Useful and Interesting Health IT Links from the Last Week – 08/02/2009.

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

First we have:

Flying docs pilot first national e-health database

Regional sites united after 80 years

Darren Pauli 03/02/2009 20:40:00

The Royal Flying Doctor Service (RFDS) is deploying what may be the first national e-health records management system to unify disparate medical databases across its four regional sites.

The RFDS was established in 1928 as the Area Medical Service and provides not-for-profit aero-medical and primary healthcare to regional and remote Australia. It consists of four independent divisions, with 25 sites and 776 staff, and services all but the upper region of the Northern Territory.

Speaking at an e-health summit in Sydney today, RFDS national and sectional ICT manager Gary Oldman said the $2.9 million government-funded e-health records system will replace siloed databases and manual processes throughout the organisation.

“Electronic records are being deployed to other regions [following] the success of the first roll out in our South East [division],” Oldman said, adding it will be the first time the RFDS sites have cooperated in 80 years.

“[Other regions] have separate databases in their laptops without central storage… There are problems with remote access and retrieving patient data after-hours.

“We want to end-up with a single national medical identifier, but [RFDS] is split into legally separate entities. We will use separate identifiers for now.”

The national deployment, dubbed E-Health for Remote Australia (EHRA), will mirror the initial e-health system deployment which centralised nine isolated databases.

It is expected that the Medical Doctor content management database will be installed on all RFDS laptops to facilitate central storage of medical data using Telstra’s Next G mobile network. A replication feature allows data uploads to be delayed during coverage black spots in remote areas.

Oldman said the transition to EHRA will be a “huge challenge” for some RFDS sites, but is confident of meeting the February 2010 completion date thanks to the recruitment of a dedicated project manager, extensive system testing and scheduled staff training.

More here:

http://www.computerworld.com.au/article/275281/flying_docs_pilot_first_national_e-health_database?eid=-255

The amazing thing about all this is just how long it has taken and is planned to take to get a shared Medical Director (I assume) database operational on a wider scale – given the software already does this in large group practices.

As can be see the announcement of this project was made in 2007

Rural health wins $23 million in broadband subsidies

Round two of Clever Network initiatives announced

Darren Pauli 31/08/2007 10:27:11

.....

The Royal Flying Doctor Service will receive a new $2.7 million e-health medical record system to improve its health care service for its 750,000 remote patients across New South Wales, South Australia, Queensland and Western Australia.

.....

More here:

http://www.computerworld.com.au/article/192192/rural_health_wins_23_million_broadband_subsidies

I look forward to the evaluation of the system. I wonder does an evaluation report of the first phase of this exist or has it just been suppressed as seems usual!

Second we have:

ACS, AIIA disappointed at Rudd stimulus package

IT industry representative bodies welcome the overall economic stimulus package but express frustration at the lack of big ICT infrastructure spending

Trevor Clarke (ARN) 04/02/2009 14:30:00

Australian ICT industry representative bodies have panned the exclusion of ICT infrastructure spending from the Rudd Government’s economic stimulus package. In response to the grim global economic climate and bleak forecasts of the International Monetary Fund (IMF), the Rudd Government unveiled a far-reaching $42 billion stimulus package that included, among other incentives, a 30 per cent tax break for small businesses on items worth more than $1000 purchased before June 30.

Australian Information Industry Association CEO, Ian Birks, said while the package would bring a welcome boost to technology spending by organisations, it failed to look at the big picture for ICT.

“I think we would say the package has insufficient focus on the digital economy, on new technologies, and really feels like the Government may be missing the point somewhat about the transformational impact ICT can have,” Birks said.

More here:

http://www.computerworld.com.au/article/275410/acs_aiia_disappointed_rudd_stimulus_package?eid=-255

Looks like the Health Sector are not the only ones feeling left out. I have to say that comparison with the Obama package in the US, with a real emphasis on both low and high tech infrastructure, does not fill me with any joy about what we are seeing here. There could have been a good deal more of the package devoted to infrastructure with real returns – which I find hard to see is being optimised by building assembly halls! I guess we will all see!

At the very least – as suggested by Brian Toohey – the cuts to the CSIRO, ABS and the Bureau of Meteorology should be reversed. Trivial and important, and hardly large in the context of $42 Billion! You can be sure that would save some jobs.

Third we have:

HealthSmart gets new head

Suzanne Tindal, ZDNet.com.au

03 February 2009 05:36 PM

The Victorian Department of Human Services has appointed a new CIO of health services who will also lead up the state's HealthSmart electronic health initiative.

Dr Andrew Howard, not the same Andrew Howard who holds the CIO position for the whole department and had previously been acting National E-Health Transition Authority CEO, will start next week.

A spokesperson for the Department of Human Services was sure there would be ample confusion caused by the two like-named CIOs.

The incoming CIO's role will include taking responsibility of HealthSmart, filling the shoes of Fiona Wilson who left last September.

More here:

http://www.zdnet.com.au/news/software/soa/HealthSmart-gets-new-head/0,130061733,339294729,00.htm

We can all wish Dr Howard luck and hope some of the more ‘problematic’ aspects of the project can now be addressed successfully. The Victorian Hospital system really needs this to work and deliver the benefits we all know can be achieved.

Fourth we have:

Training lags for nurses

5-Feb-2009

COMPUTERS Practice nurses must be trained to use clinical software to keep medical records accurate and up to date. By Mr Noel Stewart

THE rapid increase in the number of nurses employed in general practice has created a few problems in information management.

The major problems have been caused by a lack of a suitable orientation and training in practice information systems.

There have been cases where a new practice nurse has been told to prepare a GP management plan and health assessment. Just imagine the difficulty for a new nurse, who may have previously worked in the emergency department of a hospital. He or she is confronted by a strange world of item numbers, unfamiliar clinical soft ware and a group of GPs who are so time-poor they have no time to supply training.

The result of this lack of training in the practice computer systems is poor clinical practices. Examples include:

* Measurements such as BP, height/weight and family/ social histories entered directly into health assess ments or care plans where they are ‘buried’ and not part of the clinical record.

* The same measurements entered directly into the progress notes with the same result.

* Reasons for contact or diagnoses not coded correctly.

More here (for those with access):

http://www.australiandoctor.com.au/articles/af/0c05caaf.asp

The point Mr Stewart makes is actually a more general one in my view. In all clinical situations the use of computers should be supported by appropriate educational support for both new and old users. One day we will have a court case where someone will be blamed for permitting the untrained to use a clinical computer system and causing clinical harm

Fifth we have:

Debate over GP clinical software ads intensifies

Elizabeth McIntosh - Friday, 6 February 2009

THE company that created Medical Director, the most widely used patient management and prescribing software, has rejected calls to strip pharmaceutical advertising from its products, claiming such a move would result in GPs paying more for the software.

In a submission to the Medicines Australia Code of Conduct Review, the AMA called for an end to advertising in prescribing software.

“The AMA is opposed to the use of [this] material in prescribing software because of its potential to interfere with the doctor-patient relationship during consultations,” said Associate Professor John Gullotta, chair of the AMA Therapeutics Committee. The RACGP and the National Prescribing Service also called for the removal of such advertisements.

However, John Frost, CEO of Health Communication Network – which produces Medical Director – said targeting this revenue source would raise the price of software.

“Our customers have preferred a cheaper product that contains ads, than more expensive ad-free software,” he said.

More here (for subscribers):

http://www.medicalobserver.com.au/News/0,1734,3945,06200902.aspx

Can I just say your humble blogger thinks advertising in clinical software is an abomination and should be outlawed.

Sixth we have (from the Courier Mail a blog posting:

Another IT chief vacancy at Queensland Health

Craig Johnstone

Tuesday, December 09, 2008 at 11:14am

Regular readers might remember the sudden departure of former cop Paul Summergreene as Chief Information Officer for Queensland Health. I wondered at the time what that meant for the continued stability of what is one of the most crucial divisions of the most politically sensitive of govenment departments. Now someone has passed on an internal email sent around last week from Queensland Health director-general Mick Reid:

Changes to the CIO

I would like to congratulate Dr Richard Ashby on his appointment to the position of Executive Director and Director of Medical Services, Princess Alexandra Hospital.

Dr Ashby has been in the Chief Information Officer role since July this year and will continue in this role to the end of his 6 months secondment on 23rd January 2009.

.....

I would like to take this opportunity to congratulate Richard on his appointment and sincerely thank him for his time and contribution to Information Division and the valuable knowledge transfer that he has provided to the Senior Staff of the Division.

Michael Reid

Director-General

How goes the department’s E-health policy?

All the comments follow this head posting:

http://blogs.news.com.au/couriermail/pineapplepolitics/index.php/couriermail/comments/another_it_chief_vacancy_at_queensland_health/

The comments are well worth a browse..seems there are some insiders contributing! It does not sound good I must say – but, as always, it may be that the happy campers are not contributing.

Last a slightly more technical article:

Skype 4.0 adds better video, Linux update unclear

Linux release is still under development

Rodney Gedda 03/02/2009 16:27:00

Internet telephony software company Skype is pushing ahead with videoconferencing in a bigger way with the release of version 4.0 for Windows, but the company is yet to standardise its releases for Linux and Mac OS X.

Previous versions of Skype did include videoconferencing, but the latest release integrates “one touch” video calls into the application and sports new codecs to improve sound and video quality.

Skype's Asia Pacific vice president and general manager Dan Neary said 4.0 is not an “incremental” upgrade, but the most significant release of the product since it started.

“We have incorporated feedback from users and designed wizards for microphones and Web cams to make it truly plug-and-play,” Neary said.

“Video is becoming increasingly important for communication and with 4.0 it is easy to launch a Skype call with video on one click.”

In addition, there is now more screen real estate dedicated to video and a full-screen mode.

Skype spent three years developing its new audio codec for version 4.0, which Neary said is better quality, more efficient and requires less processing power than the codec shipped with previous versions.

More here:

http://www.computerworld.com.au/article/275270/skype_4_0_adds_better_video_linux_update_unclear?eid=-255

This is good news – with Skype being progressively enhanced and refined. If you have a broadband connection Skype can provide essentially free video-conferencing and contact with friends interstate and overseas. Well worth exploring if you are not already a user.

More next week.

David.

Medical Objects Conducting Some Courses on SNOMED CT and Decision Support.

For those who may be interested I was alerted to the following a day or so ago.

The courses are to run in late March, 2009 and have as a prerequisite an understanding of the basics of SNOMED CT.

SNOMED CT & Decision Support

In March 2009, Medical-Objects will be delivering courses in Sydney and Brisbane on the use of SNOMED CT and its application into Decision Support. Delivered by well respected clinical terminologist Dr Peter Scott and Health Information expert Dr Andrew McIntyre; this workshop will give you an understanding of SNOMED CT and complementary technologies to effectively apply decision support within your organisation.

By the end of this workshop you will:

• Understand what SNOMED CT is and how it should be applied
• How SNOMED CT fits into the Australian Health Informatics landscape
• Understand how rich electronic clinical guidelines that work with existing EHRs can be implemented
• How to create rule based systems used for decision support
• How to create structured Archetypes that are clinician friendly

About the presenters

Dr Peter Scott is a Brisbane General Practitioner with a degree in information management.

Peter worked for 5 years at the National Centre for Classification in Health (NCCH), until the end of 2005. NCCH is the body responsible for the development and maintenance of the classification ICD-10-AM. His main role was in research and development for the related field of clinical reference terminology. He has been a part of several consultancies for government looking at the integration of SNOMED-CT with local terminologies and data models.

Peter is therefore familiar with issues involved in the linking of clinical practice, (electronic) health records and reporting. He has worked with Medical-Objects between 2006 and 2008, whilst remaining in clinical practice.

Dr Andrew McIntyre is a Director of Research and Development at Medical-Objects, a Gastroenterologist, fellow of the Royal Australian College of Physicians and with a dedicated focus on health informatics. Dr McIntyre has become one of Australia's pre-eminent authorities on HL7.

There are few people, if any, in Australia with his combination of detailed IT knowledge, and knowledge of medical standards such as HL7, and a specialist medical background. His expertise in respect of HL7 has been attested to in letters received from a number of IT consultants, pathology companies and others. He is a member of Standards Australia IT-14-6-5 and IT-14-6-6 and is an active member of the Standards Australia archetype working group.

About Medical-Objects

Medical-Objects have an active standards-based research and development program. This program is represented around Australia at HL7 and Standards Australia meetings. Medical-Objects also participates in HL7 internationally where it has responsibility for V1.1 of the decision support language GELLO. Other standards, namely HL7 V2, SNOMED-CT, CEN 13606 (Archetypes) and the CCR/CCD (health record summaries), are used as platforms for the various editors and development tools that Medical-Objects uses.

All the details, forms etc are found here:

http://www.medical-objects.com.au/Default.aspx?tabid=451

This is an important course for those who need to come to grips with this critical front-line area.

David.

Report Watch – Week of 2nd February, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

"Capital crunch" forces hospitals to delay IT upgrades

January 23, 2009 | Richard Pizzi, Contributing Editor

WASHINGTON – The "capital crunch" and the recession are severely restricting U.S. hospitals in obtaining funds to upgrade their facilities and invest in new clinical and information technologies, according to the American Hospital Association.

In a conference call with reporters, AHA President and CEO Richard Umbdenstock said hospitals rely on borrowed money, philanthropy and reserves to fund capital projects, but many now find it difficult to obtain funds from these sources.

The vast majority of hospitals surveyed report that borrowing funds through tax-exempt bonds - the main source of borrowing for most hospitals - is difficult or impossible. Loans from banks or other financial institutions are similarly difficult to obtain.

Umbdenstock said hospitals' reserves have also taken a hit due to falling stock prices, while net income is down and philanthropic donations have slowed, leaving hospitals with less of their own funds to rely on to make needed improvements.

Nearly half of the hospitals surveyed by the AHA have postponed projects that were to begin within the next six months and many have stopped projects that were already in progress.

Access the full article here:

http://www.healthcareitnews.com/news/capital-crunch-forces-hospitals-delay-it-upgrades

The AHA report is available online (.pdf).

This is hardly a surprise – may be the Obama Stimulus package can reverse the trend.

We also seem to have the same problem in the UK.

Credit crunch hits UK and US hospitals

26 Jan 2009

Hospitals in the US and UK are beginning to struggle to raise the funds they need for capital investment in infrastructure and Information technology projects.

In the US the result is being seen in hospitals shelving planned investments in facilities and information technology.

In the UK an internal memo from the National Health Service reveals that the private finance initiative (PFI) hospital building programme, under which banks finance the construction of health facilities and lease them back to the health service, is now seen at risk as a result of the recession and banking crisis.

According to a BBC News report a leaked NHS memo says the hospital building programme in England could be badly disrupted by the recession, and warns there is no plan B. The UK officially entered recession in January, after experiencing two quarters of contraction.

More here:

http://www.ehealtheurope.net/news/4510/credit_crunch_hits_uk_and_us_hospitals

Second we have:

HIMSS Summarizes the I.T. Bills

January 26, 2009

The Healthcare Information and Management Systems Society in Chicago has published a summary of six pieces of legislation introduced in Congress in recent weeks that include health information technology provisions.

It's a tangled array. Three separate House committees -- Appropriations, Ways and Means, and Energy and Commerce -- have introduced bills that include components of the economic stimulus package, including billions of dollars for health I.T. initiatives. A full House vote on the package is expected this week.

Full article here:

http://www.healthdatamanagement.com/news/legislation27598-1.html?ET=healthdatamanagement:e744:100325a:&st=email&channel=policies_regulation

For the complete HIMSS summary, click here.

It is interesting to see the various legislative proposals for Health IT that are under consideration in the US.

Third we have:

NHS IT ‘in deep trouble’ and mired in secrecy, MPs warn

Public Accounts Committee demands rapid improvement or end of national care records systems

By Leo King, Computerworld UK

The Department of Health and its key IT supplier CSC have been slammed by MPs for a confidentiality agreement surrounding the £12.7 billion National Programme for IT, the world’s largest civilian IT programme.

The powerful House of Commons Public Accounts Committee also told the NHS to “get its head out of the sand” as it flagship IT project, remain far off schedule.

The PAC hit out at civil servants and CSC for agreeing a gagging order over negotiations that took place about care records deployment in the northern, central and eastern parts of the country. CSC is the exclusive lead supplier to those regions.

Responding to the report, the Department of Health said, "New IT systems in the NHS are delivering better, safer and faster care. Current costs have declined because of the delays to implementation due mainly to adding extra functions to the system. Costs are also controlled by the contracts which only pay to providers once the service has been successfully delivered."

However, the PAC said, the care records service, which will provide digital health files for every patient in the country, remains “way off the pace”, and is due to be completed at least four years behind schedule in 2014 to 2015.

Much more here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=12987

The full report can be found here:

http://www.parliament.uk/parliamentary_committees/committee_of_public_accounts.cfm

This is a worry – as once politicians get involved – things can get de-railed for reasons that are not purely sensible and pragmatic!

More coverage is here:

http://www.ehealtheurope.net/news/4513/pac_gives_npfit_six_months_to_deliver_crs

Fourth we have:

Costs And Benefits Of Health Information Technology: New Trends From The Literature

Caroline Lubick Goldzweig ^1*, Ali Towfigh ², Margaret Maglione ³, Paul G. Shekelle ⁴

¹ Caroline Goldzweig is associate chief of staff, Clinical Informatics, at the Veterans Affairs (VA) Greater Los Angeles Healthcare System in California.
² Ali Towfigh is an assistant professor of medicine at the Veterans Affairs (VA) Greater Los Angeles Healthcare System in California.
³ Margaret Maglione is associate director of the Southern California Evidence-based Practice Center, at RAND in Santa Monica.
⁴ Paul Shekelle is director of the Southern California Evidence-based Practice Center, at RAND in Santa Monica. Shekelle also is a staff physician at the VA Greater Los Angeles Healthcare System.

^*Corresponding author.

Abstract

To understand what is new in health information technology (IT), we updated a systematic review of health IT with studies published during 2004-2007. From 4,683 titles, 179 met inclusion criteria. We identified a proliferation of patient-focused applications although little formal evaluation in this area; more descriptions of commercial electronic health records (EHRs) and health IT systems designed to run independently from EHRs; and proportionately fewer relevant studies from the health IT leaders. Accelerating the adoption of health IT will require greater public-private partnerships, new policies to address the misalignment of financial incentives, and a more robust evidence base regarding IT implementation. [Health Affairs 28, no. 2 (2009): w282-w293 (published online 27 January 2009; 10.1377/hlthaff.28.2.w282)]

Key Words: Consumer Issues, Health Reform, Research And Technology, Health Spending, Health Information Technology

More here:

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w282

Full free access to the article and the .pdf will be available for another week or so – along with a range of other important articles. Go and browse ASAP.

Fifth we have:

Study: Savings from Home Monitoring

January 28, 2009

Remote, home-based physiological monitoring of patients with congestive heart failure can save thousands of dollars per patient per year through fewer hospitalizations, according to a new report.

The New England Healthcare Institute, a Cambridge, Mass.-based independent research firm, has updated a report on remote physiological monitoring it published in 2004. The new data estimates an annual cost of $2,052 per patient for the monitoring technology. Add disease management software to the mix, and that price would go up to $2,802.

.....

Consequently, the technology has the potential to save $4.7 billion to $6.4 billion a year, report authors conclude.

More here

http://www.healthdatamanagement.com/news/home_health27647-1.html?ET=healthdatamanagement:e748:100325a:&st=email&channel=mobile_tech

For the full report, "Research Update: Remote Physiological Monitoring," click here.

Sixth we have a report on the good old consent issue from a US perspective

Article is here:

http://www.eweek.com/c/a/Health-Care-IT/New-Approaches-Touted-for-Health-IT-Policies/

Go here to review the report:

http://www.cdt.org/healthprivacy/20090126Consent.pdf

Last we have:

Report: DOD, VA need better planning for e-health records interoperability

• By William Jackson
• Jan 28, 2009

The operators of two of the largest health care systems in the world are making progress in sharing patients’ electronic health records, but they lack a clear plan for meeting a September deadline for fully interoperable systems, according to the Government Accountability Office.

The Defense and Veterans Affairs departments provide medical services to millions of Americans. All of VA’s patients come from DOD, and some are treated simultaneously in both systems. The departments have a mandate to establish an interoperable electronic system for handling patient records and exchanging information by the end of the fiscal year. The number of patients whose records the departments are sharing is growing, but it remains a small percentage of the overall patient population. Furthermore, VA and DOD have yet to establish a joint office to oversee the project.

The absence of clearly defined goals and milestones limits the departments’ ability to measure their progress and ensure success, GAO auditors wrote in a report titled “Electronic Health Records: DOD’s and VA’s Sharing of Information Could Benefit from Improved Management.”

More here:

http://gcn.com/articles/2009/01/28/gao-on-dod-and-va-data-sharing.aspx

The report is here:

GAO report

These reports and associated materials are worth a close look.

David.

Getting Health IT Right – One Groups View.

Modern’s Medicine’s Joseph Conn wrote a two part set of interesting articles last week.

The first covered a review of a new report on Health IT developed by the Human Services Department of the US Government.

Groups deemed IT leaders 'fall far short' of IOM goals

By Joseph Conn / HITS staff writer

Posted: January 22, 2009 - 5:59 am EDT

There is too much good stuff in the recently released report, “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions,” to do it all justice in just one Health IT Strategist-length article, evidenced by an interview with one report co-editor, William Stead.

On a call for an interview that was scheduled for 15 minutes, we spoke for an hour and still didn’t cover everything. So we’ll be doing a two-part series based on the 138-page report and the discussion with Stead prompted by it.

Stead, a physician who is associate vice chancellor for strategy/transformation and the chief information officer of the Vanderbilt University Medical Center in Nashville, worked with Herbert Lin as co-editors of the report, prepared by the Committee on Engaging the Computer Science Research Community in Health Care Informatics, a committee of the Computer Science and Telecommunications Board of the National Research Council of the National Academies.

The report was funded by HHS, the National Science Foundation, Vanderbilt University, 10-hospital Partners HealthCare System, Boston, the Robert Wood Johnson Foundation and the Commonwealth Fund. Stead is a member of the Computer Science and Telecommunications Board and Lin is its chief scientist. Corporate members of the board include representatives from Google, IBM Corp., Microsoft Corp. and Yahoo! Research.

The study had two goals: to identify how computer usage might be applied more effectively to healthcare, and how the limitations of current technologies and approaches might be overcome through additional research and development. The study group focused on the information technology usage of major healthcare organizations, which its authors conceded is a limitation, noting “the majority of healthcare is delivered in small-practice settings (of two to five physicians) that lack significant organizational support.” (Actually, about 37% of office-based physicians are in solo practice, according to National Center for Health Statistics survey data.) Still, the authors say they hoped their efforts “would lay the groundwork for future efforts” of exploring unanswered questions raised by this study.

The study group visited eight hospital organizations deemed leaders in the use of health IT, including government, not-for-profit and for-profit organizations where “many of the important innovations” in IT would be found. They were the Palo Alto (Calif.) Medical Foundation; the 642-bed UCSF Medical Center, San Francisco; 18-hospital Intermountain Healthcare, Salt Lake City; 12-hospital Partners HealthCare System, Boston; 833-bed Vanderbilt University Medical Center, Nashville; TriStar Health System, Nashville; 291-bed Veterans Affairs Medical Center, Washington; and 12-hospital UPMC, Pittsburgh. In addition to site visits, the committee also leaned heavily on previous work by the Institute of Medicine, particularly its 2001 report, Crossing the Quality Chasm, as well as a review of other literature and the committee members’ own experience.

.....

The report included several recommendations to the federal government along these lines, including the following:

• Any government incentives should be for clinical performance, not IT acquisition per se. These incentives should reward one-foot-at-a-time improvements in quality of care using an iterative process of software and system development.
• The government should encourage the development of performance standards and measures for decision support.
• It also should encourage interdisciplinary research into the design of healthcare systems processes and workflow, “computable knowledge structures and models for medicine” and “human-computer interaction” in a clinical setting.
• And the government should at the least not impede, but at best, encourage the aggregation of healthcare data, processes and outcomes “subject to appropriate protection of privacy and confidentiality.”

The full article is found here:

http://modernhealthcare.com/article/20090122/REG/301229997/1134/FREE

The second explores some simple and practical steps that can be taken to improve the current US situation

Use available IT to take little steps, Stead advises

By Joseph Conn / HITS staff writer

Posted: January 23, 2009 - 5:59 am EDT

Since almost everyone these days is giving advice to the Obama administration, I asked William Stead, co-editor of the report, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, what advice he would give to the new president, who mentioned healthcare reform in his inaugural address and who has proposed billions of dollars of federal spending on health information technology.

One draft of a stimulus bill made public last week by the influential House Ways and Means Committee includes $2 billion for HHS’ Office of the National Coordinator for IT grant-making, so rather than make recommendations to President Barack Obama, Stead directed his recommendations to Congress and to Robert Kolodner, the physician who at this writing remains the holdover head of the ONC.

Stead, a physician who is associate vice chancellor for strategy/transformation and the chief information officer of Vanderbilt University Medical Center in Nashville, volunteered that he served on the congressionally mandated Commission on Systemic Interoperability of heath IT, which served up several slickly bound reports in 2005 that have been scarcely heard of since. Asked if the previous administration erred in pressing for interoperability in its healthcare IT promotional activities, Stead bluntly indicated yes, in macrocosm, but no, in microcosm.

The suggested steps are here:

http://modernhealthcare.com/article/20090123/REG/301239997/1134/FREE

At the core of all this discussion are two central and important points in my view. First we already have the technology available to address many of the problems we face in Australia. The trick is to re-engineer and re-design the way healthcare is delivered and then provide the technology to optimise the way the new models work – not the other way around (develop software and force health system to use the technology).

The second major point is to move incrementally, driven by improvements in clinical, administrative and patient outcomes, rather than being driven by short term savings etc. That way the money that is invested will be spent where it does the most real good.

Both articles are worth a close read.

David.

International News Extras For the Week (04/02/2009).

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

First we have:

Course Interprets Rx Marketing Messages

January 26, 2009

A new, free online course is designed to help clinicians assess the confusing drug information they receive from pharmaceutical companies.

The goal is to help clinicians make better prescribing decisions. Wake Forest University School of Medicine in Winston-Salem, N.C., developed the course with a regional unit of the North Carolina Area Health Education Centers Program.

The five-lesson course, called SmartPrescribe, targets physicians, physician assistants, nurse practitioners and medical students. Covered topics include:

* distinguishing between good studies and mediocre studies,

* understanding problems and recent improvements in FDA regulation of new drugs,

* learning about pharmaceutical marketing strategies,

* assessing how much course participants are influenced by marketing, and

* determining if course participants are prescribing dangerous drug combinations.

More here:

http://www.healthdatamanagement.com/news/education27600-1.html?ET=healthdatamanagement:e745:100325a:&st=email&channel=medication_management

What an excellent idea – this is certainly something the TGA should look at replicating in Australia!

Second we have:

Worthing may dump Cerner Millennium

26 Jan 2009

Worthing and Southlands Hospitals NHS Trust may ditch its brand new Cerner Millennium system in favour of a 20-year old legacy patient administration system.

This April, the trust will merge with neighbour The Royal West Sussex Hospital NHS Trust. Following the merger, E-Health Insider understands the intention is to run the long established Sema-Helix PAS, currently in use at The Royal Wessex, across the whole of the new trust.

E-Health Insider understands the decision to move to Sema-Helix was taken in principal by the Worthing and Southlands board in December.

It is believed to be based on the problems experienced since go-live in September 2007, and lack of ongoing development following Fujitsu’s removal as local service provider in the South.

The trust declined to confirm or deny any decision had been taken. NHS South East instead responded to questions directed to the trust, saying no “final” decision had been taken; a message repeated by NHS Connecting for Health.

More here:

http://www.e-health-insider.com/news/4511/worthing_may_dump_cerner_millennium

Sounds like “trouble at mill” with this installation!

Third we have:

Technology Gets a Piece of Stimulus

STEVE LOHR

Published: Monday, January 26, 2009 at 5:12 a.m.

Last Modified: Monday, January 26, 2009 at 5:12 a.m.

The time-tested way for governments to create jobs in a hurry is to pour money into old-fashioned public works projects like roads and bridges. President Obama’s economic recovery plan will do that, but it also has some ambitious 21st century twists.

The $825 billion stimulus plan presented this month by House Democrats called for $37 billion in spending in three high-tech areas: $20 billion to computerize medical records, $11 billion to create smarter electrical grids and $6 billion to expand high-speed Internet access in rural and underserved communities.

A study published this month, which was prepared for the Obama transition team, concluded that putting $30 billion into those three fields could produce more than 900,000 jobs in the first year. The mix of proposed spending is different in the House plan, but the results would be similar, said Robert D. Atkinson, president of the Information Technology and Innovation Foundation, which did the study.

Beyond creating jobs, advocates say, government investment in these technology fields holds the promise of laying a lasting foundation for more business innovation and efficiency, while helping to create new digital industries.

Much more here:

http://www.nytimes.com/2009/01/26/technology/26techjobs.html?_r=1&partner=rss

This NY Times article explains the broader technology investment plans of the Obama administration. An extra investment in country broadband sounds a little familiar!

Fourth we have:

Selecting the correct healthcare software solution

January 23, 2009 | Chad A. Eckes, CIO, Cancer Treatment Centers of America and Edgar D. Staren, MD, Senior Vice President for Clinical Affairs and Chief Medical Officer, Cancer Treatment Centers of America

Most healthcare information technology vendors want you to believe that their software can meet any organization's needs. As a matter of fact, healthcare IT vendors and their software are quite unique. The single most important process for a successful software implementation is the selection of the correct solution.

There are several guiding principles that should be taken into consideration when selecting your healthcare software. First, your IT department should never be the primary entity selecting the software. The operational users of the software need to be the principal participants in the selection process. The IT department's role should primarily be to facilitate the solution selection process.

Appropriate representation takes into account the various disciplines, interest, and expertise in the organization. Second, optimal selection necessitates that a multi-disciplinary team representing the organization's stakeholders be prepared to invest a significant amount of time; typical solution selections require 4 to 6 months and up to 20,000 hours. The third principle is to not select software based upon previous relationships nor having used the technology in another organization. The fit of software is highly influenced by the culture and business processes of an organization. Finally, the best way to find the software with the closest functional fit is to follow a structured selection methodology. In that regard, we have designed a three phase and 12 task selection methodology, which follows a standard selection funnel.

Heaps more here:

http://www.healthcareitnews.com/blog/selecting-correct-healthcare-software-solution

This is an excellent article – that is worth reading in full for ideas on how to conduct a quality system selection process. Certainly one for Health IT project managers to save and a series to follow.

Fifth we have:

MDs using social networks prescribe more

By Anne

Created Jan 25 2009 - 6:44pm

The following may seem like more of a marketing than an IT issue--but I'd argue that it has implications for IT execs too, largely in what applications you'll need to slate for development in the future. As you'll see, it's a data point that suggests that physicians who engage online are physicians you want in your corner.

A new study has concluded that physicians who are currently participating in online physician communities and social networks write a mean of 24 more prescriptions per week than those who aren't interested in such communities. The study goes on to suggest that such physicians are more pharma-friendly too.

Lots more (with links) here:

http://www.fiercehealthit.com/story/mds-using-social-networks-prescribe-more/2009-01-25

The press release for the study is here:

http://www.fiercehealthcare.com/press-releases/physician-social-networkers-are-high-prescribers-and-more-likely-engage-pharma?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FH

I am not sure I know exactly what this result means – but I am not totally convinced it is a good thing!

Sixth we have:

Western NY launches patient record exchange

By CAROLYN THOMPSON – Jan 23, 2009

BUFFALO, N.Y. (AP) — Doctors in western New York have a new, electronic way to access patient records with the hope of reducing medical errors and avoiding costly duplicative tests.

The HEALTHeLINK Western New York Clinical Information Exchange is a step toward Gov. David Paterson's goal of creating a unified statewide system where doctors can access records that are now scattered among different clinics and offices.

"The emergency room doctor who's never seen that patient before ever will have access to their information, their medication history, any lab work, any radiology reports," HEALTHeLINK Executive Director Dan Porreca said.

On a national level, President Barack Obama, during his campaign, promised a $50 billion investment to store patient records electronically. Earlier this month, Obama said he wants all of the country's medical records computerized within five years.

"We believe that New York is setting the standard in fulfilling the president's goal of digitizing patient health records and HEALTHeLINK is an integral component of our statewide initiative," said Lori Evans, the state Health Department's deputy commissioner of health information and technology.

Addressing privacy concerns, Porreca said the electronic files are more secure than paper, since only authorized people will have access to the Web-based system and to a patient's records.

"If it's a paper chart, you never know who's looked at that," he said. "In electronic form, we can track who's looking at what."

More here:

http://www.google.com/hostednews/ap/article/ALeqM5hp8nUD2UaCNd1aE9cf9KaFAqMq4AD95SS7UG2

Great name for a Health Information Exchange – seems it is a bit familiar however..think NSW Health! Nevertheless a serious investment and effort is being made.

Seventh we have:

CCHIT Proposes Expansion, Leaving Some Vendors Crying Foul

Kathryn Mackenzie, for HealthLeaders Media, January 27, 2009

Since launching in 2004, the Certification Commission for Health Information Technology has become the de facto stamp of approval for EHRs, helping providers judge EHR product suitability, quality, interoperability, and security. For about $28,000, a vendor who meets the Commission's criteria can be certified, automatically proving to providers that their EHR is worth the money, say CCHIT proponents. Now, CCHIT is expanding its scope of certification, and not everyone is happy about CCHIT's increasing influence in the market.

The expansion includes two areas already named in previous years—behavioral health and long-term care—that will be developed as planned. In addition, four new program areas are proposed, all of which are optional add-on certifications for ambulatory EHRs: clinical research, dermatology, advanced interoperability, and advanced quality.

One of the main components being added to CCHIT's lineup will be increased flexibility and opening up the option of certifying advanced levels of technology for products that go "beyond the basics" in any domain, says Mark Leavitt, MD, chair of CCHIT.

"There is now a degree of sophistication with the technology and a readiness on the part of the end users that we need to have different levels of certification. You will still have the certification for ambulatory EHR, but those with advanced decision support, for example, would get additional certification that says this product also offers advanced decision support so if that's something you are ready for and looking for, this has it," says Leavitt.

He says the group chose the expansion areas based on a model that quantified the benefit of certification by looking at how many patients are affected by the specialty, how many dollars are spent in the specialty, the readiness of the specialty (for example, have providers gotten together and formed committees to define what they need or would CCHIT have to start from scratch) and then, "we balanced those out. We ultimately came out with a prioritization, and published that January 14 open for comment. We are accepting comment through February 5," says Leavitt. CCHIT also is considering eventual certification programs for software to support eye care, oncology, obstetrics/gynecology, advanced security, and advanced clinical decision support.

More here:

http://www.healthleadersmedia.com/content/227160/topic/WS_HLM2_TEC/CCHIT-Proposes-Expansion-Leaving-Some-Vendors-Crying-Foul.html

This is a useful article describing the pressures Health IT Certification functions can come under. NEHTA should have a close read! – along with the comments that have been posted.

See here for example.

http://www.smartbrief.com/news/chime/storyDetails.jsp?issueid=2ED668E3-6F37-47A2-92FE-0943072C024E&copyid=A27B4E34-6C32-4642-9639-D0A980ED90F8

and here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090127/REG/301279962/1031/FREE

Eighth we have:

Database Helps Assess Your Breast Cancer Risk

By Serena Gordon

HealthDay Reporter

Sunday, January 25, 2009; 12:00 AM

SUNDAY, Jan. 25 (HealthDay News) -- If you want to learn more about the key risk factors for breast cancer, such as obesity, pollutants or smoking, a database can guide you to the available evidence that confirms or quells an association.

"Breast cancer is multifactorial. It would be rare for there to be a single environmental chemical that alone would be sufficient to cause an increase in breast cancer," said Dr. Robert Schneider, co-director of breast cancer research at New York University School of Medicine in New York City.

"In many cases, an increased risk of breast cancer is quite small, and we don't yet know how each factor affects the risk of breast cancer," he said, explaining that it's similar to a puzzle. "We need to know how all of the pieces fit together, and this database begins to help us start assessing some of that."

The database, a joint project of Susan G. Komen for the Cure and the Environmental Factors and Breast Cancer Science Review project led by the Silent Spring Institute, includes information on 216 chemicals, diet, smoking, physical activity and weight that may play a role in the development of breast cancer.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/01/25/AR2009012500665.html

The database is found here:

http://sciencereview.silentspring.org/index.cfm

Ninth we have:

Detailed Care Records for 3.5m patients

27 Jan 2009

More than 3.5m patients in Yorkshire and the Humber now have a Detailed Care Record for primary and community care, in one of the lesser-known success stories of the National Programme for IT in the NHS.

The records form part of a fully operational DCR, with information being shared between general practice, community and child health systems.

According to figures supplied to EHI Primary Care, Yorkshire and the Humber has 100% of primary care trust community teams, 40% of GP practices and approaching 100% of child health teams using TPP’s SystmOne, supplied by its local service provider, Computer Sciences Corporation.

NHS East of England is close behind, with 3.4m patients on the system, followed by NHS East Midlands (2m) and the NHS North East (1.2m).

In an exclusive interview with EHI Primary Care, Tony Megaw, head of primary care IT for NHS Yorkshire and the Humber , estimated that the DCR created by SystmOne was now being used by as many as 50% of primary care NHS staff in the strategic health authority's area.

He said: “The NPfIT vision of integrated, detailed care records improving patient care is a reality in Yorkshire and the Humber.”

Full article here:

http://www.ehiprimarycare.com/news/4508/detailed_care_records_for_3.5m_patients

With all the bad news – it is important to realise good things are also happening in the UK!

Much more detail here:

http://www.ehiprimarycare.com/comment_and_analysis/383/making_a_detailed_care_record_a_reality

See also here for more good news.

http://www.ehiprimarycare.com/news/4520/gp2gp_milestone_reached

GP2GP milestone reached

28 Jan 2009

Tenth we have:

Electronic records to support $2.5M diabetes study at Palo Alto

January 28, 2009 | Bernie Monegain, Editor

PALO ALTO, CA – Electronic health records in use at the Palo Alto Medical Foundation for nearly a decade will support a new $2.5 million diabetes research project focused on California's Asian population.

PAMF announced earlier this week it had received a $2.5 million grant from the National Institutes of Health to conduct a five-year study on diabetes and its risk factors among the six largest Asian ethnic groups in California - Asian Indians, Chinese, Filipino, Japanese, Korean and Vietnamese.

PAMF's EHR system gives researchers a unique resource to better understand variations in treatment for diabetes, identify best practices and recommend ways to improve care both inside and outside of the organization, PAMF officials say. In addition to reviewing existing medical records as part of the study, researchers will use the EHR system to select and follow a group of patients over more than a decade to study diabetes risk factors that may be unique to Asian Americans.

"By the end of the study, we hope to gain a much better understanding of what puts certain Asian ethnic minorities at greater risk for diabetes, one of the most costly and prevalent chronic health conditions," said Latha Palaniappan, MD, principal investigator for the study. "The study also holds substantial promise for clinicians and policymakers, as we will offer information and recommendations on how to identify and target high-risk Asian populations for diabetes prevention, treatment and management."

More here:

http://www.healthcareitnews.com/news/electronic-records-support-25m-diabetes-study-palo-alto

This is the extra value add we get from EHRs that – while not getting on with it – we are missing out on!

Eleventh we have:

Groups push for health IT privacy safeguards

By GRANT GROSS, IDG News Service\Washington Bureau, IDG

U.S. lawmakers need to make sure privacy safeguards are in place before pushing electronic health records on the public, senators and witnesses at a hearing said.

Health IT improvements are needed to improve the quality and efficiency of health care in the U.S., but patients might be wary of electronic health records without strong privacy safeguards built in, Senator Patrick Leahy, a Vermont Democrat, said during a Senate Judiciary Committee hearing Tuesday.

"If you don't have adequate safeguards to protect privacy, many Americans aren't going to seek medical treatment," Leahy said. "Health-care providers who think there's a privacy risk ... are going to see that as inconsistent with their professional obligations, and they won't want to participate."

A US$825 billion economic stimulus package, called the American Recovery and Reinvestment Act, includes $20 billion targeted toward health IT efforts. The bill, which could come before the full House this week, establishes an Office of the National Coordinator for Health Information Technology, with the duty of driving health IT standards.

More here:

http://www.nytimes.com/external/idg/2009/01/27/27idg-Groups-push-for.html

Again a lesson about how important it is the get the approach to privacy right – and to communicate it clearly to re-assure people.

Last for this week we have:

Health Central acquires Wellsphere

Silicon Valley / San Jose Business Journal

HealthCentral Inc., a collection of online condition-specific consumer health and wellness information, said Wednesday it acquired health technology company Wellsphere Inc.

Arlington, Va.-based HealthCentral did not disclose terms of the deal with Wellsphere, which is based in San Mateo.

"The acquisition combines HealthCentral's high-quality, condition-specific interactive experiences, content and audience with Wellsphere's aggregation of over 1,500 health and wellness bloggers and unique Health Knowledge Engine technology that deciphers highly specific health information," the company said.

More here:

http://www.bizjournals.com/sanjose/stories/2009/01/26/daily53.html?

From the growth figures quoted it seems there is a place for detailed consumer health information out there!

There is an amazing amount happening (lots of stuff left out) – and - as Peter Cundall would say ‘ that is your bloomin lot for the week’!

David.

A Press Release On Health Information Privacy Worth Noting.

The following appeared a few days ago.

For immediate release:
January 17, 2009

Contact:
Brock N Meeks, CDT
(202) 637-9800 ex. 114
(703) 989-3547 (CELL)

CDT Applauds Critical Privacy, Security Provisions in Health IT Stimulus Bill

Washington -- CDT applauds Congress for including critical privacy and security protections in the health information technology (health IT) portions of the American Recovery and Reinvestment Act of 2009, the proposed economic recovery bill.

"Now is the critical time for addressing privacy," said Deven McGraw, director of the Health Privacy Project at CDT. "Restoring public trust after it has been undermined by a high profile privacy violation, is far more difficult, and more expensive, than building it into the design of health IT systems from the beginning," McGraw said. "Ensuring adequate privacy and security protections for electronic health information will help facilitate the widespread adoption of health IT."

The bill's privacy provisions include the following:

• Stronger protections against the use of personal heath information for marketing purposes;
• Accountability for all entities that handle personal health information;
• A federal, individual right to be notified in the event of a breach of identifiable health information;
• Prohibitions on the sale of valuable patient-identifiable data for inappropriate purposes;
• Development and implementation of federal privacy and security protections for personal health records;
• Easy access by patients to electronic copies of their records; and
• Strengthened enforcement of health privacy rules.

The provisions in the bill are similar to those that received bipartisan approval by the House Energy & Commerce Committee in the last Congress.

Surveys show a majority of Americans support greater use of health IT. At the same time, consumers have significant privacy concerns about putting their medical records online. Providing a comprehensive framework of privacy and security protections for electronic personal health information is critical for building public trust in a nationwide health IT system.

Senate testimony from the Government Accountability Office last week underscored the need for privacy noting that, "a robust approach to privacy protection is essential to establish the high degree of public confidence and trust needed to encourage widespread adoption of health IT and particularly electronic medical records."

"An interconnected health system is possible only if there are sufficient protections in place for privacy and security," said Leslie Harris, President and CEO of the Center for Democracy & Technology. "It is critical that privacy provisions remain in this legislation as it moves forward. We look forward to working with Congress and the Administration to ensure we have a comprehensive privacy and security policy framework in place to protect personal health information."

The release is found here:

http://cdt.org/press/20090117press.php

I have to say each of the seven bullet points could equally be popped into an Act of the Australian Parliament and make a considerable difference as well.

While they are at it they could also set a uniform approach to Health Information Privacy that would be enforceable nationwide and ensure that the rights of all the less powerful and influential are properly protected. Right now we have a state by state patchwork which includes nonsense such a permitting consent to be obtained on an ‘opt-out’ basis in the NSW Healthelink trail.

It is important to keep an eye on the following site in the next few months.

http://www.privacy.gov.au/health/index.html

This is because we must be getting close to the time when the outcome of the Australian Law Reform Commission’s Review of the Federal Privacy Act is finalised. The ALRC's review of privacy was handed to Government on 31 May 2008 and to date I have not seen the government response.

For those interested it is worth noting Short final submissions to Government identifying any perceived problems or gaps with the ALRC's recommendations in relation to the UPPs or credit provisions can be lodged up until the end of January 2009.

The Government response can’t be far off now! It will be interesting to see how many of the issues raised above are properly addressed.

David.

p.s. This is the 700th post on the blog. Bets taken on when we will reach 1000 with e-health still not properly addressed!

D.

AHHA Press Release - Health ignored in stimulus package

The Australian Healthcare and Hospitals Association (AHHA) released the following a little while ago.

Health ignored in stimulus package

3rd February 2009

By ignoring the health sector in today's stimulus package the Federal Government has missed the opportunity to support one of the most important areas of the Australian economy, according to the Australian Healthcare and Hospitals Association (AHHA).

The AHHA is the peak national body representing public hospitals, area health services, community health centres and public aged care providers.

"Health and community services contribute to the overall strength of our economy in a number of ways and should have been a key focus of this stimulus package," said Ms Prue Power, Executive Director, AHHA.

"Firstly, health is one of the biggest components of the services sector, the largest section of the Australian economy. Health care is a growth industry which has the potential to further expand with support from the Federal Government.

"Secondly, the health sector is one of our nation's largest employers with over 10 per cent of workers being employed in the area of health and community services. With widespread workforce shortages, there is considerable scope to train and employ health care workers throughout the sector thus creating new jobs and meeting existing needs for health care.

"Thirdly, the productivity of our workforce depends upon high quality and accessible health care services. When people lack adequate access to health care it can reduce their capacity to work, affecting both them and their families and compromising the overall efficiency of our economy.

"There is clear evidence that our health system currently does not perform well in areas such as the diagnosis and management of chronic disease and the provision of preventive dental care. This leads to the development of more serious conditions which can prevent people from seeking or continuing in employment.

"AHHA urges the Federal Government to expand the suite of initiatives contained in today's stimulus package to include an injection of funds into the health sector, in particular focussing on the critical areas of infrastructure and workforce.

"This would enable health services to upgrade their infrastructure, train more health care workers and increase the provision of essential health care to the Australian population, providing flow-on benefits to the economy and resulting in a healthier and more productive workforce," Ms Power said.

Contact: Prue Power, Executive Director, 0417 419 857

All I can say is that I am amazed and disappointed. The Minister for Health seems to have blown it again – or is saving a whopper for the Budget etc! I wonder which?

David.

Why is Ms Roxon Avoiding Taking Leadership and Initiating Action on E-Health?

On Friday last week the following appeared on the Australian Doctor web-site.

No deadline for e-health records

30-Jan-2009

By Paul Smith

THE Federal Government is refusing to set a deadline for the introduction of national e-health records, despite admitting the system is fundamental to its ambitious reform program.

Recently, a further $216 million was handed over to fund the body responsible for making e-health a reality: the National E-Health Transition Authority.

An additional $1 billion is expected to be committed for infrastructure development via the Council of Australian Governments.

Federal Health Minister Ms Nicola Roxon said: “Workforce and e-health are the chief enablers of all the health reforms. Without them the reforms will not be able to work.”

But she would not be drawn on a timetable for when the system will be in place, only stressing that it would be after 2010.

“The steps are going ahead but I can't give you a date. It takes a lot of time,” she told Australian Doctor.

She also said no decision had been made on the government’s role in delivering national e-health records.

.....

And talking about the progress being made in the UK she said.

“I'm agnostic about it. We will go with what will work.”

More here if you have access:

http://www.australiandoctor.com.au/articles/86/0c05ce86.asp

So what we have here is as follows.

First the health minister realises this stuff is very important and that health reform (which she desperately needs and wants) probably is impossible without major investment in the area..

Two she does not really have an action plan – or there would be some sort of dates and deliverables she could talk about. She does not seem to want to adopt the Deloittes work.

Three, despite the comments from NEHTA earlier in the week, it is not clear who is going to do what as far as progressing e-Health is concerned.

Four, we have a pretty clear statement that she does not see herself leading or really being accountable for progress in the area.

Fifth, commentary which is not really designed to be noted by the mainstream media (Fairfax, News Ltd etc)

The present government is now 14 or 15 months into a three year term and it has made no substantive identifiable progress compared with the previous Howard regime. We all know Tony Abbott found the area both important and deeply frustrating during his tenure of the job and it seems Ms Roxon is having the same difficulties.

The only difference is that she has a clear, well thought out plan (developed by Deloittes) to have her bureaucrats – who incidentally are many of the same people who worked for Mr Abbott – get on and implement.

This is the only way she has any chance of going to the next election without an “F” for Fail in the whole e-Health space.

She needs to simply get an appropriate quantum of funds from the Health and Hospitals Infrastructure Fund and tell DoHA to get on with implementing the Deloittes blueprint. She also has to make it clear she is going to sponsor the implementation and crash through the inevitable road-blocks to implementation as they emerge.

We have a plan – we need leadership, commitment and some sensible level funding. That should not be too hard if you actually want to be remembered as a Health Minister who made something of a difference for the good.

If Mr Obama can find the will and funds in the awful times so should she!

David.