Telehealth and Telemedicine in the News.

The following press release arrived a few days ago

Patients manage health at home with telehealth

November 21, 2008 (Kimberley, BC) - More congestive heart failure patients living in Interior Health can now use a monitoring system at home to check their condition and send data on their vital signs direct to their care providers.

East Kootenay MLA Bill Bennett, on behalf of Health Services Minister George Abbott, got a first-hand demonstration of the system at work at the home of Mr. Charles Park in Kimberley.

"Patients can check their vital signs to better manage their own care and know that information is also going to their doctor or nurse - I am delighted to see this innovation helping heart patients in the Kootenays," said MLA Bennett. "This practical demonstration in a patient's home shows how telehealth gives patient's access to a greater role in their own care and more timely delivery of patient care when they need it."

"Telehealth is one way we are breaking down barriers to quality health care for British Columbians regardless of where people live," said Health Services Minister George Abbott. "Telehealth homecare enables faster detection of problems, lets patients self-manage their care and saves travel time for patients and caregivers."

Interior Health deployed 40 monitoring units in a pilot in the Cranbrook and Kimberley areas in July 2006 serving 87 patients. It will add another 20 units so more patients in the East Kootenay can use the system. The monitors are placed in homes for up to three months to learn about how to better manage their congestive heart failure. After three months the monitor is removed from that patient's home and deployed in another. This program is based on a partnership between the patient, physician and nurse. The patients are given the opportunity to learn how to manage their disease with the help of the care team. The knowledge gives the patients more confidence and freedom.

"Working with clients in the Congestive Heart Failure (CHF) program is very rewarding. I work with clients to increase their knowledge, skills and confidence in managing their own care, part of which is early detection of increasing signs and symptoms of heart failure, and what to do when this happens," said Catherine Blake, a CHF nurse with Interior Health's home telemonitoring program." The end result is that they often prevent severe exacerbations of their illness, their quality of life improves, they stay out of emergency departments and they feel empowered to make informed decisions around their care."

"This program illustrates how a bit of knowledge can reinforce medicine to allow people a better lifestyle and keep them out of the hospital and doctor's offices" said Mr. Charles Park, heart patient.

Patients utilize the system using text and voice prompts, guides the patient through the collection of vital signs (weight, blood pressure, heart rate and oxygen saturation levels). The patient's vital signs are encrypted and automatically transmitted to the health authority. Health staff can then examine the patient data, and see if immediate intervention, a visit to a physician or a home visit is needed.

Vancouver Island Health Authority will also be adopting a similar system for the first time and expects to have the system up and running by early spring 2009. The Vancouver Island Health Authority and Interior Health project budget for this project is $836,000, with $333,000 provided by Canada Health Infoway.

"Our home monitoring system reduces the need for patients to travel and gives patients in rural and remote areas better access to care because health care providers can monitor them from a distance as frequently as needed," said Interior Health CEO Murray Ramsden.

Canada Health Infoway is leading the development and implementation of electronic health projects across Canada. Infoway works with provinces and territories to invest in electronic health projects, which support safer, more efficient health-care delivery.

"It has been estimated that 20 per cent of hospitalizations for coronary heart failure could be prevented through improvements in medical management and patient self-management," said Richard Alvarez, president and CEO, Canada Health Infoway. "The investment made in the telehomecare project enables the expansion in the circle of patient care, empowering the patient to become an active member in self-management."

Telehealth videoconferencing technology is now in place in more than 100 communities throughout the province. There are approximately 200 Telehealth facilities providing access to approximately 470 videoconferencing end points. Two First nations Telehealth networks are providing health education and training to approximately 30 sites in B.C. Telehealth helps to overcome barriers of geography, transportation infrastructure, or socio-economic disparity by enabling clinical consultation, continuing professional education, and healthcare management.

Full release here:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=348

We also had this arrive a few days ago:

Right Here Right Now: Ten Telehealth Pioneers Make It Work

Jane Sarasohn-Kahn, THINK-Health

November 2008

This iHealth Report describes how ten telehealth innovators are using electronic means to make high-quality health care available remotely. They use an array of communications instruments, from ordinary telephones and televisions to broadband connections and 3G-driven iPhones.

The ways that patients and providers can benefit are as varied as the ten pioneers' approaches, including:

• "Virtual house calls" and home-based monitoring;
• More efficient office visits and medical research;
• Cost-effective expert advice and second opinions;
• Access in rural areas;
• Medical education made available internationally; and
• Round-the-clock radiology coverage.

The complete report is available under Document Downloads below.

This report complements another CHCF iHealth Report, titled Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem, which is available under Related CHCF Pages below.

Document Downloads

Right Here Right Now: Ten Telehealth Pioneers Make It Work (.pdf, 255K)

Related CHCF Pages

Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem

Access the information from here:

http://www.chcf.org/topics/view.cfm?itemID=133788

All in all lots of useful reading in the area.

David.

News Extras For the Week (18/12/2008).

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

First we have:

Obama announces electronic medical-records plan

Posted: December 8, 2008 - 5:59 am EDT

President-elect Barack Obama outlined a plan to electronically link hospitals, physician offices and the patients who rely on them as part of a multipronged approach to help boost the U.S. economy.

Though still measured on details, Obama sketched out a plan in a weekend radio address to “make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year.”

In Washington last week, congressional aides confirmed that health information technology is being considered as part of a larger economic stimulus package, though it’s unclear which bill would be used as the framework to such a proposal. One Senate aide said that the Wired for Healthcare Quality Act, sponsored by Sens. Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.), could make the cut. But other bills are likely to be in contention as well, including one passed by the House Energy and Commerce Committee earlier this year and another proposed by Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Health Subcommittee.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081208/DOSE/312089950

And he is backing it up with billions – No comment!

Second we have:

Electronic vs. paper

Are your medical records secure?

Sunday, December 7, 2008 3:28 AM

By Suzanne Hoholik

THE COLUMBUS DISPATCH

You might expect health-care providers and insurance companies to use the best security measures to keep your medical information private.

But a national expert on patient privacy said it's naive to think that your health record is secure. And with the federal government pushing for more electronic records, security will only get worse.

"Because of the primitive state of health technology, there are a lot of risks with electronic records, frankly far more than paper," said Dr. Deborah Peel, founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas.

Peel, who recently spoke at a health-policy conference in Columbus, said most people don't know about all of the nonmedical staff people who have access to their electronic health information.

And she questions providers who promise privacy.

Much more here:

http://www.dispatch.com/live/content/local_news/stories/2008/12/07/EMR.ART_ART_12-07-08_B1_LOC5H3M.html

Bit of a silly debate – but I must say I prefer audit trails to undetectable snooping of paper records any day!

Third we have:

Perfect vision for health informatics

10 Dec 2008

Representatives of international and regional e-health advocacy groups are meeting at the Wellcome Trust in London this week to agree plans for building “capacity” in the global health informatics workforce, thanks to a €0.9m ($1.2m) grant from the Bill and Melinda Gates Foundation.

The American Medical Informatics Association (AMIA) announced on Monday that it received the grant to promote health informatics and biomedical education and training worldwide, particularly in developing countries.

AMIA is convening the meeting with the European Federation for Medical Informatics (EFMI) and the Asia Pacific Association for Medical Informatics (APAMI), under the umbrella of the International Medical Informatics Association (IMIA).

This will be planning the first project of a programme called 20/20, in which IMIA and its regional affiliates will attempt to train 20,000 informatics professionals globally by 2020. This is an outgrowth of the well-established AMIA 10x10 programme to train 10,000 people in informatics in the US by 2010. The 20/20 effort is chaired by Dr NT Cheung, head of IT for the Hong Kong Hospital Authority.

The Gates money is intended to develop “scaleable” approaches to e-health education, including a replicable blueprint for training informatics leaders, including physicians, medical records specialists, computer scientists and medical librarians.

More here:

http://www.ehealtheurope.net/news/4396/perfect_vision_for_health_informatics

Good to see some effort being devoted to this area. Right now I really think Australia is a bit behind in many aspects of HI Professional development.

Fourth we have:

Jordan EHR project could have global effect: experts

By: Joseph Conn / HITS staff writer

Posted: December 10, 2008 - 5:59 am EDT

Part one of a two-part series:
The recently announced decision by the Middle East nation of Jordan to install the Veterans Affairs Department’s VistA electronic health record in its government-run healthcare system probably won’t be a dam-breaker for VistA in the private sector in the U.S., but it could have a huge impact on information technology globally, people close to the project said.

Under terms of the contract for the pilot project, Perot Systems Corp., Plano, Texas, is to install WorldVistA EHR, an open-source version of the VA’s system, at 488-bed Prince Hamza Hospital, a teaching hospital opened in 2006 in Amman, the capital of Jordan.

Perot also is to install the software at the hospital’s affiliated outpatient Amman Comprehensive Medical Clinic and at the King Hussein Cancer Center, which was founded in 1997 and is undergoing a renovation due to be completed this year, increasing its capacity to 200 beds.

Physician Rami Farraj is chairman of the board of directors of E-Health Solutions, a not-for-profit Jordanian company created to oversee the government’s IT development program. Farraj said the Jordanian government chose the WorldVistA version that runs on GT.M, an open-source iteration of the Massachusetts General Hospital Utility Multi-Programming System, or MUMPS, database and programming language. GT.M is developed by Fidelity National Information Services, Jacksonville, Fla. The VA runs VistA on Cache, a proprietary version of MUMPS from InterSystems Corp., Cambridge, Mass.

Much more here and in the second article

http://modernhealthcare.com/article/20081210/REG/312109996/1134/FREE

It is really good to see headway being made with WorldVistA. The developing world can now access some very useful software for much lower than the commercial costs.

Fifth we have:

Many U.S. Hospitals Do Not Share Information on Medical Errors, Survey Finds

[Dec 10, 2008]

Most hospitals nationwide collect information about patient injuries or deaths that result from medical errors, but only one in five shares the data with managers and others who could implement measures to address the problems, according to a survey conducted by the Agency for Healthcare Research and Quality that appeared on Monday in the journal Quality and Safety in Health Care, the Newark Star-Ledger reports. The survey included responses from risk managers at more than 1,600 hospitals nationwide.

According to the survey, 32% of U.S. hospitals have established "supportive environments" that allow staff to report anonymously patient injuries or deaths that result from medical errors, and 13% have broad staff involvement in such reporting. The survey found that physicians often do not participate in such reporting because of concerns about liability, professional embarrassment and time requirements.

More here:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=56020

This is a real worry indeed – I wonder do we know how Australian hospitals perform?

Last for this week we have:

The Link Between Genetic Medicine and IT

Kathryn Mackenzie, for HealthLeaders Media, December 9, 2008

The premise behind personalized medicine seems astonishing and yet simple at the same time: Each of us receives medical treatment tailored to our unique genetic makeup. By using molecular analysis to better manage a patient's disease or predisposition to disease, physicians are able to choose the approach best suited to the patient's genetic profile. The benefits of genetic and molecular medicine are so many, says outgoing Health and Human Services Secretary Michael Leavitt, that personalized healthcare should be an "explicit goal of President-elect Barack Obama's healthcare reform plan."

In the second report from his Initiative on Personalized Health Care, Leavitt says that personalized medicine could be one of the key measures to reduce waste and overuse of prescription drugs and health resources. "We have developed powerful pharmaceuticals, yet most drugs prescribed in the United States today are effective in fewer than 60% of treated patients," he writes, noting that the "trial-and-error" approach remains the most common process for diagnosing and treating patients.

Leavitt also stresses the need for links between information technology and personalized medicine. "The base of interoperable health information technology is critical and remains far from complete. It is not merely a matter of electronic health records, but equally the capacity to exchange information securely," he writes.

More here:

http://www.healthleadersmedia.com/content/224660/topic/WS_HLM2_TEC/The-Link-Between-Genetic-Medicine-and-IT.html

This is an area that is only going to become more important over time – worth a read.

David.

The NSW HealtheLink Evaluation – The Devil is in The Detail.

This is an interesting report but as usual what is said is less important than what is omitted.

The report – such as it is – is found here:

An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)

A comment made on the announcement in many ways said it all – to paraphrase “one or two clinician evaluations is worth more than a host of accountants”!

The random points I found interesting were (given the trial period reported is from March 2006 to September 2008):

First any thought of reporting costs of the pilot was blocked by the terms of reference.

Second there was no attempt reported to make any assessment of clinical impact.

Third, despite the time allowed for adoption, only 165 of 800 clinicians had actually used the system at all in the last 90 days.

Fourth, despite 2.5 years of trialling, and compulsory enrolment, a useful critical mass of patients and information is yet to be gathered.

Fifth, it seem pretty clear that while there are claims of technology success the time allocated has not permitted development of any really useful seamless integration of Healthelink and GP client systems. Clinician access and workflow problems remain major issues.

Sixth is appears the project team have, for whatever reason, failed to get GP software providers to co-operate and successfully integrate Healthelink into their client systems.

Seventh the benefits claimed are anecdotal and not evaluated in any hard way in terms of time saving, clinical improvements, patient satisfaction or anything else I can spot.

Eighth what has been done has been rather ‘National Standards Free’ and it is suggested this should be addressed sooner rather than later.

Ninth, despite the time available for improvement, the system is functionally poor and does not yet even provide a basic patient summary for each patient. (This really should be the core of any Shared EHR in my view as it is in Denmark, Scotland etc).

Tenth 35% of patients wanted an opt-in – not opt-out consent model – hardly a number to be ignored despite the clinicians being happy with opt-out. (Amazing that 66% of patients first found out they had been enrolled when the information pack turned up in the mail and then almost ½ did not read it fully!)

The scope of the pilot involved approximately 40,000 at the end of the trial with ½ being enrolled in the last 4-5 months.

Of the records created 95% of the Maitland records and 98% of the Western Sydney records were not accessed during the trial – hardly a heavy use!

Patients ignored internet access to their record in droves – only one in 492 looking at them in Maitland and one in 1078 in Western Sydney.

Overall it really seems to me this is one of those trials which should have been conducted as a learning experiment – given the length of time it ran – to get things really working. It seems that has not really happened and that the opportunity to really find out what might works has for now been lost.

Even the report we have should force a total re-think and a much improved approach before broader implementation is planned. The recommendations for improvement in Section 6.0 of the document need to be taken very much to heart.

The final point is, of course, if this pilot was actually a success, why are we not allowed to see the whole evaluation report - and if less than that why can't the most learnings be obtained through full disclosure?

Right now we can only say ‘Healthelink and NSW Health needs to try much harder’

David.

Summary Evaluation Report of NSW HealtheLink Finally Released.

For your reading pleasure the following was pointed out today.

Evaluation

This report presents the results of an evaluation of the Healthelink electronic health record (EHR) pilot. This report was prepared by KPMG. It focuses on the implementation, functioning and performance of the Healthelink EHR pilot from the time of its commencement in March 2006 to September 2008.

An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)

The site is located here:

http://www.healthelink.nsw.gov.au/evaluation

Bit of a pity – yet again – we have a summary report – because citizens are not grown up enough to be allowed the full truth!

Maybe some commentary a bit later.

David.

The Evidence Mounts for the Real World Value of Health IT.

Despite the nonsense that seems to be going on in the leadership of e-Health in Australia the evidence of the real world positive impact of Health IT continues to accumulate.

First this week we have:

Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost

Michael A. Fischer, MD, MS; Christine Vogeli, PhD; Margaret Stedman, MPH; Timothy Ferris, MD, MPH; M. Alan Brookhart, PhD; Joel S. Weissman, PhD

Arch Intern Med. 2008;168(22):2433-2439.

Background Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.

Methods Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.

Results More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.

Conclusions Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.

Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital (Drs Fischer and Brookhart and Ms Stedman), and Institute for Health Policy, Massachusetts General Hospital (Drs Vogeli, Ferris, and Weissman), Harvard Medical School, Boston.

Full paper is found here if you have access.

http://archinte.ama-assn.org/cgi/content/abstract/168/22/2433?etoc

There are articles also available with more details.

See here:

With e-prescribing, US doctors pick cheaper drugs

Mon Dec 8, 2008 4:00pm EST

By Will Dunham

WASHINGTON, Dec 8 (Reuters) - Doctors who put aside their paper pads and prescribe medicines electronically may be more likely to choose lower-cost drugs, saving money for patients and insurers, U.S. researchers said on Monday.

Only about 6 percent of U.S. doctors use "e-prescribing" even though doing so may improve efficiency and reduce errors such as a pharmacy misreading a doctor's sloppy handwriting or dispensing a different drug with a similar name.

Dr. Michael Fischer of Brigham and Women's Hospital and Harvard Medical School in Boston and colleagues detailed another e-prescribing benefit: encouraging doctors to choose cheaper drugs.

The researchers evaluated a program in Massachusetts in which two large insurers worked with a maker of e-prescribing systems, Zix Corp (ZIXI.O), to get doctors to use one that employed simple color coding to identify prescription medication, whether name-brand or generic, by price level.

Insurers use a three-tiered system regarding drug costs.

In the year after adopting this e-prescribing system, the doctors increased their use of tier 1 prescriptions -- those with the lowest cost -- by 3.3 percent, while prescriptions for the more expensive drugs declined, the researchers wrote in the Archives of Internal Medicine.

That translates to a savings for consumers and insurers of $845,000 per 100,000 patients per year. In a country of 300 million people, such savings could be substantial.

"When you use an electronic prescribing system to give physicians information on which drugs are less expensive for their patients at the point of prescribing -- right when they're making that decision -- they're going to choose medications that are more affordable for their patients," Fischer said in a telephone interview.

Full report here:

http://www.reuters.com/article/americasIpoNews/idUSN0851025220081208

And here:

Electronic Prescribing Saves Patients Money

It steers doctors toward lower-cost drugs, study finds

Posted December 8, 2008

By Ed Edelson

HealthDay Reporter

MONDAY, Dec. 8 (HealthDay News) -- An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.

"One of the challenges physicians face is that they don't know which drugs are preferred or not preferred," said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine. "The insurance companies involved in the study provided that information by a color code -- green for drugs that were preferred, red for drugs that were not preferred."

Full article here:

http://health.usnews.com/articles/health/healthday/2008/12/08/electronic-prescribing-saves-patients-money.html

On a different but also important tack we have:

MDdatacor and Wellmark Release Quality Improvement Program Results

Wednesday December 10, 10:00 am ET

ATLANTA, Dec. 10 /PRNewswire/ -- MDdatacor(R), Inc. and Wellmark(R) Blue Cross and Blue Shield today released the first set of results of a quality improvement program of more than 9,000 Wellmark members living with diabetes. The dramatic results showed a significant improvement in both process and patient outcome measures.

Wellmark and MDdatacor Collaboration

The results are part of Wellmark's Collaboration on Quality(R) Incent and Reward Best Practices primary care initiative, a collaboration between Wellmark and network physicians to promote the improved quality and efficiency of health care. Wellmark contracted with MDdatacor to provide a technology platform that helps doctors identify gaps in patient care, as well as opportunities to enhance treatment for their patients, through access to clinical data.

"Providing physicians with actionable data at the point-of-care creates opportunities to enhance patient care," said Tim Roche, co-founder, president and CEO of MDdatacor. "MDdatacor has the unique ability to capture clinically-relevant information right from the physician's own patient records. Physicians find the data to be more credible because it is based on clinical data and not solely on claims data."

MDdatacor's patented and interoperable CareInformatix(TM) platform provides the most comprehensive patient information through collecting and analyzing data from all available sources in a physician practice, including electronic medical records, lab, registry and practice management systems, dictated transcriptions and claims.

Study Results Demonstrate Significant Improvement in Patient Outcomes

Using evidence-based guidelines, Wellmark's quality improvement program measured the percentage increase in diabetic patients receiving an annual HgA1C, low-density lipoprotein (LDL) and blood pressure tests, as well as improved clinical outcomes as measured by lowered test scores for each of those measures.

Prior to the implementation of Wellmark's Collaboration on Quality program, only 46 percent of the 9,012 members living with diabetes were receiving an annual HgA1C test. That number increased to 90 percent at the end of the program period. This can be attributed to the fact that physicians had access to critical data about their patients, showing that they were in need of the tests.

Patient outcomes also improved notably, with the percentage of patients with an HgA1C level less than 8 rising from 37 percent to 75 percent. Controlling blood glucose levels lowers the chance of a diabetic patient having diabetes-related health problems, such as heart attack, stroke blindness, kidney failure and life-threatening infections.

Full press release here:

http://biz.yahoo.com/prnews/081210/ny51187.html?.v=1

Again a large real world study with a positive outcome!

It seems there a none so blind as cannot see in OZ.

David.

Finally Some Reaction to the Deloittes Strategy In the Press.

It is good to see there has now been some reaction to the release of the Deloittes National E- Health Strategy.

I have found the following so far:

1. ZD-Net Australia.

E-Health: Australia's $5bn black hole

Renai LeMay, ZDNet.com.au

15 December 2008 02:41 PM

Much more here – with some of the blog commentary:

http://www.zdnet.com.au/news/software/soa/E-Health-Australia-s-5bn-black-hole/0,130061733,339293816,00.htm

2. MIS Australia.

Another decade wait for e-health

Tuesday, 16 December 2008 | Ben Woodhead

Article here:

http://www.misaustralia.com/viewer.aspx?EDP://1229380777039&section=news&xmlSource=/news/feed.xml&title=Another+decade+wait+for+e-health

3. Australian Financial Review.

Health records fail the IT test

Tuesday, 16 December 2008 | Ben Woodhead

Article here (expensive subscription required):

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20081216000030649416

All three articles were pretty negative on what had gone on to date and did not seem all that positive about the future – to say the least.

Most also seemed to suggest that while the plan was sound without funding and political commitment there would be a long wait!

Let me know if you spot other coverage.

David.

Useful and Interesting Health IT Links from the Last Week –14/12/2008.

Huge interest in the story of yesterday – with the seeming hoax of an e-health strategy being released.

If you want to contribute to the effort of making the hopeless politicians grasp the need for e-health can I suggest you go to the site below and get in touch! All hands to the pumps is my view!

Site to contact.

The Coalition for E-Health (Australia)

http://www.ceh.net.au/

Now the news!

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

These include first:

Ten prophecies for the digital millennium

Graeme Philipson

December 9, 2008

A summary of the main trends in IT, from the rise of the supernet
to the threat posed by intelligent machines.

Recently I was asked to speak at a conference about what's going to happen in IT predictions in the next 10 years. It's always hard to tell the future, but here goes anyway - 10 predictions, in no particular order. I have mentioned most of these ideas in various columns during the past year or two. So treat this, my last column for the year, as sort of a summary of what I believe to be the trends in IT as we near the end of the first decade of the digital millennium.

1. The internet will become the "supernet"

The internet has been around since 1969, but it's only 15 years since it has become the web - easy to use, easy to navigate, with billions of web pages and billions of users.

We have already reached the point at which most devices connected to the internet are mobile - phones, cars, even household appliances. That trend will continue, with the move to "embedded computing", where the internet links objects as well as general-purpose computers.

The other nine are here:

http://www.smh.com.au/news/technology/biztech/ten-prophecies-for-the-digital-millennium/2008/12/09/1228584755498.html

This is a good list and looks about right to me for the next 5-10 years. Good to see more e-health gets a run in the list!

Second we have:

Mobile e-health van trial

PM - Monday, 8 December , 2008 18:42:00

Reporter: Donna Field

MARK COLVIN: A new medical program in Queensland is using state of the art technology to treat children living in remote Indigenous communities.

A mobile health clinic will tour the communities capturing patient images. It will then relay that information to specialists in Brisbane.

The trial of the mobile telemedicine program is the first in Australia. Health professionals hope that it will reduce preventable conditions like ear infections.

Donna Field reports.

DONNA FIELD: Cherbourg in south-east Queensland is the third largest Indigenous community in the State - home to about 1200 people.

It will also house a new van that will be hard to miss. The mobile e-health van has been painted brightly by a local artist and on board is specialised medical equipment.

Dr Anthony Smith from the University of Queensland's Centre for Online Health came up with the idea.

ANTHONY SMITH: It will improve screening rates because what we're doing is providing screening in a much more systematic fashion. Instead of doing screening once or twice a year by sending specialist groups out to schools and communities, what we're doing is providing a facility which will be present every day throughout the year so that children will be able to access the service through the schools. They'll be screened systematically. We aim to screen 90 per cent of children every year.

More here:

http://www.abc.net.au/pm/content/2008/s2440968.htm

This certainly seems like very good news – given the toll on education and quality of life ear disease causes in these communities.

Third we have:

Software vendors get visibility of e-health

8 November, 2008. Healthcare software vendors will be able to view the messaging protocols for a nationwide e-health environment, following the publication of a suite of technical specifications today.

The National E-Health Transition Authority (NEHTA) has published specifications for both messaging and connectivity architecture which underpin the approach to e-health communications for NEHTA’s ePathology, eDischarge Summary, eReferral and eMedications Management.

“The specifications define the technical protocols by which messages will be transported and secured and the means by which parties will identify, locate and connect to each other," said Chief Executive Peter Fleming.

The specifications relate to those aspects of e-health communication which will apply in a common way across all of NEHTA’s packages.

They are accompanied by a range of supporting material, including example implementations and implementation guides, which are designed to assist organisations seeking to adopt and apply the specifications.

“The specifications have been the culmination of several years of effort by NEHTA to develop an approach to e-health communication that is interoperable, secure, open, robust, reliable, and adaptable to future needs," Mr Fleming said.

More (including links to material) here:

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=386&Itemid=144

This is actually pretty important stuff. I really wonder why they got the date wrong (it was released December 8) and is clearly out of order on the NEHTA web site.

One thing about this documentation I do find astonishing is that it would seem to be the outcome of almost 2 years work. I am at a loss to understand why it would have taken so long. In the meantime, of course, people have moved forward with messaging all over the country. I hope not too much of this effort is invalidated by what has now been released. I would be interested in comments from those at the ‘bleeding edge’ about how useful this all is.

Fourth we have:

PC marks 40th birthday

December 9, 2008 - 10:54AM

Little did the world realise 40 years ago that a San Francisco stage was featuring the first public glimpse of an invention that would revolutionise not only our daily lives but also our ability to solve the world's problems.

An audience of about 1000 people had witnessed the premiere of the personal computer.

The December 9, 1968, unveiling of the primitive device with a mouse and interactive screen - in a now-legendary demonstration by its inventor, Douglas Engelbart of the Stanford Research Institute - drew a rousing, standing ovation from the computing cognoscenti who recognised the significance of what they had just seen.

The machine raised hopes of solving a major modern quandary - how to navigate the world's rapidly accumulating and increasingly complex store of information. That year's fledgling efforts to navigate the physical universe in spaceships seemed ponderous and slow compared to the prospect of speeding through the universe of information in the digital ships promised by the new computers.

The invention featured rudimentary windows and hyperlinks that allowed jumping from one document to another, as well as the ability to edit text and add graphics on a video monitor. The presentation also offered a peek at future computer networks that would become the internet.

"No one has ever before or since seen such a collection of great ideas in one demonstration," said SRI President and CEO Curt Carlson.

The event - dubbed "the mother of all demos" by chroniclers of the computer industry and Silicon Valley - was being commemorated on its 40th anniversary in a program at Stanford University. The event included Engelbart and some of the other pioneers who worked with him.

The 1968 demonstration was years before anyone dreamed of Microsoft or Apple. "Bill Gates was 12 at the time; Steve Jobs was 13," writes John Naughton in his book A Brief History of the Future.

Though Engelbart may have not achieved the fame of a Gates or Jobs, his profound influence is widely acknowledged in the field.

Engelbart is "the Moses of computers," writes Steven Levy in his history of the Macintosh.

More here:

http://www.smh.com.au/news/technology/gadgets/laptops--desktops/pc-marks-40th-birthday/2008/12/09/1228584794750.html

This is just a fascinating report as I had no idea the PC went so far back – as they say you learn something new every day!

Fifth we have:

Industry baffled over clean-feed internet pilot

Filtering the net akin to boiling the ocean: Telstra

Darren Pauli 12/12/2008 15:43:00

Internet Service Providers (ISPs) participating in live trials of the national Internet content filtering scheme say the tests will be undermined by a government decision to test the “clean-feed” blacklist under watered-down conditions.

The voluntary trials will test the efficiency of ISP-level Internet content filtering which, if successful, will be implemented across all Australian Web connections at an estimated cost of $70 million. The initiative, part of the government's $125.8 million cyber safety plan to reduce child pornography, will block nefarious and illegal content listed in a separate clean-feed and opt-out blacklist, operated by the Australian Communications and Media Authority (ACMA).

Blacklists will be immune from public scrutiny under an ACMA exemption to the Freedom of Information Act as disclosure of the banned Web sites would allow paedophiles to avoid detection and would hinder law enforcement efforts. The addition of new content categories to the blacklists requires parliamentary approval.

The plan has come under intense fire from industry experts and privacy lobby groups that argue ISP-level filtering will choke Internet speeds and encourage censorship abuse.

Many participating telcos, which include Optus, Internode, and iiNet, have told Computerworld they do not agree with the scheme and expect the trials to return unacceptable results.

Telstra, the nation's largest telco, has refused to participate in the voluntary trials. Chief operations officer Greg Winn, responding to questions at a Sydney media lunch, said the scheme is a no-win for government and industry.

“It is like trying to boil the ocean,” Winn said.

“It is my personal opinion, but there is just no win for anyone in this.”

The telco has said it will implement its own content filters if the plan is mandated.

More here:

http://www.computerworld.com.au/article/270791/industry_baffled_over_clean-feed_internet_pilot?eid=-6787

This issue really seems to be hotting up – what with Telstra playing hard ball and the Get-Up campaign now in full swing. I think Minister Conroy is likely to find the compulsory nature of the plan may just be a bridge to far. This will be an issue to follow closely next year – given e-Health’s need for optimal internet infrastructure.

Last we have the slightly more technical note.

Review: Firefox 3.1 Beta 2 adds speed and privacy

Mozilla's new beta adds private browsing and other nifty features

Preston Gralla 12/12/2008 12:48:00

Firefox 3.1 may only be a point release -- from 3.0 to 3.1 -- but its just-released Beta 2 version is a good indication that the final release will be a must-have upgrade for anyone using Firefox.

Beta 2 (now available from Mozilla) unveils the browser's most important new feature -- Private Browsing, which automatically deletes all traces of a browsing session. In addition, the new beta turns on a feature designed to make the browser up to 40 times faster (at least, according to Mozilla).

Browsing in private

The most important new feature in Beta 2 is the addition of Private Browsing -- the same feature that is called Incognito Mode in Chrome and InPrivate Browsing in Internet Explorer 8. All traces of your browsing session are deleted when you use Private Browsing -- your browsing history, temporary Internet files, search history, download history, Web form history and cookies. (For obvious reasons, it's popularly known as "porn mode.")

Much more here:

http://www.computerworld.com.au/article/270772/review_firefox_3_1_beta_2_adds_speed_privacy?eid=-6787

I agree with the review having been using it for a few days – fast, stable etc. As Preston says the final release will be a must have!

For the supporters of Linux – we also have a major release:

Fedora turns 10

Red Hat's open source standard bearer and mineshaft canary is still everything to every Linux power user

Paul Venezia (InfoWorld) 09/12/2008 08:29:00

There comes a point in the life of any hard-core Linux user when the idea of digging about to find yet another obscure piece of software, compiling the code, and integrating it into your daily routine just seems annoying, not compelling. This is where Fedora comes through. Because more of the popular and necessary packages "just work" with Fedora, less time is burned spinning wheels and more time is available for productive tasks.

To those who grew up with Red Hat Linux, the birth of Fedora was a bit of a surprise. In 2003, Fedora rose from the ashes of Red Hat Linux when Red Hat commercialized its Linux offering under the now-familiar name of Red Hat Enterprise Linux and made Fedora its open source initiative. As it played out, Fedora was, and is, essentially the beta release of Red Hat Enterprise Server. When a Fedora distribution has been released and used the world over for a significant period of time, it forks to become the next iteration of RHEL. Thus, Fedora has always been a community-supported preview of the next version of RHEL.

Full article here:

http://www.computerworld.com.au/article/270173/fedora_turns_10?eid=-255

More next week.

David.

The Amazing Effect of Media Management!

I thought I would see what coverage of the late Friday afternoon release of the summary of the Deloittes National E-Health Strategy.

I have checked out web sites from The SMH, The Age, Fin Review as well as Computerworld and ZDNet.

Not a whisper so far! (1.00 pm 15 Dec, 2008). Release was on Friday 12 Dec in the afternoon.

Just amazing and show how well the late Friday night hides information – especially close to Christmas!

I would love to hear when people spot some mainstream media coverage.

David.

Australia’s National E-Health Strategy – An Obvious and Disappointing Hoax.

OK, I have now had 24 hours to consider how to respond to the document released by the Australian Health Ministers Advisory Council (AHMAC).

The report is available for download here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

In a few words I am ‘shocked and amazed’ at what has just happened.

AHMAC, for reasons it chooses not to publicly explain, has released about 20 pages of the 120 page document which was developed by Deloittes. ( As expected the summary report was released Friday afternoon close to Christmas to minimise any negative reaction!)

There are some very good principles to be found among the pages we have been given but sadly, without significant funding, it can and will go absolutely nowhere and its development has been a total waste of time.

These good things include focus on applications and messaging, standards, conformance and certification, governance, and incremental staged approach and getting basic infrastructure in place.

Sadly all this will cost some money to plan and implement – and there is neither funding, organisational will or organisational responsibility for moving the strategy forward identified

Actually, what was released is a classic case of bureaucratic ‘box ticking’. A country has to have a published National E-Health Strategy – so now we have one. Sad it is a total unfunded fraud on all those who have been waiting for some sign of change over the last 4 years since the bureaucrats last decided they would not invest in Health IT (When HealthConnect morphed from a real project into a “change management strategy”). Frankly I don’t think the box has been ticked if you don’t ensure action after planning.

What is worse still it is the same DoHA leadership people who did the blocking of funding act last time.

See here for the time line of that seven or so year saga:

http://aushealthit.blogspot.com/2007/12/abject-failure-of-howard-government-in.html

It was July 2005 this happened and 3.5 years later we are very little further ahead.

I find it just astonishing that the Australian Health System cannot find the capability to invest 0.5% of its expenditure in technology that, in time, will allow it to become safer, more efficient and more sustainable. Sure I know times are tough – but they are going to become a great deal tougher and more difficult if this is not done – as every other advanced economy recognises.

While not perfect, the full Deloittes plan was a very good, sensibly costed roadmap of a pragmatic way forward which, if adopted, would have made a real difference. It would also have required some investment which it seems is simply not available for no sane reason.

This is so short-sighted it is just awful. As the title says it is a hoax on all those who actually care for our health system!

I wonder is there any chance there might be some funds in the up-coming Budget – due in May, 2009. We can only hope the $60M or so spent in “Program 10.2 e-Health Implementation” can be some core start-up funding to get something going. (That plus some of the apparent NEHTA underspend might make a vaguely useful, but very small, bucket!)

See here for 2008/09 budget details.

http://aushealthit.blogspot.com/2008/05/federal-budget-for-2008-9-e-health-cut.html

News tomorrow!

David.

Australian National E- Health Strategy Released.

The following has just appeared.

National Ehealth Strategy

In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. As part of this process, Deloitte conducted a series of national consultations which included Commonwealth, State and Territory Governments, general practitioners, medical specialists, nursing and allied health, pathology, radiology and pharmacy sectors, health information specialists, health service managers, researchers, academics and consumers.

The National E-Health Strategy developed by Deloitte, together with key stakeholders, provides a useful guide to the further development of E-Health in Australia. It adopts an incremental and staged approach to developing E-Health capabilities to:

• leverage what currently exists in the Australian E-Health landscape;
• manage the underlying variation in capacity across the health sector and States and Territories; and
• allow scope for change as lessons are learned and technology is developed further.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia. It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.

A Summary of National E-Health Strategy can be accessed by clicking here (PDF 246 KB).

The page is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

Commentary later.

Enjoy!

David.

I Have a Bad Feeling About This!

I have been thinking about the Australian Health Ministers’ Conference Joint Communiqué of the 5th December 2008.

The communiqué is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept051208.htm

The relevant part is the following:

“E-health

All Ministers endorsed the National E-Health Strategy developed by Deloitte in consultation with key stakeholders, as a guide to the further development of E-Health in Australia.

The Strategy provides a practical framework and set of priorities that will help to support health reform.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia.

It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.”

Note that there is no mention of any funding for implementation of the agreed Strategy.

As a little background I have been told the version of the Strategy considered by Ministers was dated 7 October, 2008. This provides a decent window for all aspects of the plan, including funding of the recommendations, to have been properly considered I believe.

In the meantime we have seen announcements for spending of gazillions of dollars.

Examples include:

1. The almost $15 Billion of new money from the Council of Australian Government’s Meeting of 29 November, 2008 over the next 4 years. (including the Commonwealth’s $108M for NEHTA over the next 3 years – to be added to equally by the States – making the total $216M over 3 years).

See:

http://www.pm.gov.au/media/index.cfm?type=1

Entries for November 30.

2. The announcement today of $4.7B for road and rail infrastructure and the various small business tax breaks.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0687.cfm

3. The 14 October Announcement of the: Rudd Government's $10.4 billion Economic Security Strategy which contained five key measures:

• $4.8 billion for an immediate down payment on long term pension reform.
• $3.9 billion in support payments for low and middle income families.
• $1.5 billion investment to help first home buyers purchase a home.
• $187 million to create 56,000 new training places in 2008-09.
• Accelerate the implementation of the Government's three nation building funds and bring forward, the commencement of investment in nation building projects to 2009.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0550.cfm

4. The $6.4 billion green car plan announced on the 10^th November, 2008.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0592.cfm

Now I understand some of this was probably in the works for a month or so before it was announced but in each case the funding was announced at decision time.

It is now a week since the AHMC meeting and acceptance of the Deloittes work. But we have no funding announcement, I hear of all sorts of discussions happening in NEHTA and DoHA, and we have yet to see the Strategy document publicly.

As all readers know I am often wrong but I wonder if what is going on is that NEHTA’s plans are being re-jigged and that at the end of the day to funding for both NEHTA and the implementation of the E-Health Strategy will have to come from the $216M over three years.

I hope I am wrong as that will simply not be enough to do what is needed!

I look forward to a clarifying release some time real soon.

David.

Obama and Change - Some Real Differences are Emerging like Using Health IT as an Economic Stimulus!

It looks like there are some really interesting things that are relevant to Australia happening during the Obama transition.

First – as we all know – there is a bit of a crisis of sustainability and quality in the US Healthcare System.

In was therefore good to see the following report a few days ago.

Obama Policymakers Turn to Campaign Tools
Network of Supporters Tapped on Health-Care Issues

By Ceci Connolly
Washington Post Staff Writer
Thursday, December 4, 2008; A01

Barack Obama's incoming administration has begun to draw on the high-tech organizational tools that helped get him elected to lay the groundwork for an attempt to restructure the U.S. health-care system.

Former senator Thomas A. Daschle, Obama's point person on health care, launched an effort to create political momentum yesterday in a conference call with 1,000 invited supporters culled from 10,000 who had expressed interest in health issues, promising it would be the first of many opportunities for Americans to weigh in.

The health-care mobilization taking shape before Obama even takes office will include online videos, blogs and e-mail alerts as well as traditional public forums. Already, several thousand people have posted comments on health on the Obama transition Web site.

"We'll have some exciting news about town halls, we'll have some outreach efforts in December," Daschle said during the call. And tomorrow, when he appears at a health-care summit with Sen. Ken Salazar (D-Colo.) in Denver, Daschle said, "we'll be making some announcements there."

It is the first attempt by the Obama team to harness its vast and sophisticated grass-roots network to shape public policy. Although the president-elect is a long way from crafting actual legislation, he promised during the campaign to make the twin challenge of controlling health-care costs and expanding coverage a top priority in his first term.

Daschle, who is expected to become the next secretary of health and human services, is waging the outreach campaign by marrying old-fashioned Washington-style lobbying and cutting-edge social-networking technologies. Although he has yet to be formally nominated, he has already met with more than 100 insiders, ranging from union leaders and the seniors group AARP to hospital executives and representatives of corporate America.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/03/AR2008120303829.html

It seems to me there is no reason why the National Healthcare and Hospitals Commission could not be being a little more innovative in gathering public views than simply asking for submissions and commissioning expert papers. Australians are pretty much as worried about their health system as Americans and would like an easy way to have a say!

Second we have the following rather great idea – Health IT to improve the economy.

Health IT weighed for economic stimulus package

By Paul McCloskey

Published on December 5, 2008

Senate health care leaders are discussing whether to add health information technology to the programs that would be funded under the economic stimulus package now being readied by aides to President-elect Barack Obama and congressional staff members, sources said.

House Speaker Nancy Pelosi has promised to have a broad economic stimulus plan ready for Obama to sign by the time he takes office Jan. 20, and it may be ready earlier. The package, which could inject as much as $500 billion into large public works programs, has led to a scramble to identify projects that would create jobs and spur economic growth.

Transportation infrastructure and green energy top the list of projects being considered. But using the bill to encourage adoption of health IT, the goal of several nearly successful attempts to pass health IT legislation this year, is also being weighed, health care officials said.

One strategy would be to attach the Wired for Health Care Quality Act to the stimulus legislation, congressional sources said. The Wired bill, which failed to pass the Senate this summer, created incentives for health IT adoption and addressed several security and privacy problems that had long delayed action on the bill.

At the annual conference of the e-Health Initiative in Washington this week, health policy leaders voiced caution about driving health IT adoption through a big financial stimulus program.

Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said health IT financing is most productive when tied to specific standards, or functional and performance requirements focused on health outcomes.

Although direct financing of health IT is one way to raise levels of health IT adoption, he said, “I’m not sure that, by itself, it would lead to better care,” McClellan said.

Howard Dean, chairman of the Democratic National Committee and a medical internist, warned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted before purchasing started.

“In theory it’s a great idea,” Dean said. “We would just have to make damn sure the system works before we do it.”

ore here:

http://www.govhealthit.com/online/news/350700-1.html

I just love the idea – certainly makes justifying the hoped for spend a bit easier!

Third we have this

Obama to broaden role of genetics in medical care

By RICARDO ALONSO-ZALDIVAR,

Associated Press Writer Fri Nov 28, 1:58 pm ET

WASHINGTON – For years, scientists have held out hope that the rapidly evolving field of genetics could transform medical diagnosis and treatment, moving beyond a trial-and-error approach as old as the Hippocratic Oath.

But the vision of individualized treatment based on a patient's genetic makeup and other biological markers has yet to materialize, even if better use of genetic information has led to advances in cancer care and other areas.

Now the pursuit of "personalized medicine" is expected to get a major push from the incoming administration of President-elect Barack Obama. As a senator, Obama introduced legislation to coordinate the sometimes conflicting policies of government agencies and provide more support for private research. He remains keen on the idea.

"The president-elect has indicated his support for both advancing personalized medicine and increasing (research) funding," said Rep. Patrick J. Kennedy, D-R.I., who has introduced legislation in the House that builds on Obama's.

Obama is also interested in the role that personalized medicine could play as an element of changes in the broader health care system.

"The issue of getting the right treatment to the right person goes with his whole emphasis on health reform," said Mark McClellan, a noted Republican health care expert who served President George W. Bush as Medicare director and head of the Food and Drug Administration. "If we're thinking about reforming the health care system, we should be thinking about what medicine will be like down the road when health care reform is fully implemented," McClellan said.

Much more detail here:

http://news.yahoo.com/s/ap/20081128/ap_ca/transition_genetic_medicine_2

This approach to medicine is clearly part of the future – and really relies on detailed electronic records to work as hoped for. More stimulus to invest.

One can really sense there is serious change around as major papers run articles such as this.

U.S. 'Not Getting What We Pay For'

Many Experts Say Health-Care System Inefficient, Wasteful

By Ceci Connolly

Washington Post Staff Writer

Sunday, November 30, 2008; A01

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley (Iowa), argues the government does not have.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/29/AR2008112902182.html

We are certainly living in exciting times to see how all this energy plays out. Well I hope!

David.