NEHTA E-Health ID - Looking Like a Big Mess So Far.

NEHTA, with very considerable public funding, has now been developing the UHI service for almost 3 years, having initially been funded to undertake the work in around August 2006.

The following very interesting and carefully researched article appeared yesterday.

Medicare the base for e-health IDs

Karen Dearne | June 23, 2009

PATIENTS' medical records will be linked across health providers using the present Medicare number and card, under the $98 million Unique Healthcare Identifier (UHI) program being developed by the National E-Health Transition Authority.

Few details of the planned UHI service have been revealed to date, despite the January 2010 deadline for completion of the project's design and build. The work has been directed by the Australian Health Ministers' Council (AHMC) and funded by the Council of Australian Governments

Although healthcare providers - doctors, pharmacists, community clinics and hospital administrators, in both the public and private arenas - will be issued with highly secure smartcards using PKI-based identity verification, consumers' individual healthcare numbers (IHIs) will be accessed by linking through the old Medicare number.

The stronger credentials for medical professionals will be managed through the planned National Authentication Service for Health (NASH), an extension of Medicare's existing arrangements to securely identify doctors accessing the agency's systems for claiming or payment transactions.

Individual healthcare identifiers have been touted as a key building block in the nationwide shift to e-health systems, with the free-flowing exchange of people's health records set to revolutionise patient care through improved safety and quality outcomes, together with greater efficiencies, cost savings and a wealth of new opportunities through telemedicine, remote monitoring of chronic disease and public health surveillance.

Eventually, the plan is for each person to have an individual e-health record, which holds their personal details; a summary health profile that can be shared with the person's permission between treating doctors; event summaries such as hospital discharge reports, care plans and test results, and a self-care management record where people can add their own material.

But consumer and privacy groups may be disappointed by the barebones approach outlined to The Australian, in response to questions put to NEHTA, Medicare Australia - which is creating the UHI system under contract to NEHTA - and federal Health Minister Nicola Roxon.

It appears Ms Roxon has been mistaken in her recent comments that patients will access their health records through a smartcard.

Instead, doctors or staff members will have to call up a person's shared record via the Medicare number, together with the existing, additional family member number.

"The IHI is simply an identifier that will facilitate the secure transmission of health information," a NEHTA spokeswoman said. "The IHI will predominantly be retrieved using an individual's Medicare number as opposed to a 'look-up' system, but separate security and authentication processes will be put in place regarding the actual use of the IHI in relation to health records.

"If an individual does not have a Medicare card, their healthcare provider will be able to use demographic information to obtain an IHI from the service. A patient will normally be asked to provide only his or her name and date of birth."

This approach assumes Medicare's well-publicised difficulties with data quality - mailing out replacement cards to deceased persons, duplications and other errors, and fake cards circulating in the black market - have been fixed.

Another issue involves ensuring the proper separation of data in the new registration and record databases from Medicare's financial transactions and business operations.

Read much more detail here:

http://www.australianit.news.com.au/story/0,24897,25679209-15306,00.html

The way this whole project is being run reveals frankly an astonishing level of arrogance and failure of technical and public consultation.

NEHTA apparently believes Privacy Impact Assessments should be kept from the public. This is clearly an absurdity and deserves condemnation.

NEHTA has not even got to the stage of even the draftest of legislation which they admit will be needed. With the present government turmoil and hostile Senate what chance of legislation, which seems to be likely to be privacy invasive, getting through in other than geological time?

NEHTA apparently plans to have an operational service available at the beginning of 2010. What seems to be missing are the technical specifications that people who will use the service will need to develop to in order to use the service once it is operational. We have lots of business specifications but not much in the way of technical specifications.

See here for the presently available documents.

http://www.nehta.gov.au/connecting-australia/e-health-id

(Note in passing how most documents are nearly 2 years old!)

I wonder does NEHTA have a plan to pay software developers to interface with their service or is that another unexpected cost they plan to impose.

On the basis of what we all know about the data integrity of Medicare Identifiers who would trust this to be used to assemble and manage a clinical record. I certainly would not. The Medicare ID databases are just not ‘fit for purpose’ in this context (creating an aggregate trustworthy EHR). What is going on here is that we will very possibly wind up with a less than satisfactorily robust individual identifier and over time it will fall into disuse as it causes more misidentification and problems than it is worth.

I am sure additionally NEHTA has vastly underestimated the complexity and cost of issuance, maintenance and deletion of certificates and tokens to 500,000 health professionals. Frankly that is a huge task which is not done properly will also cause more problems than it is worth.

I also wonder who is going to pay to operate this service in the longer term and at what stage will the users be charged a fee for use to recover ‘costs’.

NEHTA needs to get the PIAs, Technical Specs and Draft Legislation out pronto so their plans can be reviewed and assessed publicly to prevent any continuing waste of money and effort. Sneaking around fobbing people off with vague details and timelines is really not good enough.

We need identifiers I believe to make patient records work optimally – but not developed in secret like this.

David.

Review of State Health IT Budgets – A Mixed Bag to Say the Least.

We have now seen pretty much all the State Budgets that matter.

First we have NSW.

NSW Health gets $63m IT injection

Karen Dearne | June 16, 2009

NSW Health Minister John Della Bosca has committed more than $603 million to building better health infrastructure this year, with around 10 per cent going to IT projects.

The IT funding falls far short of the $700 million urgently needed to upgrade IT systems across the state's public hospitals before July 2011, as ordered by Special Commissioner Peter Garling in his searing review of the acute care sector.

Mr Della Bosca said the delivery of major IT initiatives to enhance patient services was "also a Government priority over the next four years".

For the moment, however, he allocated $63.1 million in 2009-10 "to upgrade business information technology, including medical imaging and clinical systems across the state".

"The Government is boosting health funding right across NSW to ensure local communities continue to have access to high quality services closer to home now and into the future," he said.

Most of the $603 million will be spent on rebuilding hospitals and regional health centres.

A further $485 million has been allocated to "Caring Together" initiatives, previously announced in March, when the NSW Government made its formal response to the Garling Report.

Rather than spending money on new IT systems to reduce the administrative and planning burden on frontline doctors and nurses, the Government plans to employ 500 clinical support officers, at a cost of $44 million per year, to take over the paperwork.

It will also employ 64 new clinical pharmacists, at a cost of $8.6 million, to improve patient safety by monitoring the use of medications.

More here:

http://www.australianit.news.com.au/story/0,24897,25646141-15306,00.html

This seems to me to be a relatively poor effort from the Health IT perspective. The deployment of more staff rather than enabling technologies shows how little the present NSW government understands about making the system sustainable in the longer term.

The papers refer to “the introduction of state of the art information systems such as the First Net Emergency Department software program” in 2008/09 so this can only be a good thing. (Page 13-6).

Sadly as mentioned in the article the “Caring Together” programme does not seem to really have the Health IT Mr Garling was suggesting.

We also see the following as the only e-Health nominated funding:

E-Health

“As part of its continued commitment to e-Health, the Government will invest $35.7 million over the next three years to continue its support of the National E-Health Transition Authority. This investment will commence with the allocation of $9.4 million in 2009-10.” (Page 13-12)

Oddly there is also this which is not tagged as e-Health (Capital):

“commencement of new Information and Communication Technology programs including the implementation of a new Community Health and Outpatients Information System, the upgrade of infrastructure, and further development of the department’s corporate information systems. These projects will enhance clinical and corporate information management and deliver improved service” (Page 13-15)

All sounds a bit like a refresh rather than new capital!

What I can’t find is what the recurrent expenditure for Health IT is. I suspect that is buried in the Shared Services Area to maximise how opaque it is. Anyone who can provide the figures I would be grateful for a comment!

Next report we have was here:

Health IT gets mixed funding in state budgets

Karen Dearne | June 17, 2009

QUEENSLAND has dug deep to add $270 million to its Health IT spending in this year's budget, while South Australia has performed a surprise U-turn, ripping $42 million from its planned e-health infrastructure program over the next four years.

In the SA Budget, only $8.3 million has been committed to new health ICT projects in 2009-10, down from $12 million in 2008-09, although a further $8 million has been allocated to continue work on a new clinical nursing and midwifery system.

"Savings initiatives" have rubbed out planned expenditure of $9.2 million next year, and $10.9 million, $11.3 million and $10.6 million in the years to 2012-13.

SA Health portfolio details show the foundation IT program has been stripped to just $890,000 next year, from $7 million this year.

No money has been allocated for "minor" technology projects, compared with $890,000 last year; there is also no money for a SA ambulance IT project, compared with $410,000 last year.

Lots more here:

http://www.australianit.news.com.au/story/0,25197,25650119-15306,00.html

I have already commented on South Australia. See here:

http://aushealthit.blogspot.com/2009/06/south-australia-works-hard-to-be.html

The ACT Budget was pretty early and is covered here:

http://aushealthit.blogspot.com/2009/05/aus-health-it-gets-some-facts-wrong-on.html

So we can push on to Queensland.

The key capital parts are here (Budget Paper 3 – Page 83) :

“In 2009-10, $84.5 million will fund provision of health technology equipment that supports the efficient delivery of safe, quality health services.”

And here

“A total of $87.1 million will be invested in 2009-10 in projects across e-Health Clinical Systems and other health systems. These are a series of interlinked projects that will contribute to the objectives of the e-Health strategy in delivering an electronic medical record to support a patient-centric, networked model of care to ensure location-independent delivery of health services. Key highlights of this investment include:

- ongoing statewide rollout of a new Radiology Information System enabling a significant reduction in the time taken for radiologists to view, assess and diagnose medical problems;

- implementation of digital technology for breast screening that will enable faster communication of the results to patients and the potential for improved detection of breast cancer;

- ongoing implementation of an Enterprise Discharge Summary to provide a more accurate care record to consumers and improve communication to General Practitioners; and

- Information and Communication Technology projects to enable secured system access, integration of existing systems and manage reference datasets.

$86.2 million for information and communication technology equipment to replace, upgrade and provide future capacity/capability to support the e-Health strategy and clinical information solutions. This investment incorporates telephone system replacements, network and server upgrades.”

This is all encouraging but again there is a theme of refresh of systems rather than newer ones – allowing that there are a few new ones – The RIS for example.

At least, other than the RIS, most of the planned expenditure is for ongoing programs previously announced. In total there seems to be about $55M for ongoing actual clinical e-Health expenditure. (Page 87)

This level of investment, given the false starts in the past, is really not all that impressive.

For Victoria we had a rather disappointing e-Health outcome.

This was even noticed by the AMA.

AMA Victoria underwhelmed by Budget

5 May 2009.

AMA Victoria has labelled the Victorian Budget “underwhelming”, saying it misses an opportunity for real action.

....

AMA Victoria was particularly disappointed that the Budget fails again to invest in information technology. HealthSMART has been very disappointing, and doctors are still lacking the basic IT tools needed to provide best possible care to patients.

“What’s missing from this Budget is a plan for health. There is no vision of how to care for a growing state’s health needs now and into the future. We need to invest more in training, in capacity, in IT and the drivers of reform.”

.....

“This Budget will see the Victorian health system continue to limp along rather than make great strides in caring for our sick.”

Full commentary here:

http://www.amavic.com.au/page/Media/News/AMA_Victoria_underwhelmed_by_Budget/

I must say the word ‘HealthSMART’ does not seem to appear in the budget papers at all – which I find very odd indeed! Seems like there is a plan to have it just ‘fade away’!

We do however find this:

The 2009-10 Budget also provides:

• $27 million over three years for Victoria's contribution to the National E-health Transition Authority to enable it to continue its existing work program (Paper 3 – Page 27)

(7.1M, 9.1M and 10.1M over the next 3 years) Page 315

On Page 323 we find.

National E-Health Transition Authority’s Core Operations

Funding is provided to support Victoria’s contribution to the National E-Health Transition Authority (NEHTA) for foundation work agreed to by the Council of Australian Governments. Funding will support identifier and authentication services to allow the development of a National Individual Electronic Health Record (IEHR) system.

This initiative contributes to the Department of Human Services’ Acute Health Services outputs.

This compares with this from 2007/08

“The hospital sector is an information intense sector increasingly dependent on reliable and up-to-date Information and Communications Technology (ICT) to support delivery of high quality, efficient and patient focused care. The government is investing $77 million over four years and $27 million TEI for new and upgraded ICT equipment to support the HealthSMART system.”

There appears to be about $26M pa for 4 years here but odd it is not mentioned this year.

Now we also have to move on to Western Australia and their eHealthWA programme:

Health Information

“• In 2006, WA Health commenced a 10 year program to implement eHealthWA, a major reform initiative designed to provide a modern, integrated platform to facilitate the delivery of world-class health services. The program aligns with the national eHealth program which aims to provide a national approach and framework for the delivery of information and the way it is used to deliver health services across Australia. In 2009-10, work will be progressed on the implementation of the pharmacy module, the planning and early implementation of a replacement Patient Administration System, and hardware and software technology to support eHealth.

• Currently, health information in Western Australia consists of many discrete ‘islands of Information’. eHealthWA will allow health information to flow regardless of where you interact with the system. It will provide access to information and clinical evidence at the point of care to support effective decision-making. That is, having the right information available to the right person at the right time in the right place. It will also allow information to be collected and analysed to guide management, funding and policy decision-making. Consumers, care providers and health care managers will all benefit from the introduction of eHealthWA.”

What is a bit of a worry is that this section does not mention any figures!

There is also some funds to keep NEHTA going.

It seems last year’s budget had some specific funds:

“This is 4yrs too late, and perhaps longer for many Western Australians. Why not ask the Minister and the IT Executive why the eHealthWA Program penned for 600m over 10yrs some 4 years ago has only just been kicked off? and at that with no more than 5% of the original allocation! This program addresses systems that are some 20yrs old, multiple point systems across hospitals with no way of seeing a holistic summary of service utilisation, no shared health records, no single patient ID, no effective medication management cycle management, a die'ing PC fleet, multiple information portals, some of the worst IT management practices in Australia, the list goes on. Health is very much Information Centric, beds are critical, emergency department spend is important, but we are some 10 to 15yrs behind any modern Hospital environment from an ICT perspective, and this is a significant contributor to enhance health delivery across the state.

Posted by: Bobby of Perth 7:55pm December 29, 2008”

http://www.news.com.au/perthnow/comments/0,21590,24852391-948,00.html

There is a recent presentation from the CIO here:

http://www.aiia.com.au/docs/states/wa/Richard%20McFadden%20Presentation.pdf

Sadly no dollars mentioned!

The whole things gets very high points for vagueness in my view.

Second last we have Tasmania.

From the health budget commentary we find:

“$12.9M over the next three years – including $5.3M in 2009-10 – for information technology advancements to support reform of service delivery. Funded projects include new patient/client administration systems for hospitals and mental health services.”

See here:

http://www.budget.tas.gov.au/ministers-on-the-budget/lara-giddings

This is the detail.

Health Information Technology

Funding of $18.5 million has been allocated over four years from the Infrastructure Tasmania Fund to support the development of integrated health information systems and related infrastructure in the Department to enable and support reform in health service delivery. Funding of $5.5 million is allocated in 2009-10 for the implementation of information technology projects including: a patient administration system ($1.5 million); messaging and identifier systems ($500 000); Mental Health Services Electronic Client Management and Reporting System ($750 000); LAN and Infrastructure Upgrade ($1.0 million); Enterprise Storage Solution ($500 000); Child Protection Information Systems Phase Two ($200 000); and Medical Imaging Project ($1.0 million).

Better than nothing I guess and at least some detail provided.

Interestingly no special mention of NEHTA I could spot.

Last we have the Northern Territory.

Here we find and under the Health and Families Department Budget Highlights.

-> Additional funding of $2 million for continued implementation of eHealthNT initiatives.

Not much really given the budget for the Department was just over $1 Billion.

All in all not a great set of figures for e-Health. Sadly it is virtually impossible to understand what level of recurrent investment is being made. This really would be useful for Governments to provide.

Maybe when we actually start to implement a national E-Health Strategy we can get proper information and co-ordination.

David.

Ever Wonder What Happened to the Founding CEO of NEHTA?

The following arrived in my inbox today to clear up any uncertainty.

From today’s Slattery’s Watch we have the following:

Government 2.0 Taskforce announced

Lindsay Tanner, Minister for Finance and Deregulation has formed a Government 2.0 Taskforce to be chaired by Dr Nicholas Gruen. Other members of the fifteen member taskforce include: Ann Steward, Alan Noble, Martin Hoffman, Mia Garlick, Ian Reinecke, Prof Brian Fitzgerald, Lisa Harvey and Pip Marlow.

The work of the Taskforce is divided into promoting transparency and encouraging engagement. The Taskforce will be able to fund initiatives and incentives through a Project Fund of $2.45 million to support the development of Web 2.0 tools and applications that either enable engagement between government and the community or support the innovative use of government information.

The Taskforce will also identify policies and frameworks to assist the Information Commissioner and other agencies in - developing and managing a whole of government information publication scheme to encourage greater disclosure of public sector information; extending opportunities for the reuse of government information and encouraging effective online innovation, consultation and engagement by government.

The full newsletter can be viewed here:

http://www.rippledirect.com.au/Virtemail.cfm?H=2482b14xn83

The taskforce has a web site with video introduction here:

http://gov2.net.au/

There is more coverage here:

Govt unleashes web 2.0 taskforce

Suzanne Tindal, ZDNet.com.au

22 June 2009 02:33 PM

Tags: government, web 2.0, tanner, gruen, taskforce, steward, noble

The Federal Government today launched a taskforce to investigate web 2.0's ability to make government more transparent and increase community engagement.

A video introduction to the taskforce (Credit: Federal Govt)

The taskforce will table a report at the end of this year on how government information can become more accessible and usable, how the government can make use of the views, resources and knowledge of the public, and how to promote collaboration across agencies. After the report the taskforce will disband.

Comments on the taskforce abounded this morning in Twitter under the tag #publicsphere from people participating in Senator Kate Lundy's Public Sphere open government event in Canberra. Many tweets were supportive, pointing out sites where web 2.0 has worked which the government could examine, while others were concerned about the taskforce's commitment to open standards and innovation given Microsoft's involvement.

The taskforce will be chaired by Dr Nicholas Gruen, CEO of Lateral Economics. It also features some prominent members including Australian Government CIO Ann Steward as deputy chair, Google Australia engineering director Alan Noble, Department of Education, Employment and Workplace Relations CIO Glenn Archer, assistant secretary for the Department of Broadband, Communications and the Digital Economy Mia Garlick, Microsoft public sector director Pip Marlow and former NEHTA CEO Dr Ian Reinecke.

Much more here:

http://www.zdnet.com.au/news/software/soa/Govt-unleashes-web-2-0-taskforce/0,130061733,339297051,00.htm

All I can say is that it is good Dr Reinecke’s expertise in “promoting transparency and encouraging engagement” is to be fully utilised!

David.

Useful and Interesting Health IT News from the Last Week – 21/06/2009.

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

First we have:

Good medicine

By Elinore Martel

June 17, 2009

Internet pharmacies offer some savings and convenience, but consumers need to be aware of the limitations.

Melbourne mother Nicki Azzopardi used to save a bundle by buying her contraceptive pills online.

But when it was time to have a family and she took maternity leave, she kept on shopping at an online pharmacy.

"When I went on maternity leave, it was very useful," she says. "Particularly in those early months, to have all my formula and nappies arrive on the front doorstep. Not having to go anywhere was priceless."

It helped that her purchases were cheaper, too. Now, she says, most of her mothers' group shop online with Pharmacy Direct. "If you do those bulk orders, you get free postage, plus the convenience of having it delivered to your front door," she says.

More Australians may be looking to online pharmacies for savings, following warnings that price rises and the economic crisis are making people less likely to take their medicine.

But are there savings to be made by shopping online?

And what other options are there to save money on pharmaceuticals?

A spokeswoman for Choice, Elise Davidson, says shoppers with a Pharmaceutical Benefits Scheme (PBS) prescription pay the same for the drug regardless of where it is bought.

The best way to save money is to buy generic drugs, she says. These are copies of branded drugs, which may differ in colour or size because of the filler or other ingredients but must contain the same active ingredient as the original.

A reason many can save money by shopping online is because it's easier to make price comparisons and find the cheapest supplier, Davidson says.

Lots more here:

http://www.smh.com.au/news/business/money/planning/good-medicine/2009/06/15/1244917984497.html?sssdmh=dm16.382497

This is an interesting article. It is hard to see why people with chronic diseases should not be able to shop around for the cheapest supply of genuine Australian sourced medications (under no circumstances should anything be sourced from overseas). The obstruction from community pharmacy and the Guild in trying to block consumer access to such services is really ridiculous.

Second we have:

Survey: Elderly, poor narrow broadband service gap

PETER SVENSSON

June 18, 2009 - 6:50AM

Some groups that have lagged in signing up for high-speed Internet service, like the elderly, the poor and rural residents, have started to gain on those who have had a head start, according to a new survey.

Those conclusions come as the government is set to decide how to spend $7.2 billion in stimulus money on expanding the availability of broadband.

Broadband usage among those 65 or older grew from 19 percent in May 2008 to 30 percent this April, the Pew Internet & American Life Project said Wednesday.

Among households with annual income of less than $20,000, 35 percent subscribed to broadband this year, compared with 25 percent last year. By contrast, broadband penetration for households that earn more than $75,000 per year, already well connected, remained roughly unchanged at 85 percent.

In rural America, a target for the broadband stimulus money, broadband penetration is now 46 percent, up from 38 percent.

.....

The Pew study also found that people pay less for broadband where there is competition. The average was $44.70 per month for those with only one available provider, compared with $38.30 for others.

© 2009 AP DIGITAL
This story is sourced direct from an overseas news agency as an additional service to readers. Spelling follows North American usage, along with foreign currency and measurement units.

More here:

http://news.smh.com.au/breaking-news-technology/survey-elderly-poor-narrow-broadband-service-gap-20090618-ci9x.html

This is interesting in the sense that it shows the US is investing in broadband in less well served areas – much as intended in Australia. It also shows how disadvantaged groups are typically the least well served – which has implications for the value of Personal Health Records.

The costs are interesting in that these costs are for totally unlimited download levels as are typical in the US.

Some comparative Australian information is found here:

http://news.smh.com.au/breaking-news-world/survey-says-72-of-homes-have-broadband-20090619-cmcf.html

Survey says 72% of homes have broadband

June 19, 2009 - 8:29AM

South Korea, where 95 per cent of homes have broadband, topped a world survey on access to the high-speed internet.

Among other Asia-Pacific nations, Australia ranked 11th with 72 per cent, Japan ranked 16th with 64 per cent, New Zealand ranked 25th with 57 per cent and China ranked 43rd with 21 per cent.

The United States, where just 60 per cent of households had broadband as of last year, ranked 20th in the survey of 58 countries by Boston-based Strategy Analytics, released on Thursday.

Third we have:

Concern over patient records proposal

19:48 AEST Wed Jun 17 2009

By Samuel Cardwell

Doctors will be forced to hand over patients' medical records to Medicare under proposed changes to laws, despite privacy concerns.

The Senate community affairs committee handed down its final report into the exposure draft of the Rudd Government's proposed increase to Medicare compliance auditing on Thursday night.

The legislation increases Medicare Australia's auditing powers, allowing them to require doctors to hand over patient records to substantiate their benefit claims.

The committee received numerous submissions from medical and privacy groups voicing concern with the fact that private medical records could be viewed by non-medical Medicare staff as part of the audit process.

More here:

http://news.ninemsn.com.au/national/826797/concern-over-patient-records-proposal

It is interesting that concern on this continues to bubble along – even in the mainstream media.

Fourth we have:

Cognos cures hospital staffing woes

Mater Health Services in Brisbane has implemented a workforce planning solution from IBM Cognos to help with management of its seven hospitals and 7000 staff.

"The power of the IBM Cognos workforce planning solution enables us to be forward thinking," claimed Caroline Hudson, executive director of people and learning at Mater Health Services.

Full article here:

http://tc106.metawerx.com.au/Rustreport/rustreport_jun19_09.pdf

Good to see investment in business systems is also proceeding in the hospital sector.

Fifth we have:

Aussie academic earns post as Obama health adviser

Catherine Hanrahan - Friday, 19 June 2009

AFTER a long career as a leading Australian health academic, Dr Lesley Russell (PhD) will be moving across the Pacific to share her knowledge on health policy with the US Government.

Dr Russell, a Menzies Centre for Health Policy foundation fellow at the University of Sydney, will relocate to Washington DC next month to take up a post with the Centre for American Progress, a Democratic think tank that advises the Obama Administration.

During her post – which will run for up to six years – she hopes to encourage an exchange of the best health policy ideas emerging from both countries.

“For a long time we used to look at the US and think there was nothing we could learn except how not to run a health system. I think that’s changing,” Dr Russell said.

She added that many health issues the two countries faced were surprisingly similar. She pointed to e-health as one example, noting both countries had recognised the importance of electronic patient records in creating health system efficiencies and preventing adverse events.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,4689,19200906.aspx

Dr Russell goes on to say that Australia is ahead of the US with e-Health. With what President Obama is planning and the strategic leadership vacuum in the e-Health domain we have here this situation, even if true now, won’t persist for long.

Sixth we have:

Reactor delay threatens medical tests

Richard Macey

June 17, 2009

ALMOST two years after it was shut by a technical glitch, long delays in bringing Australia's new $400 million nuclear reactor into full commercial operation continue to threaten the supply of medical isotopes needed every week for thousands of cancer and heart tests.

Australia's production of molybdenum-99, used in making key diagnostic radiopharmaceuticals, stopped in January 2007 when the 49-year-old HIFAR nuclear reactor at Lucas Heights was shut down. Production was to have resumed using the new OPAL reactor, officially opened in April 2007 by the then prime minister, John Howard.

Those plans stalled when, three months after the opening, the Argentinean-designed reactor had to be shut down after 13 fuel core uranium plates came loose.

Since then the Australian Nuclear Science and Technology Organisation (ANSTO) has been spending $100,000 a week importing the medical isotope from a South African reactor, one of only three in the world producing commercial volumes.

A global shortage was triggered recently when technical problems forced the Canadian Chalk River reactor to close. Now the third reactor, in the Netherlands, is to be shut next month for maintenance.

"South Africa is committed to maintaining Australia's supply," a Lucas Heights spokesman, Andrew Humpherson, said yesterday.

More here:

http://www.smh.com.au/national/reactor-delay-threatens-medical-tests-20090616-cgjr.html

This is a scandal in my view. How can it be that it takes 2 and a half years to get the new reactor actually doing what was one of its two core tasks (the other being research).

Seventh we have:

Hospital staff disciplined for false waiting lists

Nick McKenzie and Julia Medew

June 15, 2009

ROYAL Women's Hospital is disciplining staff it has blamed for contributing to the patient waiting list rorting scandal, after an internal investigation found hospital officials had acted in an "unacceptable" fashion.

The decision by hospital chief executive Dale Fisher to take action against a small number of employees is believed to have caused ructions, with claims that senior officials have not been held accountable.

In a statement to The Age, Ms Fisher stressed that the hospital's inquiry had been taken "very seriously". "The review has found that their behaviour and the actions of a small number of individuals is unacceptable and based on this, disciplinary procedures are now under way with those individuals," Ms Fisher said.

A hospital spokeswoman refused to reveal the seniority of the staff who had or were due to be disciplined, saying they came from "all levels".

Earlier this year, the hospital admitted it had been doctoring its elective surgery waiting lists for at least a decade. The admission came after The Age revealed that the hospital had privately admitted to the Department of Human Services that it had fudged its data.

More here:

http://www.theage.com.au/national/hospital-staff-disciplined-for-false-waiting-lists-20090614-c7er.html

This article seems to imply there has been a focus on disciplining junior staff for what were clearly policies put in place by management to improve their cash flow. If this is true it is pretty sad, to say the least! As I have said previously it is vital to ensure that any incentives that are put in place to improve performance do not have unintended consequences – such as fostering fraud and dishonesty for financial gain!

Eighth we have:

Microsoft to deliver free antimalware next Tuesday

Will deny beta of Microsoft Security Essentials, formerly 'Morro,' to users running counterfeit Windows

Gregg Keizer 19 June, 2009 07:30

Tags: windows xp, Windows Vista, Windows 7, Microsoft, anti-malware

Microsoft Corp. today said it will release a public beta of its free antimalware software, now called Microsoft Security Essentials, formerly "Morro," next Tuesday for Windows XP, Vista and Windows 7.

Although Microsoft was vague about a final ship date -- saying only that it would wrap up sometime this year -- it was crystal clear that it will deny the program to PCs running counterfeit copies of Windows.

Microsoft pitched Security Essentials as a basic antivirus, antispyware program that boasts a simplistic interface and consumes less memory and disk space than commercial security suites like those from vendors such as Symantec Corp. and McAfee Inc.

"This is security you can trust," said Alan Packer, general manager of Microsoft's antimalware team, when asked to define how it differs from rivals, both free and not. "And it's easy to get and easy to use."

He stressed the Security Essentials' real-time protection over its scanning functions, which are both integral to any security software worth its weight. "Rather than scan and clean, which it also does, it's trying to keep you from being infected in the first place," Packer said.

One of its most interesting features is what Microsoft calls "Dynamic Signature Service," a back-and-forth communications link between a Security Essentials-equipped PC and Microsoft's servers.

More here:

http://www.computerworld.com.au/article/308128/microsoft_deliver_free_antimalware_next_tuesday?fp=16&fpid=1

It is hard to know why Microsoft did not do this years ago – but it is good they are finally seriously on the case!

Lastly the slightly more technically orientated article for the week:

Review: Hard disk vs. solid-state drive -- is an SSD worth the money?

SSDs have the speed, but HDDs have the capacity

Lucas Mearian 19 June, 2009 07:57

Tags: storage, solid-state drives, seagate, hard-disk drives

Solid-state disk (SSD) drives are all the rage among techies. The drives use non-volatile NAND flash memory, meaning there are no moving parts. Because there is no actuator arm and read/write head that must seek out data on a platter like on a hard disk drive (HDD), they are faster in reading and, in most cases, writing data.

But SSDs are also much more expensive than their hard-disk drive (HDD) counterparts, which offer 300GB of capacity or more for less than $100.

Most consumer-grade SSDs from leading vendors now cost around $3 per gigabyte, while traditional hard drives cost about 20 to 30 cents per gigabyte for 2.5-in. laptop drives and 10 to 20 cents per gigabyte for 3.5-in. desktop drives, according storage market research firm Coughlin Associates Inc. In other words, even the cheapest 120GB SSDs are going to be around $300, though some are available on sale for less. So should you buy a high-capacity HDD for little cash or plunk down hundreds of dollars more for a fast, but lower-capacity, SSD? Or, should you wait?

Coughlin Associates founder Tom Coughlin said per-gigabyte prices for HDDs and SSDs are dropping at the same pace -- about 50% per year -- so the sizeable price gap between the two will remain for years to come.

Much more here:

http://www.computerworld.com.au/article/308109/review_hard_disk_vs_solid-state_drive_--_an_ssd_worth_money?fp=16&fpid=1

What is clear is that these solid state drives have reached the stage where in critical mobile applications, where weight, reliability and speed are important, useful disc capacity is now affordable – if not yet exactly cheap!

More next week.

David.

Google’s Flu Tracker Really Seems to be Working in Australia!

Given the recent move in our N1H1 flu alert level to ‘Protect’ I thought it would be interesting to check back with the Google Flu Trends site and see how it was going.

The main site is here:

http://www.google.org/flutrends/

If you are interested to know how the Flu Tracker works go here:

http://www.google.org/about/flutrends/how.html

Of even more interest, in the Australian context, is this page which allows access to the activity levels of flu by State.

This is found here:

http://www.google.org/flutrends/intl/en_au/

What is also interesting is that we see the Victorian hot spot and the quite low levels in the NT and WA.

This matches up just perfectly with what we see here:

http://www.news.com.au/story/0,27574,25651578-421,00.html

Australia upgrades swine flu phase to 'protect'

AAP

June 17, 2009 07:26pm

• Australia now in "protect" swine flu phase
• Most at risk to get drugs, less quarantine
• Infections now over 2000

AUSTRALIA has swung into a new pandemic "protect" phase, as the number of swine flu cases soars past 2000.

The new phase will focus antiviral drugs and medical attention on those deemed most at risk, including pregnant women, the morbidly obese and those with respiratory conditions such as asthma.

People who live with or have come into contact with swine flu patients will no longer be quarantined.

Federal Health Minister Nicola Roxon said the states and territories would reopen schools closed due to swine flu and students who had returned from areas affected by the disease would be allowed to attend classes.

"Excluding well children from school if they're in an area of sustained community transmission is now a less practical or useful measure,'' she said in Canberra.

Full article here (wait for map to load):

http://www.news.com.au/story/0,27574,25651578-421,00.html

Also interesting is that the graph for Victoria is looking to be running well above trend for the last few years in terms of numbers. All the other states seem to be running at trend or even a little below. I looks like when this virus get going it is an infectious little beast.

It will be interesting to keep an eye on the graph over coming weeks!

Thanks Google.

David.

Health Informatics Society Of Australia Workforce Survey Invitation.

The following comes from Dr Michael Legg, HISA President

Dear AushealthIT Blogger,

HISA is working with the Australian Department of Health and Ageing to get a better understanding of the health informatics workforce in Australia.

While there has been previous work on education in health informatics, this is the first time we are aware of that a study has been undertaken to characterise the jobs of those who work in the field.

We hope that you will see this as important enough to take the time to answer this short survey and so ensure we have a balanced and comprehensive view.

To begin the survey just click on the hyperlink below. You can also copy and paste the hyperlink into your browser to go directly to the survey site. You can contact the HISA office on 613-9388-0555 if you are having any problems with the survey.

http://www.zoomerang.com/Survey/?p=WEB229B4R62VVT

The value of the survey will be greatly enhanced if it is distributed as broadly as possible. Please feel free to circulate this email to your network of colleagues or place it on the appropriate email list servers.

Thank you for your support.

Regards,

Michael

-----

Dr Michael Legg, PhD FAICD FAIM FACHI MACS(PCP) ARCPA

Principal, Michael Legg & Associates, Consultants in Information and Organisational Systems;

President, Health Informatics Society of Australia.

I hope those who have not heard about the survey elsewhere will choose to respond.

David.

Report Watch – Week of 15 June, 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:

Information governance

Data breaches continue to hit the headlines, even though there is plenty of guidance and more than a few products on the market to help stop them. Daloni Carlisle reports.

Now let’s be clear about this: data security is not just important, it is career limiting. And that’s not just for the home “flipping” ministers or the moat-owning MPs whose expenses were leaked to the Daily Telegraph.

These days, losing confidential patient data could mean the axe for NHS chief executives and often does mean the chop for the staff directly involved. This is a change from 18 months ago, when the loss of child benefit records by HM Revenue and Customs sparked a data security review across government and the public services.

Of course, the public sector in general and the NHS in particular did not suddenly start losing data in 2007; but the HMRC scandal put a new focus on the problem. Ever since, week after week, newspapers have been gleefully reporting the loss of laptop here, a USB stick there, ratcheting up the political need to be seen to be doing something.

Clear expectations

The NHS was, in fact, in a reasonable position to respond to the initial outcry. NHS chief executive David Nicholson and then chief information officer Matthew Swindells sent out a series of letters asking NHS organisations first to review their data security and then giving some strong and clear guidance on what they should do to protect it.

“There has been some very clear guidance from both the Cabinet Office and the Department of Health,” says Harry Cayton, chair of the National Information Governance Board. “There is no doubt that chief executives across the system recognise that information governance is a serious matter.”

The report length discussion is found here cited here:

http://www.e-health-insider.com/Features/item.cfm?&docId=300

An important topic and well worth a browse.

Second we have:

Study Looks at Genetic Testing Privacy

HDM Breaking News, June 5, 2009

Personal genetic testing services can help consumers learn of their genetic risks for disease, but consumers also need to be aware of risks to their privacy, according to a just-published study.

Personal genetic information is relevant not only for the individual who got a test, but for other family members, says Sandra Soo-Jin Lee, PhD, a co-author of the study and senior research scholar at Stanford University School of Medicine's Center for Biomedical Ethics. "For example, if you receive information on your breast cancer risk and share it with others, you might also be sharing information about your daughter's risk for breast cancer--even though she never consented to have that information shared."

.....

Much more here with links :

http://www.healthdatamanagement.com/news/genomics-38445-1.html?ET=healthdatamanagement:e900:100325a:&st=email

The new study, "Research 2.0: Social Network and Direct-to-Consumer Genomics," was published in the June 5 issue of the American Journal of Bioethics. Registration is required and the cost is approximately $35. The special double-issue also has numerous other articles and studies assessing genomic ethical considerations.

For more information, visit bioethics.net/journal.

This is surely an area that will become more important going forward.

Third we have:

KLAS Report Takes a Comprehensive Look at Potential Components of ‘Meaningful Use’ for Hospitals

Study evaluates which acute care EMR vendor solutions have shown the most success at driving clinician adoption

OREM, Utah – June 8, 2009 – As the healthcare IT (HIT) industry awaits a formal definition for the meaningful use of electronic medical records (EMRs), HIT research firm KLAS has released a comprehensive report outlining which acute care EMR products are best positioned to achieve whatever meaningful use standard is adopted. The report, Meaningful Use Leading to Improved Outcomes, takes a broad look at the EMR market, assessing how well core clinical vendors are delivering solutions for CPOE, nursing automation, medication administration and other key areas.

“Since the introduction of the stimulus package and its provisions for health IT, much of the market rhetoric and industry debate has centered on the concept of meaningful use – what will it entail and how will it impact the receipt of stimulus dollars,” said KLAS Founder and Chairman Kent Gale. “Whatever the final definition of the term, if improved patient outcomes are indeed the ultimate goal, then some form of clinician adoption will be critical.

“In particular, deep adoption among physicians is pivotal to the overarching success of an EMR implementation,” Gale said.

The Need for Physician Adoption

The KLAS report notes that while EMR vendors Cerner, Eclipsys and Epic are the most successful with regard to physician adoption, Meditech has the largest number of clinical information system (CIS) customers over 200 beds (327 hospitals), followed by Cerner (263) and McKesson (242). However, the Meditech customer base, encompassing the MAGIC and C/S product lines, has the smallest number of hospitals over 200 beds with deep CPOE adoption – that is, where more than 50 percent of all orders are entered electronically by doctors. Only 3 percent of Meditech customers have achieved this level of adoption. Among the CIS market share leaders, McKesson exceeds Meditech in this area with 5 percent of its customer base enjoying deep adoption, while Cerner leads both McKesson and Meditech at 23 percent. GE, QuadraMed and Siemens also enjoy some success with CPOE adoption.

Beyond CPOE, the report also evaluates vendor offerings for nurse charting, an electronic medication administration record (eMAR), patient-monitor interfaces to the EMR, electronic flow sheets and barcoding at the point-of-care (BPOC) for medication administration. For each solution area, KLAS evaluates the risk the vendor poses to provider customers who want to achieve a comprehensive EMR implementation.

No vendor is perfect in every area, but Cerner and Epic are the strongest, followed by Eclipsys. Within this threesome, only Cerner extends to really meet the needs of both larger facilities over 200 beds and some community hospitals. Meditech has a broad install base across all hospital sizes and covers virtually every aspect of automation, with nurses using the product across the country; but Meditech’s Achilles’ heel is the lack of adoption by physicians. Other vendors deliver functional solutions but face a variety of challenges that have hindered deployment, such as the lack of tight integration among McKesson’s core clinical modules or Siemens Soarian clients awaiting version C6 availability.

More here:

http://www.klasresearch.com/Klas/Site/News/PressReleases/2009/MeaningfulUse.aspx

There is more detail in the press release and the full report can be purchased from KLAS.

Fourth we have:

Electronic Medication Reconciliation: A Work in Progress

Electronic medical reconciliation and process redesign lessen potential for adverse drug events.

In 2005, the Joint Commission on Accreditation of Healthcare Organizations mandated medication reconciliation as a national patient safety goal. Establishing an accurate list of a patient’s current medications intuitively seems like a prerequisite for high-quality care, but few rigorous studies have been designed to assess whether medication reconciliation improves patient outcomes.

.....

Comment: Because this study was not designed to examine healthcare use or actual adverse drug events, we can say only that it provides an interesting look at how information technology and interdisciplinary collaboration potentially improve patient safety. As the authors note, the intervention was far from perfect (1.05 PADEs per patient in the intervention group), but I would expect this rate to improve as hospital teamwork becomes more pervasive and software integration evolves.

— Neil H. Winawer, MD, FHM

Published in Journal Watch Hospital Medicine June 8, 2009

Citation(s):

Schnipper JL et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: A cluster-randomized trial. Arch Intern Med 2009 Apr 27; 169:771.

• Original article (Subscription may be required)
• Medline abstract (Free)

More here (subscription required):

http://hospital-medicine.jwatch.org/cgi/content/full/2009/608/1?q=featured_hm

Links to articles are in text.

Fifth we have:

Consumers want technology to help keep them healthy, survey shows

June 05, 2009 | Bernie Monegain, Editor

REDMOND, WA – A new survey from Microsoft Corp. shows that Americans want their doctors and their health plans to use technology to help them become healthier.

The Microsoft Health Engagement Survey 2009, conducted by Kelton Research, found that consumers want electronic coaching via e-mail and phones to help them improve health habits, self-manage conditions and better coordinate care with providers.

Kelton Research conducted the Microsoft Health Engagement Survey 2009 in March 2009 among 1,002 Americans, ages 18 and older.

"Insurers can no longer wait for consumers to self-manage their chronic conditions through standalone Web tools," said Dennis Schmuland, MD, U.S. health insurance industry solutions director at Microsoft. "Consumers want their providers and insurers to team together to help them replace bad health habits with good ones, reduce their health risks and equip them to self-manage their conditions. This requires a new generation of technology designed to proactively improve health and coordinate care at the individual and community levels."

According to the survey, 66 percent of Americans are interested in receiving health-related encouragement or reminder e-mails from their health insurance company and 52 percent would be open to receiving e-mails that provide them with feedback on their health progress. In addition, 62 percent of Americans believe that personal health record services are valuable.

Much more here:

http://www.healthcareitnews.com/news/consumers-want-technology-help-keep-them-healthy-survey-shows

The full report is here:

http://www.microsoft.com/presspass/presskits/industries/healthandlifesciences/docs/MSHealthEngagementSurvey2009.ppt

Sixth we have:

NQF panel recommends nine EHR measures

By Jean DerGurahian / HITS staff writer

Posted: June 10, 2009 - 11:00 am EDT

An expert panel established by the National Quality Forum is making nine recommendations to advance the development of standardized electronic health-record data measures.

The forum’s Health Information Technology Expert Panel, the second version of HITEP, established last November, looked at ways to expand the use of quality data sets and other electronic data sources out of guidelines first established in 2007. The panel’s report provides details on establishing a quality data set—including standard elements, quality data elements and data flow attributes—and sources of data for specific quality information.

More here:

http://www.modernhealthcare.com/article/20090610/REG/306109993

The links are found in the text.

Seventh we have:

Video Decision-Support Tool Is Effective for Advance Care Planning in Dementia

A video depiction of advanced dementia persuaded older people to choose comfort care.

Visual images can enhance healthcare communication and decision making. In this randomized trial, Boston investigators determined the effects of a video decision-support tool on older people’s (age, 65) preferences for future care if they develop advanced dementia.

....

Comment: Unsurprisingly, older people who hear and watch depictions of advanced dementia are more likely to prefer comfort care for dementia and have more stable preferences than patients who only hear a description of dementia. These results should encourage development of video decision-support tools for other scenarios (e.g., life-sustaining technologies such as hemodialysis, left ventricular assist devices). The video is available online.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine June 11, 2009

Citation(s):

Volandes AE et al. Video decision support tool for advance care planning in dementia: Randomised controlled trial. BMJ 2009 May 28; 338:b2159. (http://dx.doi.org/10.1136/bmj.b2159)

Original article (Subscription may be required)

Medline abstract (Free)

More here (subscription required):

http://general-medicine.jwatch.org/cgi/content/full/2009/611/3

The videos are here:

http://www.acpdecisions.com/acpdecisions/Videos.html

I must say it is hardly surprising this works!

Last we have:

Report: VA Lacks I.T. Controls

HDM Breaking News, June 10, 2009

The Office of Inspector General within the Veterans Administration is voicing concern that the VA is not effectively managing its information technology capital investments.

The OIG conducted an audit after the VA failed to meet a deadline to submit documentation to justify funds for I.T. capital investments for budget year 2010. The documentation is called Exhibit 300s.

More detail here:

http://www.healthdatamanagement.com/news/VA-38463-1.html?ET=healthdatamanagement:e905:100325a:&st=email

For the full OIG report, click here.

Enough for one week!

Enjoy!

David.

The National Health and Hospitals Reform Commission Totally Fails to Understand E-Health!

The NHHRC released a new discussion paper earlier this month. It was entitled:

The Australian Health Care System: The Potential for Efficiency Gains (A Review of the Literature).

This links to a download page:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/background-papers

The direct link to the document is:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/A5665B8B9EAB34B2CA2575CB00184FB9/$File/Potential%20Efficiency%20Gains%20-%20NHHRC%20Background%20Paper.pdf

On page 23 we are told there are 3 possible solutions that can deliver improved ‘Operational Efficiency’

These are:

1. activity-based funding;

2. e-health and patient electronic health records; and

3. greater use of data through measurement and surveillance of health system performance.

The E-Health Section reads as follows:

“Solution: E-health and patient electronic health records

It is expected that the introduction of health information technology, in particular individual patient electronic health records (IEHR), would enhance labour productivity and technical efficiency within the health system. Uptake has been low because of problems associated with implementation (delays and the lack of a coherent national strategy) and the high costs associated with start-up. Currently no country can claim to have a fully implemented and operational IEHR network. Germany is arguably the most advanced, and is aiming for implementation in 2010 (at the earliest) (Bartlett and Boehncke, 2008).

Efficiencies are expected to be delivered across in-patient and out-patient services by minimising the need to transcribe medical records, wait for paper records to be delivered, and re-order tests and diagnostic imaging because the results and x-rays/scans could be attached to the IEHR. Adverse events are expected to be reduced as it will be easier to manage medicines (and their interactions) and medical histories (including, for example, allergies).

Girosi (2005) estimates that full adoption of health information technology in the US could save approximately four per cent (US$81 billion) of total yearly health spending (approximately US$1.7 trillion). Although the initial investment in information technology is high, estimated to be US$7.6 billion, the annual benefits far exceed the costs. It is anticipated that IT-enabled improvements in prevention and disease management in the US could more than double these savings while also lowering age-adjusted mortality by 18 per cent and reducing annual employee sick days by forty million. It should be noted, however, that the US is starting from a low base of IEHR usage and has particularly high health service costs and high levels of operational inefficiency. Figure 9 shows an international comparison of primary health care physicians’ use of electronic medical records, although this does not show the usage of decision support tools or the capacity for records to be shared or accessed at different sites of care.

In Australia, few studies have been undertaken on the economic impact of an IEHR. One study (ACG, 2008) commissioned by the National E-Health Transitional Authority (NEHTA) found that the economic benefit to Australia from the implementation of an IEHR network would be between $6.7 billion and $7.9 billion over 10 years (in 2008-09 dollars). This may be an overstatement as the modelling assumes significant benefits to the economy through increased workplace productivity, as IEHR would lead to improvements in chronic disease management.

There is limited evidence for this (ACG, 2008). Interestingly, the modelling found that economic benefits would be enhanced if the slower paced implementation option was followed as there would be significantly less net foreign liabilities (that is, less dependence on overseas lenders).

A more precise estimate of the benefits of an IEHR system may be possible if confined to hospital and medical services. The ACG model assumes efficiency gains because of reductions in the number of adverse events (including medical errors) and duplication of services - for example, the number of repeated tests and images. There may also be further efficiency and effectiveness gains down the track if IEHR leads to the development of better decision making tools, and more accurate and rapid diagnosis. The ACG model assumes that there will be an increase in throughput (for example, a reduction in hospital queues), rather than savings (that could, for example, be handed back to government) due to excess demand for health care. Real output in the hospital and medical services sector is expected to increase by between 4.8 and six per cent by 2019 following the implementation of an IEHR network from 2010 (ACG, 2008).

The computerised physician order entry (CPOE) system is an essential element of IEHR in hospitals, and a key to delivering anticipated efficiency gains. However, the uptake of CPOE in many countries, including Australia, is limited. CPOE allows doctors and other authorised staff to enter orders electronically - for example, medication and diagnostic tests. This removes the need for paperwork and associated transport or delivery systems, and is likely to lead to substantial savings in terms of efficiencies (and patient safety). However, there continues to be difficulties with implementation including significant disruptions to work organisation and physician resistance to the CPOE systems (Georgiou and Westbrook, 2006).

Stroetmann et al. (2006) argue that a successful e-health strategy should include achievable, shorter term goals that provide incentives for change rather than ‘big-bang’ reforms over a short period of time. While there are many expected short and long term benefits from e-health, progress is slow, and change continues to occur in a fragmented fashion. Reform will only occur over time, but the right incentives for a range of players, along with national leadership, is clearly needed (Bartlett and Boehncke, 2008).”

Where to start. It is utterly clear the writers of this section are utterly clueless about e-health. (Sorry I can’t reproduce the figures)

First they totally ignore the transaction and communication efficiency provided by modern Information Technology (the same stuff that has transformed the way banks, airlines etc operate)

Second they devote almost ½ the section to discussion of a benefits paper developed for NEHTA which is not publicly available:

“ACG (Allen Consulting Group) (2008) Economic impacts of a national Individual

Electronic Health Records system, July”

As it happens I have seen this paper – and it is a Macro Economic Model of the benefits of a totally undefined Electronic Health Record systems that is assumed to provide benefits that are based on experience in the most advanced Health IT installation in existence. All these systems are hand crafted 2 decade long efforts which are essentially not replicable in Australia.

Third they clearly have bothered to read very little of the large volume of literature available regarding the benefits of deployment of health IT. The one major benefits reference they cite is 4+ years old!

There is a vast amount of much better quality material available here:

http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5664&parentname=CommunityPage&parentid=50&mode=2

Fourth the paper also totally ignores the place of CPOE in ambulatory practice where it is fully deployed in health systems like Kaiser Permanente supporting 8 million + insured lives.

Fifth the document totally ignores the huge amount of work done in the Deloittes National E-Health Strategy – finalised late last year – because, incredibly, they don’t seem to have a copy. Ms Roxon should fix that urgently – for the NHHRC and the rest of us!

Sixth, there are many countries way in advance of Germany in all this. Try Denmark, Sweden and the Netherlands.

Seventh, the issues about definitional distortion as identified in my blogs over the last few weeks are still not addressed.

Eighth, there is no recognition of the scope of e-Health capability and how it fits as a total system enabler. If not done right this will be a fiasco. E-Health can enable a safer and better health system and the NHHRC does not get it!. Really, really sad.

I won’t go on. This is just another opportunity missed to do a proper job of work to define the place of e-Health in overall health reform.

I despair!

David.