Should Doctors Sell Information Derived from Their Electronic Health Records?

The following article appeared in the Australian IT Section a day or so ago:

Grab for patient records

Karen Dearne | May 19, 2009

Article from: The Australian

MEDICAL market research firm AsteRx plans a grab for doctors' prescribing records with an offer of powerful business intelligence software free to GPs who sign up.

AsteRx managing director Jon Marshall says de-identified patient data provides valuable insight into healthcare trends -- including the spread of infectious diseases -- for which drug companies, pharmacists and others are prepared to pay.

"We essentially want to build a large network of GPs so that we can provide data that can be called on in times of need," he said. "If we were extracting data from every GP in Australia, we would be able to track the swine flu, for instance.

"From the data we already collect I can tell you whether there has been an increase in immunisations, or increased incidences of flu, right up to yesterday's figures."

In return, doctors would benefit from clinical and business insights into their own systems and activities that the software would give them.

The business intelligence application -- accessed through a dashboard -- is based on Inside Info's QlikView product and designed so users can quickly query information and create reports.

"Basically, we have built a platform that allows us to gather data from any GP software package, and run it through a layer to create common data elements that we then aggregate up," he said. "From there, you can put QlikView over the top and begin to perform the analytics, data mining and reporting."

Mr Marshall said the business involved collecting millions of lines of data from individual doctors, but until now it had been difficult to access data already in clinical and practice software.

"With QlikView, we're starting to build some really neat reports," he said.

The dashboard approach means doctors can query things like the number of patients on an asthma care plan in their practice, or identify which diabetic patients are overdue for a review.

More fascinating information here:

http://www.theaustralian.news.com.au/story/0,25197,25502296-23289,00.html

As I read the article three thoughts came to mind. The first was how would I feel as a patient if my GP was doing this sort of thing, second just what are the implications of this sort of data gathering and third I wondered what say or awareness individual patients had of their involvement in this so called ‘research’.

A visit to the web site provides some answers:

http://www.asterx.com/Corporate/AboutUs.aspx

About Us

asteRx is an Australian company that develops a number of solutions for the healthcare industry.

The lead asteRx product provides a fast and secure channel for the doctor to participate in market research. asteRx is currently on the desktop of over 16,000 Australian Doctors, and can be accessed via the scriptwriting software of Medical Director. If a doctor likes to participate in market research, then asteRx provides a fast and effective channel for that to occur.

The doctor can select which research they would like to participate, what their involvement would be, and the incentive they will receive, before actually commencing an activity.

asterx uses modern web services technology to quickly transfer data, with all data transfer performed using SSL encryption to ensure the security of all information.

Ethical Approach

asteRx is committed to strict adherence to its privacy policy and the principles of the privacy act.

We are committed to ethical and appropriate practices to maintain the expectations of the community for the security, privacy and integrity of personal health information.

asteRx is committed to ensuring that any complaints are dealt with efficiently and effectively

The Company respects doctors' clinical independence and decision-making abilities.

----- End Page:

Elsewhere it is mentioned that the fee paid to doctors for one month’s participation (and data) is a $25 cheque to the doctor and that what it is all about is the collection of prescribing data linked to an individual doctor or practice.

The privacy policy on the Web Site makes interesting reading:

http://www.asterx.com/Corporate/Privacy.aspx

Thank you for visiting www.asterx.com. Your privacy is important to us.

To better protect your privacy, we provide this Privacy Policy to explain our online information practices and the choices you can make about the way your information is collected and used at this site. If you have any questions or concerns about our Privacy Policy for this site or its implementation you may contact us by emailing to support@asterx.com

POSITION STATEMENT ON PRIVACY POLICY

asteRx recognises, that the capacity of information technology to capture and transfer information electronically, has heightened community concerns about privacy in relation to the handling of personal health information.

Personal health information is personal information:

* about a person's health, medical history or past, present or future medical care

* collected in the provision of health services to an individual; or

* about any health service provided to an individual

Personal health information is sensitive. The secure transfer, storage and disposal of personal health information are paramount to protecting and maintaining privacy. To this end, asteRx is committed to ethical and appropriate practices to maintain the expectations of the community for the security, privacy and integrity of personal health information.

asteRx takes into consideration the:

* Privacy Commissioner's Report on the Application of the National Principles for the Fair Handling of Personal Information to Personal Health Information (Crompton, 1999)

* RACGP Code of Practice for the Management of Health Information (1998)2

POSITION ON PRIVACY ON EMERGING TECHNOLOGIES

asteRx supports the use of public key and Secure Sockets Layer (SSL) technology which uses asymmetric and symmetric encryption techniques to optimise the confidentiality and integrity of information transfer through authentication of users and non-repudiation of transactions.

Consistent with asteRx's commitment to continuous quality improvement, asteRx will develop position statements on privacy for new technologies as they emerge.

REFERENCES

1. Crompton M. Privacy Commissioner's Report on the Application of the National Principles for the Fair Handling of Personal Information to Personal Health Information. Office of the Federal Privacy Commission. December, 1999.

2. Royal Australian College of General Practitioners. Code of Practice for the Management of Health Information, 1998. Authorised by Sue Phillips. http://www.racgp.org.au/policy. Accessed 13 April, 2000.

----- End Policy.

What is clear from all this is that asteRx is able to collect data which identifies the doctor, the illness for which they are prescribing and the age and sex of the patient. It is also clear they do not see there is any need for the Doctor to seek any form of permission of consent from the patient.

A few points:

First – even at the payment offered there is clearly someone seeing this information as valuable – and you can be sure that is the major drug companies – who will pay for this data and then design marketing campaigns to doctors to change prescribing behaviour. If it was not working they are smart enough business men to not pay!

Second – noting the web site is date 2005 I would venture to suggest that patient concerns might have moved on a little – and that given there is a review of how health information is to be handled underway at present – what is being done here is sailing rather close to the wind.

The comments of the Privacy Commissioner (from 2001) on such issues are relevant –but not referenced by asteRx.

See here:

http://privacy.gov.au/publications/IS9_01.html

I small communities I would doubt there could be any confidence that all data collected was indeed properly de-identified given this comment.

“Taking reasonable steps to de-identify information before it is disclosed

This means that where an organisation has collected health information without consent for the purposes listed in NPP 10.3, the organisation must ordinarily de-identify the information before it discloses it. The information should be de-identified in a manner that does not allow it to be re-identified.

For example, health information collected for a research project should be modified so that the identities of the subjects are not reasonably apparent when the results of the research are published or otherwise disclosed.

Organisations should note that simply removing the person's name may not be enough to satisfy this criterion. In some circumstances a person's identity may reasonably be ascertained from other information - for example from an identity number, or other details held about the person, or from the context in which the information is collected.

Tip for compliance

Determining what are reasonable steps will depend on the circumstances. Considerations that may be relevant in determining what steps are reasonable include: whether unit or aggregate information is being released; the 'cell size' of aggregate data; the context into which the information is being released; the capacity of the collecting organisation to re-identify the information; and the content and nature of any assurances given by, or agreement with, the receiving organisation about not attempting to re-identify information.”

Third I see this sort of activity as potentially damaging public trust in moves to adoption of e-Health – given a common concern many express is that they are unhappy as soon as they have any sense their information is not under the direct control of themselves or their clinician.

Fourth – my answer to the question posed in the title is a clear cut and definite NO!

Legislatures in a number of US States are acting to outlaw this sort of data mining and Australia should follow suit in my view!

David.

Health IT is a Good Thing – But It Has to be Done Right!

It is very easy to form a view that this blog is an unalloyed and one-eyed supporter of rapid adoption of e-Health all over our Health System. Given the prospect for that view to be formed it seems important that I point out that while keen to see sensible and planned deployments of proven technologies I am not blind to the possible downsides if it is not done well!

The following appeared in a blog written by Scot Silverstein MD.

http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html

The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians

In many past posts on Healthcare Renewal I have commented on a bewildering healthcare and IT industry blindness to a growing body of literature and experiences of those "in the trenches" that throw doubts upon Utopian views of health IT as a panacea for healthcare's problems. Those responsible for this literature advise caution and the highest levels of scientific rigor in the large scale adoption of clinical information technology if that technology is to actually improve healthcare, myself included. We know the difficulties and risks. Bad healthcare informatics wastes money and distracts clinicians. Bad healthcare informatics can kill. "Primum non nocerum" is a critical ideology in health IT.

I first wrote about these observations a decade ago and was merely standing on the shoulders of those who preceded me with their own critical thoughts and observations regarding cybernetic miracles in medicine.

I've also been puzzled about the sudden lurch by the current administration to commit tens of billions of dollars to national HIT, along with eventual penalties for resistance, within the ridiculously short time frame of 2014 and with little public discussion. The provisions seemed to simply "appear" in H.R. 1 EH, a.k.a. the Economic Recovery Act of 2009. I wrote about this here.

Finally, I was curious about the timing of a remarkable set of reports from highly respected U.S. organizations on HIT issues, such as a Dec. 2008 Sentinel Events Alert from the Joint Commission and a Jan. 2009 report from the U.S. National Research Council. What motivated their release?

The answers to these questions have become bit clearer via a remarkable article from the Washington Post. It reveals an administration heavily influenced by - no surprise - powerful industry lobbyists. (I thought this administration had pledged a different mode of government conduct, but as has been said, campaigning is done with poetry, and governing is done with prose.)

Here is an interesting explanation of how medicine has been cross-occupationally invaded by the IT industry, probably ten or more years before that industry really has the depth of understanding, depth of talent and capabilities to make useful, usable, safe, and cost effective national health IT a reality:

The Machinery Behind Health-Care Reform

How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records

By Robert O'Harrow Jr.

Washington Post Staff Writer

Saturday, May 16, 2009

The full article is found here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html

The point being made is that there was a planned and very successful lobbying program – supported by the large Health IT providers – to have the Obama Administration release a lot of money to fund the implementation of systems provided by these very same people.

Careful reading of the blog is recommended for the details of both the Washington Post article and Scot’s comments on it.

The key assertion from the blog is that we are uncertain that Health IT is as safe as it should be and that until we can be sure no harm significant harm will flow from deployment and use the precautionary principle should apply.

Example of where things can and have gone wrong are provided here:

Bad Health Informatics Can Kill

ICT can have positive impact on health care, but there are also examples on negative impact of ICT on efficiency and even outcome quality of patient care. Medical informaticians should feel responsble for the effects of ICT on patients and public. Systematic analysis of ICT errors and failures is the precondition to be able to learn from negative examples and to design better health information systems.

This document contains summaries of a number of reported incidents in healthcare where ICT was the cause or a significant factor. For each incident or problem at least one link to a source will be provided. With the following list, we want to rise awareness on this important issue, and provide information for further reading.

This summary was inspired by a citation of Prof. Chris Taylor found in the report "Pathways to Professionalism in Health Informatics" of the UK Council for Health Informatics Professions: "Bad Health Informatics can kill". We would like to acknowledge the contribution of Dr. G.M. Hayes (President, UK Council for Health Informatics Professions; Chairman, Health Informatics Committee of the British Computer Society; President, Primary Health Care Group of the BCS) in collecting those examples.

Table of all sorts of issues found here:

http://iig.umit.at/efmi/badinformatics.htm

I should also note there are others, including Professor Enrico Coiera at UNSW, who have expressed and written on related topics and expressed similar concerns.

What do I make of all this?

First I believe there is strong evidence from all around the world that Health IT has provided demonstrable benefits in many situations.

Examples of where this is true have appeared weekly here on the blog essentially since it was established.

Second I so not in any way diminish or ignore the possibility and real risk of implementations which are not carefully planned and implemented have negative unintended consequences.

Third I do believe that there are important modes of Healthcare Delivery Reform which are simply not possible without better support from information management and communications technologies

Fourth I find issues of vested interest influence to be troubling if not clearly disclosed.

How to proceed. I think there are a few key things that can be done.

First expand clinical involvement dramatically in the planning, procurement and implementation of Health IT.

Second ensure we have an adequate number of properly trained and skilled health informatics professionals who understand both the ethical and technical issues associated with the use of technology in the sector.

Third we ensure there is adequate local control of implementations to ensure possible adverse outcomes are identified and addressed before significant harm occurs.

Fourth that properly designed evaluations are properly sponsored and funded to ensure problematic outcomes are detected and addressed promptly.

Fifth the experiences gained in the implementation of time and safety critical systems in other industry sectors are fully studied and absorbed – software quality, usability, reliability, exception handling etc. (The potential for harm exists and must be addressed proactively).

Sixth we recognise that human nature and psycho-social factors are important in Health Service delivery and we be proactive in ensuring such factors are identified and addressed.

Lastly that we proceed at a pragmatic and sensible pace watching the effects as we go.

If all this is done Health IT can do enormous good with negligible harm. (Who wants to go back to the days of handwritten prescriptions, no CT or MRI scanners and so on!)

David.

The Last Chance Saloon for E-Health in Australia.

Well the budget has been delivered, the press has discussed and as far as e-Health is concerned it has been a pretty miserable outcome. Overall the Budget Washup 2009 has been a really bad trip. The obvious question is where to next?

Both the serious national dailies had considerable (disappointed and negative) commentary

First we had (just pre budget):

Leaked details show modest costs for e-health

Karen Dearne | May 12, 2009

NATIONWIDE electronic health infrastructure will cost a modest $1.5 billion over five years, or $2.6 billion over a 10-year rollout, according to leaked funding details.

Federal and state ministers have kept tight wraps on costings and timetables since agreeing last December to adopt the National E-Health Strategy, prepared by Deloitte.

The $1 billion to $2 billion range "represents a relatively modest investment" when compared with the total annual health spend of $90 billion, with $60 billion coming from all levels of government.

Deloitte found that "tangible benefits" from implementing the e-health strategy "are in the order of $5.7 billion in net present value terms over 10 years".

Annual savings from a fully integrated system "are estimated to be about $2.6 billion in 2008-09 dollar terms".

The leaking of financial information and costed work programs on David More's AushealthIT blogger website appears to reflect growing frustration with the lack of progress on e-health.

Last month, medical and consumer groups told the National Health and Hospitals Reform Commission they were astonished it had failed to put information technologies at the heart of reform plans.

More here:

http://www.australianit.news.com.au/story/0,24897,25464236-5013040,00.html

And then we had after the event these two articles.

Budget 09: Patients slugged with e-health bill?

Karen Dearne | May 13, 2009

FEARS that patients will have to fund and maintain their own electronic health records have strengthened with the federal Government refusing to put money into a nationwide information-sharing infrastructure in the budget.

Instead, the Health Department is to "develop a legislative and regulatory framework" that would open the field to businesses like Microsoft and Google wanting to cash-in on demand for personal health records.

Concerns that plans for a secure national health information system had been scrapped emerged two weeks ago, when the key healthcare reform body, the National Health and Hospitals Reform Commission, rushed out an unexpected paper suggesting "commercial IT developers" were best placed to deliver personal e-health records to patients "in an open, competitive market".

Health Minister Nicola Roxon has now directed her department to deliver new laws that permit doctors, public health providers and government authorities to use unique healthcare identifiers in support of sharing sensitive patient details, and to overcome privacy and consent concerns that have restricted secondary use of medical data to date.

"Appropriate levels of protection of an individual's health information will help provide consumers with confidence that their information is managed in a secure environment," according to 2009 budget papers.

"The department will also support secure messaging services to assist the widespread take-up of electronic referrals, prescribing and (hospital) discharge summaries, and develop policy parameters for a long-term approach to individual e-health records."

Just this week, leaked details of the federal and state governments' agreed National E-Health Strategy revealed that an Australia-wide e-health infrastructure would cost $1.5 billion over five years - vastly improving patient care and healthcare safety - and delivering financial savings of around $2.6 billion annually.

The budget notes that "since the completion of (the long-abandoned) HealthConnect and Managed Health Network Grants in 2008-09, the e-health program has been refocused to support activities that align with the National E-Health Strategy".

Lots more here:

http://www.australianit.news.com.au/story/0,24897,25474380-15319,00.html

and this one (again just before the budget):

Electronic records could dictate health funding

Julian Bajkowski

The Australian Financial Review | 12 May 2009 | Page: 31 | Information.

States and private health providers have been put on notice that federal health funding may become contingent on the adoption of a nationally compatible electronic health records scheme.

The controversial move to tie funding to the adoption of EHRs is expected to be formally recommended by June 30. That is the date when the National Health and Hospitals Reform Commission (a body of experts assigned by Prime Minister Kevin Rudd and Health Minister Nicola Roxon to modernise health care) hands down its final report.

The distinctly harder line on technology-driven improvements comes as the federal government struggles to find between $1 billion and $3 billion to create a national electronic health scheme against a background of shrinking revenues.

It remains unclear which, if any, electronic health measures will be given money in today's budget.

But the government's options include financing some of the project's outlays from the $5 billion Health Infrastructure Fund and the $43 billion national broadband network project.

More here (subscription required):

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20090512000031134287

After the event the AFR went with the headline:

E-Health Scheme in Limbo!

In this article Ben Woodhead points out (Page 26 on Thursday) that there was no good news and that the last hope was that the business case for the National Broadband Network – if such exists – would have to have a substantial e-Health component and that there may be some funds from that source.

So the sole hope we seem to have is the straw in the wind with the ACT planning to make a disproportionately large investment in the area – as discussed last week.

I don’t think that is true. There is one source of hope and that is the National Health and Hospital Reform Commission (NHHRC) will point out the need to seriously fund e-Health as part of the reform agenda and that this will open some funding from the National Health Infrastructure Fund.

Details of that fund are here:

http://aushealthit.blogspot.com/2008/12/health-and-hospitals-fund-announcement.html

As I understand it this fund started with $10Billion and was to be topped up to with another equal amount in the 2008/9 fiscal year. Needless to say with the GFC this is not happening!

Now about $3B was allocated in the present budget from the fund on non e-Health items.

So we now need to wait until the NHHRC final report and see if the response has some serious funding – presumably from this source. If not – forget it – the forces of darkness and ignorance have won!

The real worry is that the NHHRC does not seem, as a group, to understand e-Health very well so we could really wind up with a ‘pig in a poke’ which the Minister chooses to fund – without serious expert advice from the e-Health domain. The horror scenario with more waste etc!

David.

Useful and Interesting Health IT News from the Last Week – 17/05/2009.

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

First we have:

Deficient network at the heart of swine flu response

Karen Dearne | May 12, 2009

THE NetEpi data system and communication networks at the heart of the nation's swine flu response were found deficient during a live trial in NSW last year.

Hunter New England Health tested emergency departments and medical teams across 36 sites in a week-long pandemic training exercise.

While users found NetEpi had been improved since an exercise in 2006, organisers say a new system is needed, "including, but not limited to, a case and contact data collection system".

"We need a system that manages rumour surveillance, influenza-like illness data, population data, geographic mapping, anti-viral usage, adverse events data and staffing capacity to ensure an effective and efficient response," an interim report says.

"Staff found NetEpi difficult to use, data entry was problematic, and analysis and reporting functionalities could not be utilised."

NetEpi is open source web-based software designed to help public health authorities investigate and manage outbreaks of communicable disease as well as other chronic illnesses.

More here:

http://www.australianit.news.com.au/story/0,27574,25464237-15306,00.html

Yet again we find the potential of e-Health not being exploited by the Government. I wonder how long it will be before they ‘get it’.

Second we have:

Who will pay the price for electronic health records?

Rachel Lebihan, ZDNet Australia News

01 November 2000 03:47 PM

Tags: electronic health records, transaction fees, government, funding, australia

The National Electronic Health Record Taskforce estimates that funding in excess of AU$400 million would be required to put an electronic health record (EHR) system in place and to run it over a 10 year period.

Whilst industry sentiment is rife that the government needs to fork out initial funding for the project, it still isn't clear how the network will be financed in the long run.

"Long-term funding is still an open issue at the moment," director of information policy at the Department of Health and Aged Care (DHAC), Paul Fitzgerald, told ZDNet.

However, Philip Hagan, also from DHAC, said a nationwide EHR system "would have to be self-sustained in the long run".

This means that consumers and health providers would incur transaction fees for use of the network.

More here:

http://www.zdnet.com.au/news/soa/Who-will-pay-the-price-for-electronic-health-records-/0,139023165,120106640,00.htm

I could not resist this – found it a day or so ago. NOTE the date in the header! How long have we been at this!

Third we have:

Security logs, medical records and missile data discovered in disused hard drives

Study involving university researchers in the UK, US and Australia, discovers an assortment of private data on ebay

Kathryn Edwards 13 May, 2009 12:15

A third, or 34 per cent, of disused hard drives still contain confidential data according to a new study, which found missile defence system data and media records on ebay purchases.

The study, sponsored by BT and Sims Lifecycle Services, researched by Wales’ University of Glamorgan, America’s Longwood University and Australia’s Edith Cowan University, also dug up secret data from the German Embassy in Paris and business dealings from a US bank.

Around 300 hard drives from the UK, America, Australia and other countries, bought through computer auctions and on eBay were studied.

“It is clear from the sensitive information revealed by this study that a wide range of organisations, businesses and individuals all over the world are fundamentally failing in their duty to properly manage sensitive data when their IT equipment passes outside of their control,” Sims Recycling Solutions Kumar Radhakrishnan said.

More here:

http://www.computerworld.com.au/article/303011/security_logs_medical_records_missile_data_discovered_disused_hard_drives?eid=-6787

There is an important message for all those that hold confidential data on their Hard Disks. That must be many of us!

Fourth we have:

Australia: E-Health & Privacy Update

11 May 2009

Article by Alison Choy Flannigan

E-health and privacy update – including the Law Reform Commission Report and Freedom of Information Reform.

The journey towards individual electronic health records has progressed with the federal HealthConnect initiatives and the publication by the National E-Health Transition Authority Limited (NEHTA) of its 'Privacy Blueprint for the Individual Electronic Health Record' for public comment in July 2008.

The National Health and Hospitals Reform Commission Interim Report published in February 2009 has stated that 'an electronic health record that can be accessed - with the persons agreement, by all health professionals and across all settings is arguably the single most important enabler of truly person-centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia.'

Healthcare providers should keep abreast of the developments in e-health to ensure that they are well placed to adopt the technology upon its introduction.

Proposed changes in privacy laws will also affect healthcare providers who may need to review and update their privacy policies and procedures when they commence.

Full article here (free registration required):

http://www.mondaq.com/article.asp?articleid=79396&login=true

This is a useful summary of the current state of play in the area from DLA Phillips Fox – a major national law firm.

Fifth we have:

GPs face Medical Director fee hike after ad removal

Elizabeth McIntosh - Friday, 8 May 2009

GPs relying on Medical Director for their prescribing software will face annual subscription fee hikes of at least 50%, as the company moves to recoup the costs of pulling pharmaceutical company advertising from its product.

And, in a move likely to disappoint part-time GPs, Health Communication Network (HCN) – which produces the software – has also announced it will no longer offer a discounted rate to part-timers, opting instead for a flat rate.

HCN CEO John Frost attributed the price increase to intense lobbying for an advertising withdrawal by the RACGP, AMA and the National Prescribing Service.

More here:

http://www.medicalobserver.com.au/News/0,1734,4507,08200905.aspx

While it is hard to know it seems HCN might just be padding its margins a little given its competitors have been able to be competitive even with HCN having the extra income. Alternatively I guess it is possible there was very little revenue involved which would have one wonder why it took so long for this to happen. We probably will never know.

Sixth we have:

Online therapy the latest tool to beat the blues

• Tim Lott
• May 17, 2009

Most people with depression need some kind of therapy, but could a computer program replace a counsellor? Tim Lott logged in to find out.

ALTHOUGH I am not depressed — I am merely someone who has experienced a depressing amount of depression — I have just completed eight weekly sessions of a cognitive behavioural therapy course

Big deal, you might well remark. But this course is unusual because I didn't have to leave my desk or even talk to another human being. The therapy is administered entirely by a computer program. Beating the Blues is an attempt by Britain's national health service to meet the growing demand for mental health treatment without spending a fortune on face-to-face therapy.

My instincts were against it; I was insulted by the idea that my difficulties could be solved online. So I logged on to my first session with some trepidation. I was introduced by a honey-voiced computer to five other "co-sufferers" — Andrew, Elaine, Jean, Bob and Heather — who were going to share my journey.

They were played by quite convincing actors, although their characters all seemed a bit feeble. I unkindly branded them as — to use a non-clinical term — "losers". They couldn't get a grip on their lives, they blamed themselves for everything, they couldn't take on goals, and they thought they were failures.

More here:

http://www.theage.com.au/opinion/online-therapy-the-latest-tool-to-beat-the-blues-20090516-b6r7.html

This is a useful article to explain the online counselling process. A pity the article did not explore the evidence base that shows this approach really works!

Seventh we have:

Threading to boost Firefox on multi-core chips

Turns up in the nick of time

John E. Dunn (Techworld) 11 May, 2009 08:31

Mozilla's developers have announced plans to add application multi-threading to Firefox over the next two years, a feature already partially enabled in its main rivals, IE8 and Google Chrome.

As well as allowing the software to take advantage of multi-core microprocessors to boost responsiveness, the enhancement would also improve browser stability, the company said in a news blog on the subject.

More here:

http://www.computerworld.com.au/article/302625/threading_boost_firefox_multi-core_chips?eid=-255

This is very good news for all the Firefox Users out there!

Eighth we have:

Conroy rejects NBN cost analysis

Coalition comms minister furious

Darren Pauli 12 May, 2009 17:04

Communications Minister Stephen Conroy has rejected the need for a cost benefit analysis for the National Broadband Network (NBN).

He said during question time the country is "crying out" for the NBN infrastructure and that additional studies are unnecessary.

“We don’t need any more studies, any more cost benefit analysis,” Conroy said.

More here:

http://www.computerworld.com.au/article/302872/conroy_rejects_nbn_cost_analysis?eid=-255

While I am pretty sure that the NBN will have benefits I would really like to understand the costs. Seems that for a project of the scale of $43Billion it would be a worthwhile thing to be doing. I note Lindsay Tanner said a day or so ago that $43B is the upper end cost.

See here:

http://www.businessspectator.com.au/bs.nsf/Article/KGB-INTERROGATION-Lindsay-Tanner-pd20090514-S29ZU?OpenDocument&src=sph

SB is Business Spectator Commentator Stephen Bartholomeusz

LT is Finance Minister Lindsay Tanner.

“SB: Lindsay, you referred to the national broadband network a moment ago. That’s the one big chunk of the $22 billion of infrastructure spending in the budget which didn’t go through the Infrastructure Australia process and which doesn’t appear to have had a business case developed for it. Are you comfortable about the economics of a $43 billion network? I mean you’re the Finance Minister. You’re comfortable with the detail?

LT: Yes. Well, it is my job to be comfortable I suppose about these things. Look, the first point, Steve, is that $43 billion is the outer limit of the estimate and it’s got a pretty sizeable chunk of contingency built into it, because obviously projecting forward eight years into a project of that scale; it’s very difficult to come up with specific estimates about what labour costs might be in eight years time or whatever and there’s a vast array of detail underneath the whole proposition and of course that’s the reason why we’ve put in place an implementation study, so that a lot of those things can be fleshed out.

The big variable of course is Telstra’s approach and whether it decides to seek to negotiate an accommodation with the government, so that it’s in the tent or whether it decides to go it alone and oppose what the government’s doing and fight it in the market place. So, there are lots of variables, but we just formed the view that in effect we had to make the clear decision that said this is the outcome we are going to achieve come hell or high water, because it is of fundamental importance to the future of the Australian economy, it is qualitatively different from a new freeway or a rail upgrade or something which are fairly straightforward to compare with other potential applications of capital of a similar nature to a different rail project or a different road project.

It is a standalone thing that will transform the Australian economy, so yes there are risks and there are uncertainties. The question of the nature of private sector involvement of course is not absolutely certain and the implementation study will bring to light detailed issues that we will have to give consideration to, but to me it broadly is equivalent to something like electrification and it’s broadly equivalent to saying well, are we going to have a society where access to electricity for businesses and households is near universal or not? It’s of that magnitude.

SB: Does that mean that the actual economics of the network, particularly in that formative period, are less important than just building it?

LT: Oh look, they are crucial – ultimately you’ve got to have people paying for things, you’ve got to have a cash flow that’s got to be commercial, but so it’s not less important. It’s just that we felt that there’s been so much delay, so much obfuscation, so much money wasted on rubbish programs trying to make people think the government was doing something about it – I’m referring to the previous government of course – and there is so much structural regulatory inefficiency in the industry that we believe that you will see a dramatic transformation. I just think that for any telco, Telstra or anybody else and anybody who’s at all connected with the digital world, the opportunities that this is going to create will be enormous.

I saw a health expert claim the other day that the network once up and running would reduce the need for hospital beds in Australia by 25 per cent. Now, I’ve got no way of assessing the accuracy of that, but what I immediately thought of was well, if that’s true, that means that 25 per cent of hospital activities or activities associated with hospitalisation are now going to be delivered in some form, in some application by people online. That’s a whole lot of activity that currently doesn’t exist, that currently doesn’t happen, that currently doesn’t have businesses and people doing things that will be now occurring online and if you’re Telstra or if you’re Optus or any of these other telcos, that represents huge opportunities for you to innovate to create new applications, new business models, all kinds of things. In the same way that the emergence of the mobile phone, you know, and the Internet have created those opportunities and we’ve seen those flourish, so I believe this is just a unique situation that it’s only comparative that I can think of is the roll-out of electricity starting in effect in the 1920s.”

I would be curious to know what the cheapest estimated cost was! The whole article is well worth a read on a range of budget topics. It is interesting the scale of impact on the health system the Government seems to be hoping for! Has someone told the Health Minister I wonder?

More commentary is found here:

http://www.computerworld.com.au/article/302790/nbn_challenges_lay_ahead_report?eid=-255

NBN challenges lay ahead: report

Challenges include difficulty of achieving a return on investment, pricing

Kathryn Edwards 12 May, 2009 05:11

Lastly the slightly more technically orientated article for the week:

Secure your USB drives with BitLocker To Go for Windows 7

• Date: May 13th, 2009
• Author: Greg Shultz
• Category: Performance, Security, Windows 7
• Tags: Password, Microsoft Windows 7, Microsoft Windows, USB Flash Drive, BitLocker, Greg Shultz
• Special Reports » See more posts on: Windows 7, Vista Report

When Microsoft introduced Windows Vista, one of the big security features in that operating system was BitLocker, a hard drive encryption scheme designed to protect sensitive data from being accessed on lost or stolen computers — mainly laptops.

With the huge increase in the use of very small, large capacity, USB drives, the potential for sensitive data to be lost or stolen has really become more of a problem because it is much easier to lose or steal a device no bigger than a package of Wrigley chewing gum. To protect sensitive data stored on USB drives, Microsoft Windows 7 features the encryptions scheme called BitLocker To Go.

In this edition of the Windows Vista and Windows 7 Report, I’ll introduce you to BitLocker To Go and show you how it works on a 1GB USB thumb drive.

This blog post is also available in the PDF format as a free TechRepublic Download and as a TechRepublic Photo Gallery.

How it works

Basically, BitLocker To Go allows you to encrypt a USB drive and restrict access with a password. Without the password, the USB drive is worthless. When you connect the USB drive to a Windows 7 computer, you are prompted for the password and upon entering it, can read and write to the drive as you normally would.

During the encryption process, Windows 7 installs a special reader onto the USB drive. When you connect the USB drive to a computer running XP or Vista, the BitLocker To Go reader takes control, prompts for the password, and then basically makes the USB drive a read-only device.

BitLocker To Go can be used by both home and business users. In a Domain system, IT administrators can configure a policy that requires users to apply BitLocker protection to removable drives before being able to write to them. Furthermore, the policy can specify password length as well as complexity.

Much more here:

http://blogs.techrepublic.com.com/window-on-windows/?p=1176

This looks like a useful addition to Window 7 to ensure data on USB keys can be properly protected when necessary. The article explains how to use it and it looks very user friendly and straightforward.

Here we see how important this feature is:

Govt agencies losing portable data: Privacy Commissioner

New research red flags portable storage, guide released

Rodney Gedda 08/05/2009 08:51:00

Tags: privacy commissioner, privacy, federal government, data loss

Many Australian government agencies do not have appropriate controls covering the use of portable storage devices (PSDs) for the handling of personal information.According to new research by the Office of the Privacy Commissioner, this personal information is being lost at an alarming rate.

While agencies have policies regarding the transfer of personal information, more care needs to me taken to protect data on USB keys, PDAs and optical disks. More than (58 per cent) of agencies have experienced the loss or theft of an agency-issued PSD within the past 12 months.

Australian Privacy Commissioner Karen Curtis said three-quarters of government agencies have policies covering the transfer of records containing personal information, however, there is “definitely room for agencies to improve their safeguards governing the use by staff of portable storage devices”.

More here:

http://www.techworld.com.au/article/302500/govt_agencies_losing_portable_data_privacy_commissioner

More next week.

David.

Report Watch – Week of 11 May, 2009

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

First we have:

Study on the requirements and options for RFID application in healthcare

Identifying areas for Radio Frequency Identification deployment in health care delivery: A review of relevant literature

By: Anna-Marie Vilamovska, Evi Hatziandreu, Helen Rebecca Schindler, Constantijn van Oranje-Nassau, Han de Vries, Joachim Krapels

This document is the first deliverable of the RFID & Health project. It provides an overview of the state of the art in RFID (Radio Frequency Identification) applications in healthcare delivery.

Some 325 sources have been reviewed in order to draft three ‘long-lists’ of applications, enablers and barriers of RFID deployment. In the next phase of the project, these will be validated and prioritised through expert interviews and a Delphi survey. Case studies will be used to further assess the costs and benefits of the most promising applications.

The list of sources which have been reviewed for this report is believed to cover all important scientific publications, policy documents and relevant articles from the professional press, in Europe, North America and Asia, related to the topic of RFID applications in healthcare. In addition, more general literature on RFID — technology, market, enablers and barriers — has also been covered.

More here (including direct report download links)

http://www.rand.org/pubs/technical_reports/TR608/

Second we have:

Technologies C-Level Should See

May 5, 2009

Health care best practices research firm ECRI Institute has listed 10 technologies it says hospital C-suite executives should be watching.

A new report from the Plymouth Meeting, Pa.-based firm explains each technology and why it bears a close look. The technologies are:

* electronic medical records,

* ultrahigh-field strength MRI and premium-slice CT,

More here:

http://www.healthdatamanagement.com/news/executives-28159-1.html?ET=healthdatamanagement:e861:100325a:&st=email&channel=business_intelligence

For the report, "Top 10 Hospital Technology Issues: C-Suite Watch List for 2009 and Beyond," click here. The report is free but registration is required.

Additional information is also here:

http://www.healthcareitnews.com/news/research-firm-lists-top-technologies-impacting-hospital-c-suite-executives

Research firm lists top technologies impacting hospital c-suite executives

May 05, 2009 | Molly Merrill, Associate Editor

It is good to see EHRs at the top of the list.

Third we have:

Project HealthDesign Overview

Project HealthDesign is a $10-million national program of the Robert Wood Johnson Foundation (RWJF) created to stimulate innovation in personal health information technology. During the first round of funding, which received additional support from the California HealthCare Foundation, nine multidisciplinary teams created a range of tools that addressed specific but complex self-management tasks – from a cell-phone-enabled medication management system to alert children with cystic fibrosis when to take certain medicines, to a personal digital assistant that collects and supports self-reported pain and activity data. For information about the first-round grantee projects, see http://www.projecthealthdesign.org/projects.

In the second round of Project HealthDesign, RWJF will award a total of up to $2.4 million in grants to as many as five grantee teams. Teams will work to demonstrate how to improve the health and wellbeing of people with chronic disease by helping them capture, understand, interpret and act on information about the patterns of their everyday lives. During the two-year initiative, teams will work with clinical partners and patients with two or more chronic conditions to:

§ Identify, capture and store several types of ODLs for their target patient population;

§ Analyze and interpret ODL data to extract clinically useful information;

§ Use this information to provide feedback to patients so that they can better manage their conditions and improve their health;

§ Enable patients to share this information with their doctors, nurses and other members of their clinical care team;

§ Present the information to clinicians in ways they can easily integrate into their clinical work flow; and

§ Identify and explain opportunities and challenges associated with this overall approach to policymakers and clinical leaders

The program is supported by the Foundation’s Pioneer Portfolio, which funds innovative projects that can lead to fundamental breakthroughs in the health and health care of all Americans.

More here:

http://www.projecthealthdesign.org/about/overview

Not so much a report but an initiative to help understand where and how PHRs can really make a difference. Very important work before one just rushes in to implement in my view.

Fourth we have:

Health Spending Is Taking Up Bigger Chunk of National Purse

Cheryl Clark, for HealthLeaders Media, May 4, 2009

Though the rise in healthcare spending has slowed, it's taking up a much bigger space in the nation's budget, says a new report from the California Healthcare Foundation.

The report showed that national healthcare spending reached $2.2 trillion, or $7,421 per person, in 2007 representing more than 16% of the gross domestic product. Continuing at the same pace, it will reach 20.3% of the country's gross domestic product by 2018.

"Although there has been some moderation in health spending growth in recent years, its share of the economy continues to grow," the report says.

"This report shows the very trend that's behind a lot of the financial woes of the healthcare industry," said CHF senior program officer Marian Mulkey. "The fact that we are spending more and more on healthcare services translates into higher premiums, and makes it harder for businesses and employees to afford coverage. This documents the problem that is at the heart of the debate about health reform."

Mulkey said that the report, the sixth one in a series of annual reports, called Health Care Costs 101, is based on data from the Centers for Medicare and Medicaid Services.

More here:

http://healthplans.hcpro.com/content.cfm?content_id=232423&topic=WS_HLM2_HEP

The figures are really just staggering.

The report and a few back for 5 years are found here:

http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133630

Fifth we have:

Thursday, May 07, 2009

Health Information Management Profession Needs To Double in Size

by Linda Kloss

It is apparent to a growing number of concerned health care professionals that the transition from paper to electronic health records is central to health care reform, just as resolving the health information work force gap is vital to broad EHR implementation and optimization. Unfortunately, too often the understanding ends there.

The problem is this lack of understanding could very likely create confusion -- or worse, disinterest or unawareness -- among the very people health care needs to recruit in order to close the health information management (HIM) work force gap in time to accelerate the national implementation of an EHR system. If we are to reach the goal of an EHR for every American by 2014, we will most likely need to double the estimated 75,000 educated and credentialed HIM specialists engaged in managing health information and health records management today.

Ours is a field in a period of dynamic change as health care shifts from paper to EHRs. HIM professionals work across all types of care settings, including:

• Hospital and integrated delivery systems (about 60%);
• Medical groups and other ambulatory facilities (12%); and
• Long-term care and specialty care (5%).

The remainder work for IT vendors and consulting services, pharmacological manufacturers, insurers, colleges and universities, and public health and other governmental agencies.

More here with links to background information:

http://www.ihealthbeat.org/Perspectives/2009/Health-Information-Management-Profession-Needs-To-Double-in-Size.aspx

Last we have:

Proper incentives key to P4P success: study

By Rebecca Vesely

Posted: May 7, 2009 - 12:00 pm EDT

Pay-for-performance can be effective if physicians get the right incentives, according to a study by Bridges to Excellence published in the American Journal of Managed Care.

The report used statistical data from Bridges to Excellence pay-for-performance programs with more than 13,500 participating physicians in four cities: Albany, N.Y.; Boston; Cincinnati; and Louisville, Ky. The two programs focused on improving patient care while reducing medical errors in medical practices, and improving care for diabetes patients.

Physician participation rose as the potential rewards increased, but there was no “cutoff” pinpointing the exact reward driving participation. Sufficient rewards for one type of program may not be sufficient for another type of program. The more health plans offering pay-for-performance, the better the physician participation, the study concluded.

Vastly more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090507/REG/305079966

Link to article is in text.

So much to read – so little time – have fun!

David.