discovered.

The official total is now 658 laptops stolen, with another 89 lost. Just 32 have been recovered.

In a separate response, ministers said 121 of the department's USB memory sticks had been taken or misplaced since 2004.

Some 26 of those went this year - including three which contained information classified as "secret" and 19 which were "restricted".

BBC security correspondent Frank Gardner said the incident was "embarrassing" for the MoD as they had no idea how or when they had been lost or stolen.

Liberal Democrat MP Sarah Teather received the information after tabling a question in parliament.

Ms Teather said: "It seems that this government simply cannot be trusted with keeping sensitive information safe.

"This shows a shocking degree of incompetence."

Shadow defence secretary Liam Fox said: "To treat national security in such a cavalier fashion is unforgivable."

A Ministry of Defence spokesman said any loss of data was subject to a full inquiry and measures were being put into place to improve data protection.

Much more with multimedia here:

http://news.bbc.co.uk/1/hi/uk/7514281.stm

When one adds this to all the stories of loss of hospital records from the US it seems just no-one has worked out how to keep sensitive information safe. It seems it even happens in Wales!

NHS trusts lose confidential data

By Brian Meechan
BBC Wales political reporter

More than 150 incidents of data being lost at NHS trusts across Wales have put patient and staff details at risk.

Among the examples over a three year period, patient details from an entire children's ward in Wrexham were found on a piece of paper in a puddle.

In another revealed by BBC Wales after Freedom of Information (FOI) requests, a highly confidential child protection file was sent to the wrong address.

Health Minister Edwina Hart said she was "quite horrified" by the findings.

She said staff losing such data should be disciplined.

The cases were revealed in responses to BBC Wales to FOI requests to the trusts, which provide services through hospitals, health centres and clinics.

http://news.bbc.co.uk/2/hi/uk_news/wales/wales_politics/7509151.stm

As it almost always is, we find it is the people and the systems that have let us down and allowed the leaks of information to occur.

The story of what happened with the UK Customs Service makes a great and very educational read and describes well systemic failures and how they should be addressed once identified.

The reports are well worth a read – especially if you are a manager responsible for handling any sensitive information!

David.

Big Money To Be Saved with E-Prescribing

The following brief appeared a few days ago

E-prescriptions could cut federal expenses by $29 billion over next decade

Federal health expenditures could be reduced by up to $29 billion over the next decade if all Medicare prescriptions were transmitted electronically by 2010, according to a new study by Atlanta-based technology trade association AeA. But "eHealth 301: Electronic Prescriptions" notes that although e-prescribing has increased over the past several years, only two percent of all prescriptions were transmitted electronically in 2007.

Source: Telemedicine and e-Health News Alerts

The full .pdf file is found here.

http://www.aeanet.org/publications/AeA_CS_eHealth_ePrescribing.asp

A very big number – even if only half true makes a compelling case!

David.

Those Canny Scots are at IT Again!

Many reports of the Scottish Executive’s new E-Health Strategy this week.

Scotland commits to incremental e-health

01 Jul 2008

The Scottish government has pledged to further consolidate its SCI Gateway and SCI Store, and enhance its Emergency Care Summary Service, in its new e-health strategy for 2008-11.

The strategy lays out NHS Scotland’s approach to ‘electronic patient records and electronic communication becoming the primary means to manage healthcare information within the health system.’

While no specific budgetary commitment has been made, the Scottish Executive says it aims to boost the national e-health budget from the £40m spent in 2005/6 to £140m in 2010/11. In total it says NHS Scotland spent £225m on IM&T in 2006/2007.

It reiterates the commitment to stick to its current step-by-step approach and build on the systems already in use in Scotland: “We have already successfully implemented initiatives such as SCI Store, SCI Gateway and the Emergency Care Summary which help us to join systems and share information but we need to move further.”

Big bang approaches to e-health are rejected as risky and potentially disruptive: “An attempt to move to this new world in a single bound, even if achievable, would take a number of years and would be disruptive. NHS Scotland has to date chosen to approach this vision step-by-step; by building on what we have already successfully achieved, carefully addressing risks and resources to gain benefit from our effort as we go,” says the report.

Examples of exploiting existing systems includes using the SCI Gateway – a national system that integrates primary and secondary care systems - and SCI Store - an information repository which is integrated to other local systems - to support the information and reporting framework for the 18-week waits programme. This is envisaged to be completed by September

The Emergency Care Summary will also be enhanced over the next three years with additional items of patient information, such as a single medication record, and it will also be made available to a wider user base.

Lots more here:

http://www.ehealtheurope.net/news/3904/scotland_commits_to_incremental_e-health

Download the Strategy here e-health Strategy 2008.

The release is also covered here:

Scotland launches e-health strategy for 2008

Tuesday 1st July 2008

The Scottish government has launched its e-health Strategy 2008 at this year's NHS Scotland Event.

The vision for e-health supports the goals as set out in the Better Health Better Care Action Plan.

The plan aims to exploit the power of electronic information to help ensure that patients get the right care, involving the right clinicians, at the right time, to deliver the right outcomes. It is therefore as much about transforming traditional processes as it is about technology.

Nicola Sturgeon said: "Building for the future means an investment in new technology. Our eHealth Strategy demonstrates how we intend to harness the opportunities of new technology to enhance patient care.

More details are found here:

http://www.hospitaliteurope.com/default.asp?title=Scotlandlaunchese-healthstrategyfor2008&page=article.display&article.id=12067

Coverage from the GP perspective is here:

Scottish GPs to get choice of systems

30 Jun 2008

The Scottish government is to set up a national framework contract for GP systems and launch a procurement for an IT system or systems to replace GPASS, according to its new e-health strategy.

The plan means Scottish practices are likely to be brought under a Scottish version of England’s GP Systems of Choice (GPSoC) agreement with boards given flexibility about how to meet the needs of community staff. In addition a procurement will be launched for a system to replace GPASS although it is unclear whether this will involve one or more systems. Plans to procure a system that covers both primary and community staff appear to have been dropped.

The e-health strategy for Scotland was launched by Scottish health secretary Nicola Sturgeon last week at the NHS Scotland Event held to celebrate 60 years of the NHS in Scotland.

The deputy first minister told the conference the three year strategy from 2008 to 2011 would enable Scotland to build the platform for an electronic patient record to support patients and improve their experience of care throughout the healthcare journey.

More here:

http://www.ehiprimarycare.com/news/3900/scottish_gps_to_get_choice_of_systems

There is not much to really add. Scotland has worked steadily and incrementally and it is really paying off as their capabilities and range of available applications increases.

Well worth a browse.

David.

Queensland Health Loses its CIO.

It seems there has been a major policy shift at Queensland Health. It now seems it is mandatory to have a clinician as the CIO to assist with the implementation of clinical systems.

Qld Health takes a turn for worse

Abstracted from The Australian Financial Review

Richard Ashby is the new acting CIO at the IT and telco division of Queensland Health. The appointment follows the sudden departure of Paul Summergreene, who had only stepped into the CIO role less than 12 months earlier. Under a restructuring, it is apparently a requirement for the office holder to also have a clinical background.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Qld-communications-take-turn-for-worse-GRTSE?OpenDocument

The full details are here:

http://www.misaustralia.com/viewer.aspx?EDP://20080722000030050602&magsection=news-headlines-list&portal=_misnews&section=news&title=Qld+Health+take+turn+for+worse&source=/_xmlfeeds/mis/news/feed.xml

and here:

http://www.misaustralia.com/viewer.aspx?EDP://1216606621587&magsection=news-headlines-list&portal=_misnews&section=news&title=Qld+health+sacks+CIO&source=/_xmlfeeds/mis/news/feed.xml

This is not a bad idea, just as long as the individual appointed has both a strong clinical background, a strong understanding of how technology can be used to improve the health system, and the managerial skills to have the health sector come with him on the necessary journey of implementation and change. I hope Dr Ashby has all three!

Being a CIO for a State Health System is a real challenge! Sadly the incumbents often do not last long enough to get the job done.

David.

The Most Important Report on e-Health and Quality and Safety for 2008.

The following report was released a few weeks ago.

The Impact of eHealth on the Quality & Safety of Healthcare

Friday, 27 June 2008

A Systemic Overview & Synthesis of the Literature Report for the NHS Connecting for Health Evaluation Programme

Josip Car, Ashly Black, Chantelle Anandan, Kathrin Cresswell, Claudia Pagliari, Brian McKinstry, Rob Procter, Azeem Majeed and Aziz Sheikh

- There have been substantial developments in information technology hardware and software capabilities over recent decades and there is now considerable potential to apply these technological developments in relation to aspects of healthcare provision.

- Of particular international interest is the deployment of eHealth applications - that is the use of information technology in healthcare contexts - with a view to improving the quality, safety and efficiency of healthcare.

- Whilst these eHealth technologies have considerable potential to aid professionals in delivering healthcare, the use of these new technologies may also introduce significant new unanticipated risks to patients.

- Also of concern is that even when high quality interventions are developed, they frequently fail to live up to their potential when deployed in the "real world"; a major factor contributing to this paradox is professional resistance to the introduction and use of poorly designed applications.

- Given that the NHS is now committed to the largest eHealth-based modernisation programme in the world, it is appropriate and timely to critically review the international eHealth literature with a view to identifying lessons that can usefully be learnt with respect to the future development, design, deployment and evaluation of eHealth applications.

Download The Impact of eHealth on the Quality & Safety of Healthcare (.pdf, 7.220 KB).

More here:

http://www.ehealthnews.eu/content/view/1209/62/

A useful presentation is also available here.

www.pcpoh.bham.ac.uk/publichealth/cfhep/events/Claudia_Pagliari_Impact_of_eHealth.pdf

This is one of those reports that simply has to be read to be appreciated – at the very least the introductory 28 pages are vital and must not be missed by anyone interested in where e-Health is at present and where it probably needs to move.

It is good that those involved are now moving on with the following.

NHS Connecting for Health's NHS Care Record Service Evaluation Begins

Saturday, 12 July 2008

NHS Connecting for Health, the flagship NHS IT programme, is to be evaluated by a national team of researchers led by the University of Edinburgh. The £1.5m study, which begins on 1st September 2008, will run until December 2010 and also involves researchers from the Universities of Nottingham, LSE, School of Pharmacy and the NHS. It will evaluate specifically the adoption of the NHS' Care Record Service which is being implemented in hospitals throughout England.

More here:

http://www.ehealthnews.eu/content/view/1230/27/

The key lesson I take from my reading is that it seems very likely use of Health IT can make a difference to quality and safety of patient care (it is assumed efficiency and care co-ordination is doable and valuable – certainly in countries with high levels of administrative complexity like the USA) but that the hard academic work is yet to be done to prove that is actually the case.

The situation in academic e-Health in Australia is, I fear typical, where both funds and career paths are problematic. Until this is fixed and we can do the trials that are needed to link the use of technology to really improved clinical outcomes in the real world the debate will continue. I wonder will I last long enough to see that happy day?

David.

David Gonski AC Appointed As NEHTA Independent Chair.

Mr David Gonski AC has been appointed as the first independent chair of the National E-Health Transition Authority.

More details are available here.

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=335&Itemid=144

Just why a lawyer and listed company director, and Chancellor of UNSW, is a good choice for this role totally eludes me. I wish him luck but can’t for the life of me see how someone with no apparent record in health or technology is the right person for this role.

The number of directorships he holds also makes one wonder how much time and focus NEHTA can expect.

I do not subscribe to the theory that any good manager can manage anything! Indeed, I see part of the decay of our Health System as being related to the systematic exclusion of health expertise from the management of health service entities.

If Mr Gonski’s role is to try and get the badly flawed NEHTA IEHR proposal through COAG, and funded, then he needs to know – right up front – he has been handed a poison chalice in my view.

The only upside is that it seems a well constituted Reference Forum (with real sector expertise and wide representation) is about to be announced by NEHTA. If this forum can have the influence it should there just may be hope yet. This is, of course, only three years to late!

Life is always lively in e-Health!

David.

Useful and Interesting Health IT Links from the Last Week – 20/07/2008

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

Electronic records help doctors, patients work together

Electronic records help doctors, patients work together

by Connie Midey - Jul. 15, 2008 12:00 AM
The Arizona Republic

When Jesus Saavedra sits down with his doctor, his vital signs - taken just moments before - are displayed on a computer monitor in the exam room.

So are notes from previous visits, results from lab tests and his answers to a series of questions, including whether he uses a seat belt (he does) or smokes (he doesn't).

The order for a prescription he needs travels via the doctor's computer at the Carl T. Hayden VA Medical Center in Phoenix, where the Buckeye Army veteran receives outpatient health care, directly to the on-site pharmacy, where a robot will fill it.

Saavedra, 56, even signs consent forms electronically. Encounters with paper are rare during his appointments with physician Mervin Myrvik, a specialist in internal medicine and the Phoenix VA medical center's chief of informatics.

"It's a very impressive system," Saavedra says. "It even (graphs) my weight changes. They don't want you to miss that."

One of medicine's most enduring icons - the folder brimming with a patient's records - is being replaced by electronic health records, and perhaps nowhere are the changes more apparent than in the VA Health Care System.

At 153 VA hospitals nationwide, a computerized patient record system implemented in 1998 holds electronic files for the 5.5 million veterans treated, 70,000 of them in the Phoenix area. The system operates on the VA's VistA software program, a bundle of about 20,000 regularly updated programs.

VistA is short for Veterans Health Information Systems and Technology Architecture.

"Electronic health records have made a difference," Myrvik says, in the way health-care providers work and in outcomes for patients.

More here:

http://www.azcentral.com/arizonarepublic/arizonaliving/articles/2008/07/15/20080715electronicrecords0715.html

This is a useful reminder that, with time and the right level of investment, it is possible to implement a really rich EHR system that makes a real clinical difference. It’s worth remembering it is possible!

Second we have:

Open source health IT solutions

An open source developer community, Open Health Tools (OHT), has announced a collaborative effort to develop common healthcare IT products and services.

Its 26 members consist of national health agencies, government-funded organisations and agencies, major healthcare providers, international standards organisations and companies from Australia, Canada, the United Kingdom and the United States.

The members include NHS Connecting for Health, BT, IBM, Oracle and HL7, among others. Formed in November 2007, OHT's mission is to provide software tools and components that will accelerate the implementation of electronic health information interoperability platforms, which improve patient quality of care, safety and access to electronic health records (EHR).

The results will be available under an open source agreement so anyone may use them to provide interoperable healthcare platforms that will link clinics, hospitals, pharmacies and other points of care to make healthcare systems more efficient.

OHT's health interoperability framework will use standardised, open interfaces and a set of reusable software components that can be assembled into systems and products by health systems and vendors.

OHT is open to membership from any organisation and the results of member efforts are made available under a commercially friendly open source license.
More here:

http://www.mediaforfreedom.com/ReadArticle.asp?ArticleID=10472

This is an initiative that we are all going to hear more about over the next 2-3 years. Worth making sure you are across their activities and can take advantage of the ideas they develop.

Third we have:

Old-fashioned docs inspire new 'medical homes'

States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients' care.

The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.

Dubbed "medical homes," the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees — ranging from just a few dollars a month per patient to more than $35,000 a year per doctor — from states, Medicare or other insurers.

Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.

The concept aims to change rushed doctor's appointments and fragmented specialist care by creating patient care "teams," which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.

More here:

http://www.usatoday.com/news/health/2008-07-13-medical-homes_N.htm

Interesting to see continuing discussion in the mainstream US Media on the Medical Home concept and the linkage of the use of this approach to deployment of EHR services. There is no doubt that EHRs can assist in the care co-ordination and information management roles that GPs perform.

Fourth we have:

Queensland goes offline

Tony Koch and Mitchell Bingemann | July 16, 2008

A WORKER operating a backhoe on a building site at Molendinar on the Gold Coast threw Queensland's communications network into chaos yesterday morning by severing a fibre optic cable.

The Optus network collapsed, rendering landline and mobile phones to and from Queensland useless and leaving internet services blacked out. Automatic teller machines and EFTPOS services were also affected.

Tempers frayed at major business premises where communication was stopped. At Brisbane airport, lines of travellers stretched for more than 100m as they waited hours for their tickets and luggage to be manually processed.

Radio reports indicated that Optus was refusing until late yesterday to explain the collapse of its system, while media organisations were inundated with complaints about Optus.

The system went down at 7.53am and was restored after midday when technicians repaired the damaged cable.

More here:

http://www.australianit.news.com.au/story/0,24897,24028241-15306,00.html

Another amazing piece of news. It seems really very poor that links as vital as this were not duplicated and switch over tested on a regular basis. The impact makes it clear just how dependent we have all become in network communications to conduct ordinary life and business.

The fact that the cable was cut just 2 meters away from a marker alerting diggers that the cable was there – as shown by a Optus photo of the site – shows there are some pretty dumb backhoe drivers around!

The more we treat the Internet as something like water and electricity in daily life the more important it is we have contingency plans for failure. Hospitals have had generators for years – I wonder how well they can cope with network outages.

Fifth we have:

Guidelines on card rort reporting

Karen Dearne | July 15, 2008

SMALL businesses remain outside the purview of the federal Privacy Commissioner at a time when they face soaring credit card breaches.

Commissioner Karen Curtis will shortly release voluntary guidelines on reporting data breaches for use by companies and government agencies as an interim measure ahead of the Rudd Government's overhaul of the 20-year-old Privacy Act.

It's not yet clear whether the voluntary guide will involve public notification of breaches, or the industry's preferred need-to-know position. "My office is still working through issues such as this prior to the guide's release during Privacy Awareness Week, the last week in August," Ms Curtis said.

"However, in the consultation draft, it was suggested the preferred method was direct notification either by phone, letter, email or in person to affected individuals.

"Indirect notification, either by website information, posted notices or the media, should generally occur only where direct notification could cause further harm, is prohibitively expensive, or contact information is not known."

More here:

http://www.australianit.news.com.au/story/0,24897,24020190-5013044,00.html

Two points here. First it seems clear to me you are entitled to know promptly if someone has let your private information out of their control and second all organisations holding personal data (including health data) need to proactively ensure such leaks and loss do not happen – and a reasonable penalty regime should be in place to focus the mind of all data custodians.

Without pressure we seem likely to receive the ‘Mushroom Treatment’.

Silence golden on security slip-ups

Karen Dearne | July 15, 2008

A STAGGERING 96 per cent of technology decision makers don't think the public should be told when data breaches occur, according to a survey by email and web security specialist Clearswift.

But 82 per cent of respondents do say affected customers should be informed, and only 28 per cent oppose mandatory data breach notification laws.

Clearswift Asia-Pacific managing director Peter Croft says companies fear airing their dirty laundry in public will lead to a loss of customer confidence, while proposed disclosure legislation would be expensive and create work for the technology department.

"Unfortunately, some businesses are unaware of the depth of feeling on this issue," Croft says. "People like to know they can trust the organisations that deal with their personal and financial information.

"Banks like to keep news of breaches to themselves, but they are out of touch with their customers' expectations. They should be much more open about how good they are at handling other people's information."

More here:

http://www.australianit.news.com.au/story/0,24897,24019443-24169,00.html

Sixth we have:

Video sports have Wii effect

• Saved

Dan Harrison, Health
July 13, 2008

Interactive sports video games such as the Nintendo Wii are better for children than conventional computer games, but do not tackle the epidemic of childhood obesity, British research shows.

The study, published in the British Journal of Sports Medicine, found that playing virtual sports such as tennis, boxing and bowling on Nintendo Wii burned more than 50% more energy than playing sedentary computer games such as Xbox.

But the children used much less energy playing virtual sports than they would in the real versions. Real boxing burns more than twice as much energy as Wii boxing. Real tennis is 77% more demanding than the electronic version, and conventional bowling uses almost 15% more calories than the virtual kind.

The study authors calculated that in a typical week, a child who played Wii sports would use about 2% more energy than one playing sedentary computer games.

They said the increase was "trivial," and the activity was not intense enough to be counted in the recommended daily amount of physical activity. But the games could play a role in weight management and were preferable to sedentary games.

More here:

http://www.smh.com.au/news/technology/video-sports-have-wii-effect/2008/07/12/1215887493421.html

I must say I think the authors are being somewhat spoiled sports about this. Anything that gets people up an moving – even a little bit – is better than nothing and, of course, if choosing a game to purchase for children it seems hard not to think this might be a slightly preferred choice.

The critics here seem even worse – but then I suppose a small risk exist that some may worry about the body image excessively. I suspect if the Wii game can cause a problem so can all other signals being received by children however.

Wii Fit raises obesity furore

Asher Moses
July 18, 2008 - 9:00AM

Nintendo's Wii Fit game has attracted the ire of childhood obesity experts for telling healthy kids they are fat, which might cause eating disorders and self-esteem issues.

The game assesses players' fitness levels based on their body mass index, labelling them underweight, ideal weight, overweight or obese.

The BMI is a statistical measure of a person's weight relative to height, but experts say this is not an appropriate measure for children because it does not account for their age or stage of development.

The $149.95 Wii Fit was launched in Australia in May and includes a weight- and motion-sensitive balance board, which players can use for yoga, muscle workouts, aerobic exercises and balance games.

More here:

http://www.smh.com.au/news/articles/wii-fit-raises-obesity-furore/2008/07/17/1216163018848.html

Last we have our slightly technical note for the week:

Tape storage, high and low, gets more dense

HP and Sony doubled the density of their DAT data storage tapes while IBM and Sun introduced 1T-byte enterprise tape drives.

Stephen Lawson (IDG News Service) 16/07/2008 08:12:45

Two classes of tape storage are jumping to higher densities this week, potentially saving time and money at enterprises as well as small and medium-size businesses.

Hewlett-Packard and Sony on Tuesday announced a coming generation of DAT (Digital Audio Tape) media with twice the capacity of the current technology and a higher transfer speed. On Monday, Sun Microsystems introduced an enterprise-class tape drive that can pack 1T byte on a current type of tape, and on Tuesday IBM also announced a 1T-byte tape drive system.

Along with demand for hard-drive storage that has to be immediately accessible, the need for tape to reliably back up and archive older information is growing fast, according to IDC analyst Robert Amatruda. Higher capacity per tape cartridge can save space, power and money and even allow companies to save more old data, he said. In addition to greater density, the new tape technologies offer faster transfer speeds.

The next generation of DAT, called DAT 320, will be able to hold 320G bytes of data on one cartridge. It was jointly developed by HP and Sony over the past two years and should be generally available in the first half of next year, according to Bob Conway, manager of the tape product marketing team at HP. The new technology will also allow for back up from disks at speeds as high as 86G bytes per hour with 2:1 data compression, he said. Data is typically transferred to DAT decks via USB (Universal Serial Bus) or serial or parallel SCSI.

…..

To achieve the new density on a tape the same size as its predecessor, DAT 160, the companies changed the basic formula of DAT for the first time, from metal particle tape to metal evaporated tape. They also developed narrower tracks, Conway said. The companies will license the DAT 320 technology to anyone for a nominal fee.

HP and Sony's openness will help ensure there are multiple suppliers of media and components, Amatruda said. HP made 55 percent of low-end tape deck shipments worldwide in the first quarter of this year and Sony made 7 percent, he said.

Although there are a growing number of external hard-drive products available for SMB backups, they aren't as reliable as tape, he said.

"At the end of the day, maintaining hard drives is not really data protection," Amatruda said. And it can be important to have old data set aside for disaster recovery or in case of an event like a tax audit.

"If you can't produce critical data that you use to run your business ... you can be in real trouble," he said. The improved efficiency of the new tapes will probably convince more companies to use them for longer term archiving, he added.

More here:

http://www.computerworld.com.au/index.php?id=1630184913&eid=-255

Backup is an important issue that needs to be addressed carefully when acquiring and managing patient data. This is a useful reminder that the technology is getting better – with the 160 Gig drives now of the order of $1000 using a USB interface. At this price and with tape only $20-30 each there is no excuse not to have such an insurance policy in place.

http://www.smh.com.au/news/upgrade/survive-the-backup/2008/07/14/1215887537523.html

Survive the back-up

• Saved

Adam Turner

uly 15, 2008

Next

If you're not using an off-site back-up system, you're taking your digital life in your hands by not protecting data against fire and theft, as well as hardware failure. It needs to be backed up off-site - preferably at an enterprise-grade data centre.

This article is also worth a browse on the same general topic.

More next week.

David.

E-Prescribing Gets a Huge Boost in the US.

This week we have had some very good news about the use of e-Prescribing.

Congress Passes Medicare Bill with Veto Proof Margin

After multiple unsuccessful attempts in June to pass a Medicare bill, on July 9th the Congress passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which prevents a scheduled 10.6% cut to Medicare payments to physicians, and includes financial incentives to accelerate the use of electronic prescribing by physicians, among other things. Not only did both houses of Congress pass the measure, but they also passed it by a veto-proof margin, so even if President Bush refuses to sign, Congress could still force the measure through. The Senate voted 69-30 to approve the bill, while the House voted 355-59.

In addition to addressing the annual need to offset the Medicare Sustainable Growth Rate (SGR) cuts, the Medicare Improvement for Patients and Providers Act will provide positive Medicare payment incentives of up to 2% for practitioners who use qualified e-prescribing systems in 2009 through 2013, and a reduction in payments of up to 2% to providers who fail to e-prescribe by 2012. The bill permits the Secretary to establish a hardship exception to providers who are unable to use a qualified e-prescribing system. The bill also calls for a Government Accountability Office (GAO) report on the effect of the e-prescribing incentives included in the legislation.

More here:

http://www.himss.org/ASP/ContentRedirector.asp?ContentId=68157&type=HIMSSNewsItem

This is really good news as the legislation has a neat mix of carrot – extra pay and stick – a financial penalty – to really encourage adoption and use – while providing a sufficient period of time to allow prescribers to get used to the idea.

More important is that this move is the ‘thin end of the wedge’ in getting US physicians to start using computers. This will hopefully flow on to the use of more EHR functions over time with the benefits that will flow from that.

Best news is that President Bush can’t veto the legislation. If he does not sign – it becomes law in 10 days anyway because of the 2/3 majority obtained in both Congress and the Senate.

I wonder what cool functionality will not emerge to assist docs prescribing with a market of this size to compete for!

David.

AusHealth IT at 500 Posts.

Late last week the blog passed the 500 post milestone. I thought that would be a good point to provide some feedback on usage, popular articles etc.

First site usage:

VISITS

Total - 50,357

Average Per Day - 115

Average Visit Length - 1:59 mins

Last Hour - 4

Today - 22

This Week - 805

PAGE VIEWS

Total - 81,541

Average Per Day - 130

Average Per Visit 1.4

Last Hour - 4

Today - 30

This Week - 913

ARTICLE READS

Top 5 Ever.

1. An Invaluable Reference on Health IT Value - 822 Reads

2. Well, Now What is Needed in Australian e-Health is Confirmed – So Let’s Roll - 471 Reads

3. MicroSoft’s HealthVault – Is it Applicable to, and will it work in Australia - 393 Reads

4. The Australian Broadcasting Commission - 362 Reads

5. It is a Dangerous World Out There! 257 – Reads

For the last month (30 days) they have been.

1. What is Big Blue Up to in E-Health in OZ? - 210 Reads

2. Just Why are NEHTA’s Plans for the Shared EHR a Secret? - 185 Reads

3. NEHTA Just Steams On Regardless! - 176 Reads

4. NEHTA Exposes What it Is Up To – By Accident! -172 Reads

5. Could NEHTA Have Been Done Better and Cheaper - 168 Reads

E-MAIL ALERTS

The e-mail alert now goes to 148 different subscribers and total RSS and e-mail subscribers seems to be about 260 - 280.

A few bits of blog news are the following:

1. The blog is now available by RSS feed at www.hisa.com.au

2. The number of comments on controversial posts has now reached a critical mass where I think we are getting some good feedback. I really like this aspect of the blog and it certainly keeps me honest!

Thanks to all for this so far! I can’t promise to make it to 1000..I will probably have died by then (of exhaustion if nothing else) – but I hope I am around to see some real progress!

David.

Others Are Noticing the Australian E-Health Mess.

There is always the risk – when typing away in the ivory tower – that one can become a little out of touch. I have thus found it very re-assuring that increasingly other observers are noticing the mess we seem to be making of e-Health.

A couple of examples.

Ready, set… slow

Friday, 11 July 2008

What’s the hold-up on a national, linked electronic health system? Kathryn Eccles finds out.

BEING called to hospital at 2 am to assess a patient with chest pain is part of an average week for Dr Peter Rischbieth.

At his most recent early morning call-out, the RDAA president would have been forced to rely on a 73-year-old patient and her relatives for a medical history were it not for his computerised practice. But a few clicks of the mouse were all that was needed to compare the patient’s current ECG with one from a month earlier.

The comparison showed Dr Rischbieth the ECG was normal for that patient, saving her an 80 km journey to Adelaide, an $800 ambulance bill, the cost of a back-up ambulance crew to provide cover, and time waiting in casualty.

E-health, even at its most basic level – allowing doctors to access patient notes from the local hospital – is not only proving cost effective, it is also saving time and lives.

Research shows that computerised prescribing systems can significantly lower medication mistakes and adverse drug events. And, given that about one in 10 general practice patients experiences an adverse drug reaction over a six-month period (MJA 2006;184:321-24), the potential to make a difference is huge.

This is why progressing the e-health agenda across the country is crucial, says Dr Rischbieth.

…..

And, for many doctors, this lack of symmetry is where the frustration lies. Patience is wearing thin among GPs who have been waiting what seems like an eternity for a functional national system to develop.

They want to see a system that can provide crucial medical details at the touch of a button, that allows professionals to ‘talk’ to each other via secure messaging; to write and process prescriptions electronically; and to scrap the clutter of paperwork.

While all of this does happen to an extent in some areas at a local level, national progress could be described as glacial.

Original plans to introduce a national shared electronic health record were based on a 2010 timeframe.

But that now looks unlikely, with 2012 looking like a more realistic, but still challenging, goal.

Groups in charge of driving the process include the National E-Health Transition Authority (NEHTA), which has been entrusted by the Council of Australian Governments (COAG) to develop standards for the seamless delivery of e-health across every state and territory.

Consultancy firm Deloitte Touche Tohmatsu has been handed $1.3 million by COAG to prepare a national e-health strategy, due later this year.

Former chair of the now-defunct General Practice Computing Group Dr Ron Tomlins believes the extended timescale is simply because NEHTA has “picked the pineapple up by the wrong end”.

“They should be focusing on resources that people already have and encouraging them to use them better and more appropriately rather than search for some... magic solution.”

More here (if you have access to Medical Observer)

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/Ready,-set%E2%80%A6-slow-

Equally we have the following from another source.

Government dragging the e-health chain in Australia

10 July 2008

Excerpted from a special report I wrote for this week’s Australian Doctor

Jim Clark was known as Silicon Valley’s $3 billion man: the first person to start up three companies that were each capitalised at $1 billion or more. Starting in the 1980s with Silicon Graphics, a pioneer of film and CGI animation, he grew bored with that and helped found Netscape, which launched the world’s first widely used web browser, in the early 1990s.

…..

Clark had the right idea, but back in the last decade he was too far ahead of the curve to make it work. Now, however, e-health is an idea whose time has come.

“E-health is an idea whose time has not only come, it is overdue,” says Associate Professor Ron Tomlins, associate professor of general practice at the University of Sydney, who spent several years as chairman of the General Practice Computing Group.

Professor Tomlins said government and professional initiatives in Australia over the past 10 years that put computers, powerful software and broadband in practices have prepared a foundation that will enable GPs to harness the new online technologies that have been developing independently over the same period.

As more and more doctors turn to the Internet as a professional information source, more than 80% now report that the Internet is essential to their practice, according to research in the US by Manhattan Research. Consumers today, meanwhile, get more health information from the Internet than from their doctors, according to market research firm iCrossing.In Australia, trials of electronic health records and other online applications are under way in most states (see Case studies), while the Federal Government tries to set standards through the National E-Health Transition Authority (NEHTA) to ensure consistency, portability and security of records.

In Canada, the government has set a target of 50% of the population to have electronic personal health records by the end of 2009. In Australia, meanwhile, the government is “dragging the chain”, according to Professor Tomlins, with NEHTA recently announcing that it would be another 10 years before personal health records were in established use in Australia. Professor Tomlins said NEHTA is not moving fast enough, pointing out that it underspent its budget by almost $40 million last financial year.

“General practice is frustrated as hell in the lack of interest from the Commonwealth,” Professor Tomlins said. “The state governments are moving things along with projects such as Healthelink in NSW, SHER [shared electronic health records] and secure messaging projects in the Northern Territory and chronic health management programs in South Australia. But there’s a real danger that they won’t be interoperable and we will end up with a rail gauge situation.”

But regardless of that danger, Professor Tomlins says, the increase in data available to GPs puts them in a good position to use new technologies to improve patient care. “GPs have spent the past few years building up electronic databases for their practices,” according to Professor Tomlins. “Tools are now available to use that data to better understand how better care can be delivered to their patients. They can conduct clinical audits to mine that data, both clinical and financial, and benchmark themselves against other practices to find ways to improve the way care is delivered.

More here

http://wellingdigital.com.au/2008/07/10/government-dragging-the-e-health-chain-in-australia/

All I can add is that the time for messing around should be close to past. We have the Deloittes National E-Health Strategy due in 6-7 weeks and hopefully after that is released (and that it is will be a bit of a test given it can hardly be flattering) we will have a platform for discussion to move the agenda forward.

One hope is that I am hearing from a range of sources that the NEHTA Acting CEO is making a difference! – If this turns out to be sustained it is a very good development. If you read Andrew – and I know your staff do – keep it up!

I sure hope so!

David.

NEHTA’s Clinical Briefing Papers for Your Reading Pleasure.

Some will be aware that in the last month or so NEHTA has been running a range of sessions to brief clinicians on its plans for Health Identifiers and the Individual EHR.

As many will be aware for some reason the Health Informatics Community was not represented at these briefings.

For this reason I thought it would be a good idea to let the readership of the blog see some of what was presented and discussed

Please download the information from this link.

http://www.moreassoc.com.au/downloads/NEHTA eHealth Summit.zip

There seems to me to be a good deal more detail on all sorts of things than we have seen to date, and certainly NEHTA has updated the house documentation style dramatically.

I would really love views (as comments on the blog) from Health Informatics professionals on the plans outlined here. NEHTA still seems to think it can speak ‘ex-cathedra’ rather than getting expert comment before asking clinicians and the public what they think.

I can’t see any restrictions on these documents so I think it is good to have them more widely distributed.

Anyway NEHTA is a publicly owned company and we own them so we are entitled to know just what it is they are up to! – Unless there is financial risk to the Commonwealth – and there is not -they have no right to be so secretive.

Enjoy!

David.