NEHTA is Swimming Against the Tide of Expert US Opinion on Health IT Standards.

With the passage of the US HITECH Act which provides massive financial stimulus for ‘meaningful use’ of Electronic Health Records in patient care there has been renewed focus on US Health IT Standards and how they may be best used – as well as how to fill what gaps there are!

The first few paragraphs of reporting – in draft – the November 19^th Meeting of the key Committee (provided as audio, video, transcripts and presentations as opposed to the secrecy we get from NEHTA) make for very important reading.

Thursday, November 19, 2009

HIT Standards Meeting 11-19

The HIT Standards Committee met on Thursday, November 19, 2009. The meeting distilled much of their work and there were some great presentations from the committee, workgroups and stakeholders. The meeting materials from the ONC website and the rough draft transcript of the meeting are below. Also be sure to check out the FACA blog and join the conversation to help "pull adoption forward" and bring our healthcare system into the 21st century.

John Halamka, co-chairman of the committee, gave the following list of guiding principles for standards recommendations which were polished at the meeting:

• Keep it simple; think big, but start small; recommend standards as minimal as possible to support the business goal and then build as you go
• Don’t let “perfect” be the enemy of “good enough”; go for the 80% that everyone can agree on; get everyone to send the basics (medications, problem list, allergies, labs) before focusing on the more obscure
• Keep the implementation cost as low as possible; eliminate any royalties or other expenses associated with the use of standards
• Design for the little guy so that all participants can adopt the standard and not just the best resourced
• Do not try to create a one size fits all standard, it will be too heavy for the simple use cases
• Separate content standards from transmission standards; i.e., if CCD is the html, what is the https?
• Create publicly available controlled vocabularies & code sets that are easily accessible / downloadable
• Leverage the web for transport whenever possible to decrease complexity & the implementers’ learning curve (“health internet”)
• Position quality measures so that they will encourage adoption of standards
• Create Implementation Guides that are human readable, have working examples, and include testing tools

----- End Quote from Brian Ahier’s blog.

The full blog with audio links, presentations and transcript is here:

http://ahier.blogspot.com/2009/11/hit-standards-meeting-11-19.html

John Halamka’s (CIO Harvard Medical School) blog where these ideas were first published is on the link above.

For what it is worth everything that John states as guiding principles for Health Information Technology Standards setting I pretty much totally agree with and those who have read my blog will have seen many of these points mentioned – if not so succinctly and clearly.

I leave it as an exercise for the reader to figure out for themselves just how far NEHTA is off beam with all their theoretical complex documentation and so on.

It just makes you weep we are all being so badly led in all this. Don't they get, as the Americans surely do, that if you open up your processes you get much better outcomes for all concerned. Nah, not these turkeys!

David.

Just in case you were wondering, here is the brief of the committee:

Health IT Standards Committee (a Federal Advisory Committee)

The Health IT Standards Committee is charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the Health IT Standards Committee will focus on the policies developed by the Health IT Policy Committee’s initial eight areas. Within 90 days of the signing of ARRA, the Health IT Standards Committee must develop a schedule for the assessment of policy recommendations developed by the Health IT Policy Committee, to be updated annually. In developing, harmonizing, or recognizing standards and implementation specifications, the Health IT Standards Committee will also provide for the testing of the same by the National Institute for Standards and Technology (NIST).

Lots more here:

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1271&parentname=CommunityPage&parentid=3&mode=2&in_hi_userid=10741&cached=true

As you can see from the membership list – a very serious, very important and very smart lot indeed. We won't have a hope in hell of "fast following" this lot. We have already been left behind and will likely never catch up.

D.

A Useful Report on Cloud Computing and Its Implications.

The following has just been released.

ENISA clears the fog on cloud computing security

How can businesses and governments get the obvious benefits of cloud computing without putting their organisation at risk? The EU’s ‘cyber security’ agency, ENISA (the European Network and Information Security Agency) answers this question in a comprehensive, new report on “Cloud Computing: Benefits, risks and recommendations for information security”. It covers the technical, policy and legal implications and most importantly, makes concrete recommendations for how to address the risks and maximise the benefits for users.

ENISA’s new report is the first to take an independent, in-depth look at all the security and privacy issues of moving into the cloud, outlining some of the information security benefits of cloud computing, as well as 35 key security risks. ENISA and their expert group started with a survey asking businesses their main concerns in moving into the cloud. “The picture we got back from the survey was clear:” says Giles Hogben, an ENISA expert and editor of the report - “the business case for cloud computing is obvious – it’s computing on tap, available instantly, commitment-free and on-demand. But the number one issue holding many people back is security – how can I know if it’s safe to trust the cloud provider with my data and in some cases my entire business infrastructure?”

The report answers this question with a detailed check-list of criteria which anyone can use to identify whether a cloud provider is as security-conscious as they could be. “This is the most important result of our report: our check-list isn’t just pulled from thin-air,” says Daniele Catteddu, the ENISA report co-editor – “we based it on a careful risk analysis of a number of cloud computing scenarios, focussing on the needs of business customers. The most important risks addressed by the check-list include lock-in, failures in mechanisms separating customers’ data and applications, and legal risks such as the failure to comply with data protection legislation.” With the security check-list, customers now know the right questions to ask and providers can answer those questions just once instead of being overloaded with requests for assurance about their security practices.

Cloud computing also entails great economic interests, e.g. the IDC forecasts a growth of European cloud services from €971m in 2008 to €6,005m in 2013.

But as the report points out, cloud computing is also a security enabler. The Executive Director of ENISA, Dr Udo Helmbrecht, underlines: “The scale and flexibility of cloud computing gives the providers a security edge. For example, providers can instantly call on extra defensive resources like filtering and re-routing. They can also roll out new security patches more efficiently and keep more comprehensive evidence for diagnostics.”

The full report is available for download:

http://www.enisa.europa.eu/act/rm/files/deliverables/cloud-computing-risk-assessment/

Cloud Computing Risk Assessment

ENISA, supported by a group of subject matter expert comprising representatives from Industries, Academia and Governmental Organizations, has conducted, in the context of the Emerging and Future Risk Framework project, an risks assessment on cloud computing business model and technologies. The result is an in-depth and independent analysis that outlines some of the information security benefits and key security risks of cloud computing. The report provide also a set of practical recommendations.

Publication date: Nov 20, 2009

Downloads

Full report: Cloud Computing Security Risk Assessment.pdf — PDF document, 1963Kb

The report spends a few pages specifically on e-Health. Well worth a browse.

David.

Can NEHTA Really Be Serious With Consultation With This Sort of Notice?

The following hit the RSS feed late yesterday.

Invitation to participate in Electronic Transfer of Prescription workshop - 27 November

NEHTA would like to offer Software Vendors the opportunity to participate in a 1 day workshop to review the Draft Electronic Transfer of Prescription (ETP) Release 1.0 package.

The Draft ETP Release 1.0 document set which was released on the 30 October defines the minimum requirements for the interoperable exchange of prescriptions between general practices and community pharmacies within Australia and is available at http://www.nehta.gov.au/e-communications-in-practice/emedication-management.

The workshop is part of a consultative process to gain national feedback on the proposed ETP Release 1.0 specifications and to ensure that vendors can gain an understanding of the program and clarify an issues or ambiguities with the Draft ETP specifications.

When: Friday 27 November 2009

Where: Christie Corporate, 320 Adelaide St, Brisbane

Time: 9:00am for a 9:30am start

Please Note that NEHTA will not be providing compensation for travel or accommodation and there are no sitting fees for this event.

If you would like to participate in this workshop, we request that you take time to review the ETP Document set and complete and email the registration form to Melissa Roach, Engagement Analyst at melissa.roach@nehta.gov.au

Registrations need to be received by the 20 November. The agenda will be provided to those that are interested in attending.

NEHTA looks forward to your attendance.

Stakeholder Draft ETP Package Review Registration Form (23.34 kB)

Link here:

http://nehta.gov.au/media-centre/nehta-news/562-invitation-to-participate-in-electronic-transfer-of-prescription-workshop-27-november

We have all seen the scale of the documentation – so 1 week would be really pushing it even if you could work on it pretty full time. The people they want to attend however also have day jobs I am sure!

Of course accommodation and travel to get there also seems to be off the table – and Brisbane is hardly the most central spot – or even NETHA headquarters.

Seems there is a bit of panic about the lack of progress in this ETP domain with commercial players live with systems, and Standards Australia really not resourced on the basis of current output to deliver quickly.

We have not only a bolted horse! It is leaving the district at a gentle canter knowing it will never be caught!

David.

Weekly Overseas Health IT Links 16-11-2009

Here are a few I have come across this week.

http://www.google.com/hostednews/afp/article/ALeqM5iaFHrJKPoH8vrgUfqgnpoZaXBCIg

Experts agree on proposed global privacy standards

(AFP) – Nov 6, 2009

MADRID — Experts from 50 nations meeting in Madrid have reached a draft agreement on international standards for the protection of privacy and personal data, participants said Friday.

Under the proposed standards, data may only be processed after obtaining the "free, unambiguous and informed consent" of the data subjects and it should be deleted when it is no longer necessary for the purposes for which it was gathered.

-----

http://www.computing.co.uk/computing/news/2253120/nhs-spending-way-under

NHS IT spending falls short of forecasts

Delays in implementing systems mean only a fifth of forecast money has been spent on paying contractors

Written by Tom Young

Computing, 13 Nov 2009

The Department of Health has spent only around £1.2bn of the £5.1bn it forecast on paying contractors in the five regions of the National Programme for IT, according to official figures.

-----

http://www.thestar.com/news/ontario/ehealth/article/725484--ehealth-scandal-claims-deputy-health-minister

eHealth scandal claims deputy health minister

Grilled by legislature, Ron Sapsford suddenly quits his post

Ontario deputy health minister Ron Sapsford, a key player at the heart of the province's $1-billion electronic health record scandal, has resigned.

-----

http://www.healthleadersmedia.com/content/242081/topic/WS_HLM2_TEC/Nurses-Use-iTouch-and-iPhones-to-Communicate-and-Stay-Connected.html

Nurses Use iTouch and iPhones to Communicate and Stay Connected

Sarah Kearns, for HealthLeaders Media, November 13, 2009

Sarasota (FL) Memorial Healthcare System plans to bring peace and quiet, along with improved healthcare, to its hospital by supplying Apple's iTouch to all its nurses.

Sarasota Memorial was approached by Voalte to be part of a piloting program. Voalte is a startup developing point-of-care communications company that uses mobile technology, specifically applications from Apple, to send pages and alerts. During the 60-day pilot program that started in June, Sarasota Memorial handed out 25 iPod Touches to nurses on one specific floor with the goal of reducing the amount of noise and inefficiency involved in paging nurses.

-----

http://www.fortherecordmag.com/archives/110909p16.shtml

November 9, 2009

Dealing With Downtime — How to Survive If Your EHR System Fails

By Lindsey Getz

For The Record

Vol. 21 No. 21 P. 16

When a tree fell on an electrical line and Fletcher Allen Health Care suffered a power failure this past August, there wasn’t initial cause for concern. After all, the Burlington, Vt.-based facility’s new $57 million EHR system had an uninterrupted power supply (UPS) system to provide backup. However, a few bad batteries made the UPS system useless, causing the EHR system to fail and forcing employees to put the facility’s “unplanned downtime plan” into effect. While the system was functioning again by noon, it was 5 pm before updates were verified and staff were allowed to access the system.

-----

http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=221700080

Senate Bill Would Help Family Doctors Fund EHRs

The bill, introduced by Sen. John Kerry, would make small healthcare practices eligible for federal loans.

By Mitch Wagner

InformationWeek

November 13, 2009 03:52 PM

Senator John Kerry introduced a bill designed to help family doctors fund conversion to electronic health records.

Kerry, D-Mass., a senior member of the Finance Committee, introduced the Small Business Health Information Technology Financing Act of 2009 Tuesday. It would make family doctors and other small medical practices eligible for Small Business Administration loans to cover the cost of health information technology to create electronic health records and prescriptions.

-----

http://www.e-health-insider.com/news/5380/newcastle_makes_switch_to_cerner

Newcastle makes switch to Cerner

12 Nov 2009

The Newcastle upon Tyne Hospitals NHS Foundation Trust has successfully gone live with its new Cerner Millennium hospital information system.

The trust says it achieved its main objective of ‘business as usual’, switching to the new system without disrupting patient services on Sunday night.

-----

http://www.healthdatamanagement.com/issues/2009_72/-39273-1.html

The Medical Home

Howard J. Anderson

Health Data Management Magazine, November 1, 2009

The concept of the "medical home" has been kicking around since the 1960s, but how best to define the model for primary care is still the subject of intense debate. No matter how they precisely describe the model, however, many proponents say that information technology is vital to this patient-centered approach to care. Three key technologies to support the model are electronic health records, personal health records and health information exchanges.

Under the medical home model, "A primary care physician is the orchestrator of care for individuals, especially for those with chronic diseases," says Mitch Morris, M.D., national leader, health information technology for Deloitte Consulting, New York. The model also calls for "bringing together all the different resources in the community to advance the wellness of an individual and the community," he says. That means a primary care physician is the hub or "home," carefully coordinating care with a team of specialists.

"I.T. is the glue that holds it all together," Morris says.

-----

http://www.ehealtheurope.net/news/5378/guernsey_progresses_intersystems_ehscr

Guernsey progresses InterSystems EHSCR

11 Nov 2009

InterSystems has announced that Guernsey Health and Social Services Department has gone-live with key elements of its island-wide Electronic Health and Social Care Record (EHSCR).

-----

http://www.healthdatamanagement.com/news/NHIN-39343-1.html?ET=healthdatamanagement:e1076:100325a:&st=email

ONC Readies NHIN Contracts

HDM Breaking News, November 10, 2009

The Office of the National Coordinator for Health Information Technology later this year will solicit competitive bids for contracts to move the Nationwide Health Information Network to production readiness and status.

"This competitive contract process in late 2009 will result in the selection of a set of task order contractors which will provide the range of skills, knowledge and experience to advance the work toward a full production NHIN," according to a recently issued notice from the Program Support Center, on behalf of ONC.

-----

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/06/AR2009110603473.html

A glut of Google can give you a virtual fever

Carolyn Butler

Washington Post Staff Writer

Tuesday, November 10, 2009

It always starts out innocently enough -- for example, with an eye twitch. It's just a little tic, but it keeps coming and going over the course of a few weeks, and so I decide to do a little medical investigation online. I plug "recurrent eye twitch" into my friendly search engine and, after several hours poring over a range of health-related Web sites -- skimming over likely explanations such as fatigue, stress and too much caffeine in favor of dozens of worst-case scenarios, and growing increasingly panicky all the while -- I am utterly convinced that I have multiple sclerosis, at the very least, and quite possibly Lou Gehrig's disease.

-----

http://news.yahoo.com/s/afp/20091111/ts_alt_afp/usitinternetflugoogle_20091111001316;_ylt=A2KIKwI4HfpKNpUAkhiJOrgF;_ylu=X3oDMTJzMmRhNGY5BGFzc2V0A2FmcC8yMDA5MTExMS91c2l0aW50ZXJuZXRmbHVnb29nbGUEcG9zAzEEc2VjA3luX3BhZ2luYXRlX3N1bW1hcnlfbGlzdARzbGsDZ29vZ2xlbGF1bmNo

Google launches online flu shot finder

Tue Nov 10, 7:13 pm ET

SAN FRANCISCO (AFP) – Google on Tuesday launched an online tool for tracking down where to get vaccinations against H1N1 and seasonal influenza in the United States.

The flu-shot finder service went live online at google.com/flushot and will soon be available at flu.gov and websites of the American Lung Association, according to the California-based Internet giant.

-----

http://newsblaze.com/story/2009111002304300002.bw/topstory.html

Health Information Technology Market Will Show "Impressive" Worldwide Growth, Scientia Advisors Finds

BOSTON & PALO ALTO, Calif. - (BUSINESS WIRE) - Health information technology (HIT) is the fastest growing segment of the $1 trillion global health care marketplace-and its "impressive" 11 per cent combined annual growth rate is likely to continue through 2013, according to a Scientia Advisors global industry review released today.

-----

http://www.who.int/goe/ehir/2009/10_november_2009/en/index.html

10 November 2009

eHealth Worldwide

:: China - Improving reproductive health knowledge in rural china-a web-based strategy. (Journal of Health Communication, Volume 14, Issue 7 October 2009)

In China, one of the major problems in upgrading rural health services is the difficulty of communicating between the rural and urban areas. Enabling local agencies to access the Internet in resource-poor areas can provide an efficient means of diffusing current training and information and will have far-reaching policy implications. To test the feasibility of using the Internet to deliver needed health information to the countryside, the UCLA School of Public Health and the Institute of Health Studies of Kunming Medical College (IHS-KMC) collaborated in an experimental website project to improve the quality of reproductive health services to promote women's health in three rural counties of Yunnan. The project involved the county government and the Bureau of Public Health, the Bureau of Family Planning; the Bureau of Education, Women's Federation, and the Maternal and Child Health Station targeting village health workers and teachers; women's cadres.

-----

http://www.healthleadersmedia.com/content/241871/topic/WS_HLM2_PHY/PayforPerformance-Participation-Can-Be-Pricey-for-Docs.html

Pay-for-Performance Participation Can Be Pricey for Docs

Cheryl Clark, for HealthLeaders Media, November 10, 2009

Pay for performance may be the rage, and the future of physician reimbursement—but it doesn't come cheap.

Responding to all those requests for data, proper planning, training, coding, data entry, and modification of electronic systems cost physician practices between $1,000 to $11,100 in implementation costs per doctor, and from about $100 to $4,300 per year per clinician after the program was launched, according to a survey of eight physician practices participating in four quality reporting programs in North Carolina.

-----

http://www.healthdatamanagement.com/news/e-prescribing-39340-1.html?ET=healthdatamanagement:e1075:100325a:&st=email

Strong E-Prescribing Growth for Walgreens

HDM Breaking News, November 10, 2009

Drug store chain Walgreens filled four million electronic prescriptions during October, nearly triple the number it filled in October last year. The current number represents 22% of all eligible prescriptions, the Deerfield, Ill.-based company has announced.

-----

http://www.healthdatamanagement.com/news/genomics-39336-1.html

Supercomputer Maps HIV

HDM Breaking News, November 9, 2009

Researchers with the international Center for HIV/AIDS Vaccine Immunology consortium recently used the Roadrunner supercomputer at Los Alamos National Laboratory to map the largest family tree of HIV ever produced.

-----

http://www.fiercehealthcare.com/story/whit20009-challenge-helping-small-practices-go-electronic/2009-11-10?utm_medium=nl&utm_source=internal

Conversion of paper claims to digital form could save $11 billion annually

November 10, 2009 — 12:47pm ET | By Anne Zieger

Doubtless, MD On-Line CEO Bill Bartzak would like to make tons of money, but he's also a man on a mission. That mission? To help small medical practices move money in and out without touching a piece of paper.

Right now, 25 percent of claims are submitted on paper each year. That's a whopping 3 billion claims still being handled the old-fashioned way, notes Bartzak, who spoke at yesterday's session of the World Health Care Innovation and Technology Congress in Alexandria, Va. The vast majority of those claims are being filed by small provider offices with one to five physicians.
-----

http://www.healthleadersmedia.com/content/241920/topic/WS_HLM2_TEC/Three-Fundamentals-When-Designing-for-Digital-Care.html

Three Fundamentals When Designing for Digital Care

Carrie Vaughan, for HealthLeaders Media, November 10, 2009

I had the pleasure of moderating the design panel for the HealthLeaders Media Hospital of the Future Now conference held in Chicago last month. One of the learning objectives that was discussed is how should organizations be designing or renovating their facilities so they are equipped for a digital healthcare system. Here are some highlights of that discussion.

-----

http://www.modernhealthcare.com/article/20091106/REG/311069957/1029

Expect tougher privacy enforcement: IT experts

By Joseph Conn / HITS staff writer

Posted: November 6, 2009 - 5:59 am EDT

Part one of a two-part series.

You can blame the spotty record of the healthcare industry in protecting the privacy and security of medical records on lax enforcement of federal law, and you'd be right, according to healthcare information technology experts.

Or, you can blame the same poor record on the culture of the healthcare industry itself, and you'd be right, again, at least in the opinion of one those experts.

-----

http://www.boozallen.com/publications/article/42247908

Health Privacy Breaches Can Be Prevented

Why patient information is so often compromised - and what healthcare organizations can do about it.

Stemming the Rising Tide of Health Privacy Breaches

As personal health records are increasingly being stored electronically, the number of data and privacy breaches is also growing rapidly – despite safeguards such as the Health Insurance Portability and Accountability Act (HIPPA).

Healthcare organizations, already racing to prevent such breaches, now face new mandates from Congress that further tighten data-security requirements, and include greater penalties for non-compliance.

-----

http://news.cnet.com/8301-13860_3-10392637-56.html

November 6, 2009 1:59 PM PST

Microsoft launching health tech video show

by Ina Fried

Aiming to reinforce its medical pedigree, Microsoft next week is launching a video show on developments in the health care technology arena.

The show's host, Bill Crounse, senior director of worldwide health at Microsoft, is a veteran of both broadcasting and medicine, having served as a broadcaster and practicing physician before joining Microsoft. In a chat on Friday, Crounse promised that the show itself won't be an ad for Microsoft's health care software, though the company is sponsoring the first few episodes with some short commercials.

-----

http://www.healthcareitnews.com/news/mayo-clinic-stmicroelectronics-develop-heart-monitoring-platform

Mayo Clinic, STMicroelectronics to develop heart-monitoring platform

November 06, 2009 | Bernie Monegain, Editor

ROCHESTER, MN – The Mayo Clinic and STMicroelectronics, a Swiss-based semiconductor company, are collaborating on a platform for remotely monitoring patients with chronic cardiovascular disease.

-----

http://www.ethioplanet.com/vybes/2009/11/07/236m-went-into-ehealth-amid-scandal/

$236M went into eHealth amid scandal

The Ontario government quietly spent nearly a quarter-billion dollars on an eHealth deal that will link 5,700 family doctors to electronic medical records over the next three years, the Star has learned.

The $236 million investment was made in July by eHealth Ontario, just weeks after its CEO Sarah Kramer and board chair Dr. Alan Hudson resigned in the midst of a $1 billion scandal.

-----

http://www.docuticker.com/?p=28054

Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research

Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research

Source: PLoS Medicine

eHealth—the use of electronic tools in delivering health care—is rapidly emerging as an international priority in nations at all levels of development, yet the benefits and priorities have not clearly been defined. The result is that there is an urgent need for additional research in this area. International research to evaluate the impact of eHealth would be especially helpful, and unless this begins to take place potential economies of scale may not be realized.

-----

http://www.nextgov.com/nextgov/ng_20091028_2840.php

Health Hazard

By Andrew Noyes, CongressDaily 10/28/2009

Warning: Patient privacy could complicate the blueprint for an electronic medical records system.

Implementing a nationwide system of electronic medical records as prescribed by President Obama's economic stimulus package is a herculean task that will require a complex new matrix of policies and standards. Two Health and Human Services Department advisory committees are hard at work on blueprints for both, but some worry privacy safeguards will be an afterthought.

-----

Enjoy!

David.

We Bloggers Need To Stick Together!

Just a short post to highlight this rather nervous blog!

Who Will Speak For Us?

A Blog From Inside Katoomba Hospital Desperately Pressing the Call Bell For Help.

Description:

This blog is from the inside of Katoomba Hospital. It has to be anonymous because all staff of Sydney West Area Health Service are required to not speak to the media as part of their employment contract. The trouble is, where is the transparency if serious issues cannot scrutinized? Where is the accountability of the system if staff are gagged? This blog will have a limited life, either because the problems it seeks to address are addressed or because the system which has gagged staff of Sydney West Area Health will succeed in gagging them. The outcome, ultimately, is up to all of us.

URL is as follows:

http://whowillspeakforus.blogspot.com/

Oh dear, oh dear such passion.

Worth a browse!

David.

Game Connect Asia Pacific Conference – The Games for Health Forum

This is just a reminder that a workshop on the use of video games for health has been organised for the upcoming Game Connect Asia Pacific conference in Melbourne, Dec 6th.

The Game Developers of Australia E-Health Forum.

This Games for Health forum brings together the Australian game development industry with healthcare providers, clinicians and heath technology developers. It is intended for games and health practitioners, and for academics from both fields. This sector constitutes a rapidly growing $6.6 billion international market, that Australian companies are well placed to access. Experts from the medical and video game industries will speak across a range of topics including:

• Use of game technologies to engage and excite consumers in managing their health and wellness
• Building an ongoing dialogue between the games and health industries
• Current success stories: health/games crossovers that are already getting results
• Update on technology developments and user/market patterns within the games industry
• Accessing Government grants to fund development
• Setting a framework for future collaboration
• And more..

Registrations have been a little low to date so it seemed useful to use the blog to encourage those who may be interested to think about attending this event.

Registrations are through http://www.gameconnectap.com/register.html - (Forum pass, Sunday only)

Please note that this is a HISA supported event. Media will be covering the event and it is hoped the forum will kick start the Games for Health community in Australia.

The full conference web site is here:

http://www.gameconnectap.com/index.html

-----

Sounds like it might be worth spending a Sunday afternoon to learn about the topic!

David.

This Sounds Like Good News for Provider to Provider Communication in Australia.

Dr Oliver Frank cleverly noticed this piece of news from the AMA on Friday last week.

GP Network News Issue 09, Number 38 - 13 November 2009

13 November 2009 - 4:00pm

-----

Scanning and storing electronic referrals and requests

Following Medicare Australia’s review of electronic referrals and requests, individual public key technology certificates are no longer required for provider-to-provider electronic referrals and requests. In addition, the requirement for independent third party verification for referrals or requests scanned for storage has been removed. This change is the result of discussions between Medicare Australia and its stakeholder consultative group, of which the AMA is a member.

More here:

http://ama.com.au/node/5130

The implication of this as I see it is to just make the whole process of referring from one doctor to another doctor or other provider (e.g. allied health) that much simpler than it has been to date for the referring doctor to be sure the referral will be honoured by Medicare Australia and a benefit paid to the recipient of the referral at the appropriate rate.

Note this in no way removes the need for referrals to use a secure, encrypted messaging environment to ensure security and privacy of the patient information. All that has been removed is the need to apply a digital signature – using PKI – to the referral.

As a second, and slightly confusing point, the specialist can now keep a scanned copy of a referral rather than the original paper without needed third party verification of the scan.

Both these steps should have the effect of reducing the ‘friction’ of information flows within the health sector and can thus only be seen as very good things.

David.

It is By No Means Clear The Released Privacy Impact Assessments Get Us Very Far.

As noted in a short blog yesterday NEHTA have released a short commentary document and the three Privacy Impact Assessments (PIA) conducted over the last three years (since early 2006) on the IHI Service.

The documents are found here.

http://www.nehta.gov.au/connecting-australia/privacy/pias

(Note to save as a .pdf find the “Save Pages” Icon and click.)

As always the devil is in the detail. Among the things I found interesting were.

1. The Scope of the Last PIA - which is really the only relevant one (Page 7).

“2.1 Scope of this PIA

This PIA is a consideration of the potential privacy impacts of the IHI on individuals.

This PIA is limited in scope in the following ways:

(a) this PIA relates only to the proposed IHI component of the HI Service as described in 3 and 4 of this PIA

(b) this PIA does not consider the privacy implications of the proposed HPI-I or HPI-O

(c) this PIA does not consider the privacy issues that may arise from using a healthcare identifier as a key or index to identify an individual in another e-health system such as an electronic health records system or electronic prescription systems

(d) this PIA does not consider the privacy issues that may arise from other possible future initiatives which may make use of the IHI, the HI Service or data held in relation to the HI Service

(e) this PIA does not consider the privacy compliance issues involved in a Healthcare Provider’s own use or disclosure of IHIs in its own local record systems, including the possible need to remove the IHI from data for some communications (although it does consider at a high level the nature of restrictions that might be put on such further use and disclosure of IHIs in local records)

(f) this PIA does not consider the privacy impacts of current Medicare Australia procedures

(g) this PIA does not consider the privacy impacts of the content of any participation agreement between a Healthcare Provider Organisation and the HI Service Operator (although it does consider at a high level the possible content of that agreement)

(h) this PIA does not consider the privacy impact of the security measures associated with HI Service infrastructure, including Medicare Australia security measures, security features of digital certificates, and user authentication (although it does consider at a high level some specific security issues)

(i) this PIA does not consider non-privacy related matters (including non privacy supervision of the HI Service Operator)

(j) this PIA does not conduct a detailed assessment of equivalent international approaches or previous international studies (k) the depth and extent of analysis in this PIA is reliant on the depth and extent of NEHTA’s policy work and design decisions to date, and

(l) this PIA only takes into direct account the views of stakeholders that participated in the single stakeholder consultation session conducted on 29 May 2009 (see 8 below).”

So very little consultation, no consideration of the impacts of actually using an IHI and no consideration of the possible impacts on healthcare providers.

2. The NEHTA introductory documents do not make it clear just why it has taken to so long to release these. The last PIA was submitted to NEHTA in late August, 2009.

3. It is clear the outputs of the consultation process on the shape of draft legislation which ended a week or so before this PIA was finalised and which has now led to a second round of consultation.

See here:

http://aushealthit.blogspot.com/2009/11/health-ministers-agree-to-proceed-with.html

4. There is a recurring phrase found in the NEHTA summary:

NEHTA refers to Governments for consideration.

I counted 15 recommendations had that response so all those areas are still ‘up in the air’ As far as I can tell NEHTA does not make it clear just how the answers are to be obtained, specifically from whom and indeed by when. Given these answers are all pretty important to the actual workings of the IHI service it would be good to know!

5. The following from Page 40 of the Malleson’s document also makes it clear there is more PIA work to do:

“However, as stated at 2 of this PIA, this PIA is limited in its scope to addressing the IHI component of the HI Service. A PIA that addresses the privacy impacts of the IHI in isolation from the HPI-I and HPI-O, and the HI Service more generally, is therefore prevented from addressing some of the issues that arise when the three healthcare identifiers operate together. This was a concern raised by some stakeholders who were consulted as part of this PIA (see 8 below). We understand that a separate PIA will be conducted in relation to the non-IHI aspects of the HI Service.”

This is really a joke – surely we need an assessment of the total system and its impact on each of the different types of actors involved (providers, provider staff, consumers, Medicare staff etc).

6. I have to say the Malleson’s document provides a useful summary of what NEHTA has in mind but the more one reads the more wrinkles one sees. E.g. how does the system work if there are two John Smiths with the same Date of Birth – does it return no IHI or a list to choose from based on address?

Overall the documents make it pretty clear what NEHTA was proposing a few months ago for the IHI service but with all these referrals to Government for decisions and the recent Health Minister’s meeting it seems likely some rework and creation of a final PIA (and PIA’s for providers etc) after the legislative consultation will be needed.

7. The following also makes for some worrying reading. (Page 40)

“6.2.2 Uncertainty of some aspects of the HI Service

At the time of undertaking this PIA, some aspects of the HI Service had not been finalised. In particular, the governance framework had not been settled, and its development is ongoing. We identify the governance framework as one of the critical factors in ensuring that privacy aspects of the HI Service are managed appropriately and that materially adverse privacy outcomes are avoided. This PIA is limited to offering suggestions as to key elements of an appropriate governance framework from a privacy perspective.

As the title of the blog says we have a bit of a way to go yet to get real clarity on what this will all look like and how it will be governed. Of course we are all wondering just at what point all of this will be sufficiently well defined for client systems to be modified to use the IHIs!

June 2010 for being operational looks pretty tight!

David.

NEHTA Finally Releases the Privacy Impact Assessments and Its Response!

For all the information go here:

http://www.nehta.gov.au/connecting-australia/privacy/pias

Sorry, no .pdf files for comfortable reading. We have a rubbish Flash Reader presentation with blurry text.

What on earth do these people think they are doing? The rest of Government releases .doc files etc and these jokes just obstruct use of what is public information. They are just clowns in my view and every day that passes just confirms is!

Too late, badly presented and what’s more it seems there is a lot NEHTA needs to refer to Government.

Will be see a UHI any time soon? Your bet is as good as mine!

David.

Weekly Australian Health IT Links - 15-11-2009

Here are a few I have come across this week.

http://www.medicalobserver.com.au/News/0,1734,5623,13200911.aspx

Reward GPs for selling e-health to specialists

Elizabeth McIntosh - Friday, 13 November 2009

GPs are best placed to drive the e-health agenda and should be incentivised to encourage specialists and other health professionals to sign up to e-health systems, experts argue.

NSW Rural Doctors’ Association president Dr Ian Kamerman said while GPs were early adopters of e-health solutions, until other professions came onboard the system would not reach its full potential.

-----

http://www.news.com.au/couriermail/story/0,23739,26350950-952,00.html

New technology to save vision

Suellen Hinde

November 14, 2009 11:00pm

IT'S the Queensland medical breakthrough that could save some of our most vulnerable infants from a life of darkness.

In an Australian first, neonatal nurses at Brisbane's Mater Mothers' Hospital are using hi-tech camera equipment to photograph the eyes of premature babies, to identify a debilitating condition which can lead to blindness.

-----

http://www.theage.com.au/national/sick-of-secret-doctors-business-20091113-ietf.html

Sick of secret doctors' business

MARK METHERELL

November 14, 2009

SOMEWHERE in Australia is a private hospital where patients die at nearly twice the rate considered normal. In the three years to 2006, 199 more people died there than would have been expected for a hospital of its size and patient variety.

In the same 36 months, seven of 54 private hospitals categorised as ''high mortality'' had death rates at least 30 per cent higher than normal. At least 20 had death rates significantly lower than normal.

-----

http://www.onlineopinion.com.au/view.asp?article=9647&page=0

Enhancing healthcare

Australia’s health system has an enviable record internationally. There are, however, significant sectors in the community where lack of access brings with it inequities. A growing demand for healthcare reform has been recognised to prepare Australia for the future and to maintain the high standards we have and demand. Drivers include an ageing population, an increase in the prevalence of chronic diseases, advances in medical technology and knowledge, better informed health consumers, and a need to strengthen the safety and quality of healthcare.

To ensure a sustainable future Australia’s governments have promoted healthcare reform. Integral to this is e-health - for the system, the individuals who will use it and those who work within it.

-----

http://www.motioncomputing.com/about/news/cs_dr_murrell_au.asp

Medical Practice Reclaims Space Once Used for Paper Records, Adding Room for Teaching and Patient Care

Dr. George Murrell, after renovating a 1920s church adjacent to his existing facilities, has transformed the aging building into a modern, paperless, technology-driven orthopaedic practice.

Overview:

In a unique blend of the old and the new, innovative Australian specialist orthopaedic surgeon Dr. George Murrell has worked with Motion Computing’s Tablet PC technology to create a cutting-edge paperless medical practice in a renovated old church in southern Sydney.

Dr. Murrell is the Director of the Orthopaedic Research Institute at St George Hospital and a Professor at the University of New South Wales, dividing his time between academic work, conducting and supervising research in his specialist area of shoulder surgery with his students and Fellows; and seeing patients.

-----

http://www.livewire.org.au/parents/

Join Livewire Parents

An online community where parents and carers of people living a serious illness, chronic health condition or disability can support and connect with one another.

At Livewire Parents you can:

- Connect with other parents and carers

- Post in forums and share advice

- Create a journal about what you're going through

- Find relevant information and resources

Livewire Parents is an online community where parents and carers of someone living with a serious illness, chronic health condition or disability can support and connect with one another.

-----

http://www.computerworld.com.au/article/326022/open_source_key_successful_national_e-health?eid=-255

Is open source the key to successful national e-health?

Open source provides flexibility and agility but questions have been raised over the likelihood of implementation

Kathryn Edwards and Tim Lohman 12 November, 2009 13:23

The Federal Government and healthcare industry bodies should abandon proprietary software and embrace open source software if Australia is to have a successful national e-health platform, argues e-health academic, Professor Jon Patrick.

Professor Patrick, who heads up the health information technology research laboratory at the University of Sydney, said the existing proprietary software used in the health industry lacked the flexibility and cost-effectiveness to meet the demands of emergency department clinical situations.

-----

http://www.smh.com.au/national/warning-of-risks-in-national-gp-register-20091112-icgb.html

Warning of risks in national GP register

NATASHA WALLACE HEALTH

November 13, 2009

DOCTORS have criticised a NSW law that paves the way for national registration, saying its mandatory ''dob-in-a-doctor'' requirement may deter doctors from getting help for drug and alcohol abuse.

The Australian Medical Association said the legislation gave too much power to health ministers over training and accreditation and it was concerned that standards might be reduced to plug workforce gaps.

-----

http://www.computerworld.com.au/article/326007/health_ageing_department_implement_pharmcis?eid=-6787

Health and Ageing Department to implement PharmCIS

Pharmaceutical Consolidated Information System to support business processes associated with evaluation, pricing and listing of drugs on the PBS.

Tim Lohman 12 November, 2009 11:23

The Department of Health and Ageing is to embark on a 14 month project — the Pharmaceutical Consolidated Information System (PharmCIS) — to support the listing of drugs on the Pharmaceutical Benefit Schedule (PBS).

-----

http://www.theaustralian.com.au/australian-it/nsw-unveils-new-id-theft-laws/story-e6frgakx-1225796477366?referrer=email&source=AIT_email_nl

NSW unveils new ID theft laws

• Karen Dearne
• From: Australian IT
• November 11, 2009 2:00PM

THE NSW government plans to create three new identity offences - trafficking in identity data, possession with intent to commit a crime, and possession of equipment for the purpose of identity theft - in an overhaul of the state's Crimes Act.

-----

http://www.ehiprimarycare.com/news/5375/lorenzo_primary_care_announced

Lorenzo Primary Care announced

10 Nov 2009

ISoft executive chairman and chief executive Gary Cohen has announced that a Lorenzo Primary Care will be launched next year.

During a live link-up to E-Health Insider Live ’09, Cohen said iSoft would continue to develop its existing primary care products: Synergy, Ganymede, and Premiere.

-----

http://www.smh.com.au/small-business/finance/losing-the-super-paper-trail-20091108-i3jp.html

Losing the super paper trail

November 9, 2009

WHEN the Federal Government announced late last week that Medicare would double up as a de facto electronic payments service for the superannuation industry, it stopped the $1.1 trillion industry in its tracks.

This left-field decision to let Medicare become the new super clearing house for small businesses was seen by some as a knee-jerk reaction to a multibillion-dollar problem screaming out to be fixed, and by others as a more sinister plot to one day revive the unpalatable access card/national ID card.

-----

http://www.medicalobserver.com.au/News/0,1734,5607,09200911.aspx

Doctor-tracking mooted for attendance at pharma events

Shannon McKenzie - Monday, 9 November 2009

A RADICAL proposal to track individual doctors’ attendance at pharmaceutical company-sponsored educational events has met with a cool reception from GPs.

Writing for PLoS Medicine, Australian academics from the University of Newcastle in NSW have suggested the establishment of a “central register or database that identifies attendees at company-sponsored functions”. The database could be compiled using information collected by pharmaceutical companies.

-----

http://abnnewswire.net/press/en/61711/iSOFT_Group_Limited_ASX:ISF_Boosts_Innovation_Programme_With_New_Medical_Advisory_Board.html

iSOFT Group Limited (ASX:ISF) Boosts Innovation Programme With New Medical Advisory Board

Sydney, Nov 9, 2009 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the success of the inaugural meeting of its Medical Advisory Board (iMAB), which took place in England on 23 October.

-----

http://news.smh.com.au/breaking-news-technology/cloud-computing-market-14-bln-us-dollars-by-2014-gartner-20091110-i5sp.html

'Cloud' computing market 14 bln US dollars by 2014: Gartner

November 10, 2009 - 8:05AM

Industry tracker Gartner forecast on Monday that revenue from Internet-based "cloud computing" will top 14 billion US dollars annually by the end of 2013.

Revenue from businesses using software programs hosted online as services in the Internet "cloud" should tally 7.5 billion US dollars this year, a 17.7 percent leap from 2008, according to Gartner.

-----

http://www.businessspectator.com.au/bs.nsf/Article/Clouds-clearing-pd20091105-XGU9K?OpenDocument&src=sph

Commentary

Avoiding cloud catastrophe

6:45 AM, 9 Nov 2009

Isabelle Oderberg

In the second of a two-part series, we move from examining exactly what the cloud is and what it can save you to look at avoiding the major pitfalls.

When wading into the murky world of cloud computing there is no one-size-fits-all solution. The products on offer – billing structures, security measures, storage locations and capabilities, to name just a few – are wide and varied, but there are a few basic things to look out for.

-----

Enjoy!

David.

Health Ministers Agree to Proceed with National Health Identifiers.

We have the following release on Friday.

Australian Health Ministers’ Conference

COMMUNIQUE

13 November 2009

National Breastfeeding Strategy endorsed and more progress on e-health and elective surgery

Health Ministers today met in Adelaide to discuss a range of issues including e-health, improving elective surgery performance, and strengthening accountability and performance reporting in the health system. The meeting was chaired by South Australian Health Minister, John Hill.

-----

National e-health system one step closer

Health Ministers today affirmed their commitment to the introduction in 2010 of national healthcare identifier numbers and agreed to release for further consultation draft legislation for establishing the healthcare identifiers.

Ministers considered feedback from the first phase of public consultations held in July-August 2009. Following these consultations and feedback, further work has been done on the identifiers to clarify and strengthen patient privacy. Ministers have now agreed:

· the legislative framework will limit the use of healthcare identifiers to health information management and communication purposes as part of delivering a healthcare service;

· healthcare identifiers will be underpinned by effective national privacy arrangements, protecting health information wherever it is associated with healthcare identifiers, regardless of whether the information is held by a public or private organisation;

· the Healthcare Identifiers Service (HI Service) will have an appropriate governance framework with transparent and accountable processes;

· penalties will apply to the misuse of healthcare identifiers; and

· to review the implementation of the healthcare identifiers after a period of two years.

Healthcare Identifiers are unique numbers that will be given to all healthcare providers, healthcare organisations and healthcare consumers. These unique numbers will provide a new level of confidence when communicating patient information between the myriad of private and government healthcare providers and systems. The identifiers are an important building block for the eventual introduction of a patient controlled Individual Electronic Health Record.

The legislation to establish the Healthcare Identifiers will be introduced to the Federal Parliament in the Autumn 2010 sittings.

----

The full release is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/27E97A461DE80EC7CA25766D0010CC9B/$File/dept131109.pdf

Press coverage is found here:

Steps taken to safeguard health IDs

• Karen Dearne
• From: Australian IT
• November 13, 2009 9:37PM

AUSTRALIA's health ministers have committed to restrictions on the use of national health identity numbers, including "effective" privacy arrangements and penalties for misuse, according to a brief communique released late today.

Federal and state ministers have agreed to release draft legislation for the healthcare identifiers regime for public consultation ahead of its planned introduction to the federal parliament in the autumn 2010 sittings.

The tight timeframe means responses to the draft will likely be required during the Christmas/school holiday period, testing the resources of many largely voluntary consumer and privacy advocacy groups which have voiced concerns over aspects of the proposals this year.

Under the planned Unique Healthcare Identifier scheme, all patients will be issued with an individual health ID number linked to their existing Medicare number and card; the number, together with a person's name and date of birth, is essential for the accurate matching of health information sent across electronic systems by medical providers such as doctors, hospitals, laboratories and pharmacists.

The intention is to improve patient care and safety across the healthcare system, while the automatic collation of patient data will provide a basis for the creation of personal e-health records.

The Australian Health Ministers' Conference (AHMC) has set a mid-2010 deadline for the start of the UHI program, to be operated by Medicare, but a range of privacy and legal obstacles need to be overcome first.

Consumer and medical privacy groups have been unhappy with the handling of public consultations over the proposed legal framework for the regime to date. A discussion paper was deemed unduly limited in scope, while an initial refusal to post submissions attracted further fire.

A commitment by the National E-Health Transition Authority to release three privacy impact assessments examining aspects of the proposal also failed to defuse tensions, with the documents still not available on the organisation's website.

More here:

http://www.theaustralian.com.au/australian-it/steps-taken-to-safeguard-health-ids/story-e6frgakx-1225797531722

Fascinating stuff. If ever there was a press release where the devil will be in the detail – legislative detail no less – this is it!

As Australian IT rightly points out we have still to see the promised Privacy Impact Assessments. Indeed I suspect with what one reads from the Ministerial Statement that a new one will be required to ensure compliance with the now stated position on use and misuse of the Health Identifiers. (Certainly not as late as today Nov 15).

I hope a reasonable period is allowed to review the draft legislation and understand what implications it carries both for consumers and providers.

David.