This is Very Sad – But it Reflects the State of E-Health in Australia I Fear.

When you visit the Health Informatics site of the Central Queensland University you are now greeted with the following announcement.

http://healthinformatics.cqu.edu.au/

Health Informatics

Central Queensland University

The Health Informatics Research Group ceases to exist at Central Queensland University as from 16 November 2007. All current HI research students will continue to be supervised by former CQU staff now in adjunct positions till completion. New research students can enrol via the University of Melbourne.

CQU will no longer accept new student enrolments into its Health and Nursing Informatics educational programs. Existing students will be able to complete their active study programs. New educational programs are under development to be offered next year by another provider. More about that in 2008 as this is a work in progress.

All Health Informatics Research Group members, including current Adjunct Professors remain dedicated to their respective research areas, in particular the openEHR approach, in new positions and functions; we are continuing with the implementation of various funded projects and will continue to collaborate to realise our shared vision.

• Prof. Evelyn Hovenga will continue to be based in Rockhampton, work virtually and travel as required.
• Consultant, openEHR Foundation, University College London
• Honorary Academic Fellow, Nursing Informatics, Austin Centre for Applied Clinical Informatics, Austin Health
• Honorary Professor, Health Informatics Network, University of Melbourne (TBC)
• Dr Carola Hullin has taken up the role of facilitator of the global Health Informatics collaboration with Latino America, especially with regard to openEHR.
• Dr Sebastian Garde has taken up a position with Ocean Informatics, one of the leading providers of Health IT solutions empowered by openEHR.
• Maria Madsen will continue to be employed by CQU and look after all coursework students during the planned HI phase out period to be completed by the end of 2009.

The electronic Journal of Health Informatics (eJHI) previously hosted and managed by CQU, will continue to operate as the official journal of HISA (Health Informatics Society of Australia) and ACHI (Australian College of Health Informatics) and further collaborators are being sought.

All Health and Nursing Informatics mailing lists previously hosted by CQU have been or are in the process of being transferred to new hosts.

Continue here to the former and no longer maintained pages of the Health Informatics Research Group.

Comment:

It seems to me we have reached a bit of a nadir here. As far as I know there is no course work based Bachelors or Masters in Health Informatics currently being offered anywhere in Australia (please let me know if I am wrong – I don’t include courses in this comment that are mostly for Health Information Managers that are targeted at Medical Records Management Staff etc) and we really can’t afford to have Health Informatics Groups be closing!

We really can’t develop a profession, or make a real difference, unless we can train a reasonable number of people and ensure they have a credible career path to follow. This announcement does not bode well for any of those hopes. It would be really good that as part of the 'Education Revolution' we could start something in the Health Informatics domain!

A sad day!

David.

The Canadian Patient Speaks on Electronic Health Records.

Two recent articles cover a very interesting Canadian survey which was sponsored by Canada Health Infoway, The Canadian Privacy Commissional and Canada Health.

To the north, health IT trust is on its way up

By: Joseph Conn / HITS staff writer

Story posted: November 21, 2007 - 5:59 am EDT

Canadians, it seems, have a growing infatuation with healthcare information technology, even though, like Americans, they are concerned about privacy and fearful that their healthcare information could be used against them.

Just out in English and French is a new, 107-page report, Electronic Health Information and Privacy Survey: What Canadians Think—2007, by the federal IT booster agency, Canada Health Infoway, Health Canada and the Office of the Privacy Commission of Canada.

Researchers contacted 2,469 Canadians age 16 and older in June and July for over-the-phone interviews of about 20 minutes in length.

They gave exceedingly high marks to an oft-cited raison d’etre for IT in that 87% of respondents agreed with the statement that it is difficult for doctors and other providers to give high-quality care if they don’t have timely access to their patients’ health information.

And while a hard-core 17% consider information about them held by the healthcare system as not very safe and secure, 40% thought it was “moderately safe and secure” and 39% thought it was “safe and secure.”

But the survey did note that over the past four years there has been an erosion of trust by Canadians in healthcare workers and organizations over whether they would keep their information safe and secure.

Continue reading this very comprehensive article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071121/FREE/311210023/1029/FREE

and second

Canadians want secure e-health records, says survey

By: Lisa Williams, senior writer, InterGovWorld.com

(Nov 20, 2007 06:00:00)

The majority of Canadians support the development and use of electronic health records (EHRs), but expect that their privacy will be protected in the collection, storage and use of their personal health information.

This was one of the findings of a recent a recent survey sponsored by Canada Health Infoway, the Office of the Privacy Commissioner of Canada, and Health Canada.

The Electronic Health Information and Privacy Survey was conducted by EKOS Research Associates and is based on interviews with approximately 2,500 Canadians last summer.

Minister of Health, Tony Clement said in a statement that the government is committed to pursuing new technologies that improve health-care delivery, while ensuring the privacy of personal information.

"Once fully implemented, private and secure electronic health records will increase efficiencies, reduce wait-times and result in significant savings in our health care system," said Clement.

The poll results concluded that almost two-thirds of Canadians believe there are a few types of personal information that are more important for privacy laws to protect than personal health information, and that almost nine in 10 Canadians support the development of EHRs.

Jennifer Stoddart, Privacy Commissioner of Canada said it's clear that Canadians want the protection of their privacy to be a key factor as the government considers how these highly sensitive records are managed and the potential secondary uses for these data.

Currently, Canada Health Infoway has EHR implementation initiatives underway across Canada, according to its president and CEO, Richard Alvarez.

"This research confirms Canadians support the acceleration of private and secure electronic health records," said Alvarez.

The survey also revealed that 89 per cent of respondents believe the use of EHR systems, compared to the previous paper-based set-up, is better in terms of the overall effectiveness of the health-care delivery.

Continue reading here:

http://www.intergovworld.com/article/59f6d44e0a010408008b33e8e5c4491d/pg1.htm

The full report and the two articles are very much worth reading.

What I find most interesting about all this is that in Canada and to a lesser extent in the US there is widespread public acceptance that – as is said in the second article “respondents believe the use of EHR systems, compared to the previous paper-based set-up, is better in terms of the overall effectiveness of the health-care delivery.”

It would be a fascinating market research exercise to assess just where the Australian public is on all this. I expect that with the lack of leadership that has been so chronically manifested in this area over the last decade we would be lucky to be at half the acceptance level.

The core findings of the study are so obvious as to be totally unremarkable.

First – without patient confidence and trust that their health information is secure – the game is off.

Second – the level of trust drops rapidly the further those who access health information are from actual care delivery, and people essentially require to know if their information leaves their direct carers .

Three – if made secure – electronic records are good things.

This package is in my view indivisible and has to come together for success!

Critical background reading!

David.

Useful and Interesting Health IT Links from the Last Week – 26/11/2007

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

These include first:

E-health fails as election issue

Karen Dearne | November 20, 2007

THE election campaign is still an e-health-free zone as the major parties continue to duck the issue at the Australian General Practice Network's forum in Hobart last weekend.

Opposition health spokesperson Nicola Roxon said Labor's $2.5 billion reform plan would "kickstart investment in immediate improvements in the healthcare and hospital systems". Labor would also establish a national commission to develop a blueprint for health reform, she said.

Mr Abbott told delegates "not to hold your breath" for more Coalition promises on rural, IT or indigenous health.

He said he was frustrated nothing had come out of the Government's investment in IT, and he wasn't handing over any more money until outcomes were guaranteed, an industry journal reported.

Mr Abbott's frustration is unlikely to exceed that of industry players who have watched e-health programs and spending stall under his leadership. Tellingly, the Coalition did not claim credit for any e-health initiative in its health policy after 11 years in office.

…..

Meanwhile, the Health Informatics Society of Australia released its own vision for transforming healthcare last week.

Society president Michael Legg said there was little sign of understanding of the value of e-health at the federal level.

"Perhaps politicians are frightened because it's so hard to do and so easy to fail at," he said.

…..

Read the whole article here:

http://www.australianit.news.com.au/story/0,24897,22786526-15306,00.html

The election is over and we no longer have to put up with the e-Health incompetence of Minister Abbott – frankly all I can say is good riddance and thanks for absolutely nothing!

The wood is now on whoever becomes the new health minister to do a great deal better the previous incumbent.

Second we have:

Lost in mail: data of 25m people

Julia May in London

November 22, 2007

NEARLY half of Britain's population is on alert to the threat of identity theft after the Chancellor of the Exchequer admitted that the personal records of 25 million people had been lost in the mail.

A Scotland Yard investigation is under way and the Government braced for a wave of censure after Alistair Darling told Parliament on Tuesday that two compact discs containing bank details and addresses of 9.5 million parents and the names, dates of birth and National Insurance [social security] numbers of all 15.5 million children in the country went missing after a junior Revenue and Customs employee put them in the post.

MPs gasped as Mr Darling revealed the scale of the security breach. He said that police had discovered no evidence of fraudulent activity, but added: "I recognise that millions of people across the country will be concerned about what has happened. I deeply regret this and apologise for the anxiety that will undoubtedly be caused." He warned the public to monitor their bank accounts for unusual activity.

On October 8, in breach of security rules, the discs were burnt and sent by the unnamed tax office worker via unregistered courier to the National Audit Office for statistical sampling. The information was never meant to include addresses, bank information or parent details.

Read the complete article here:

http://www.smh.com.au/news/world/lost-in-mail-data-of-25m-people/2007/11/21/1195321867124.html

This is really a fiasco of the first order. This sort of managerial incompetence that exposes records of this sensitivity to copying or theft is beyond belief. As I have said previously such ‘stuff ups’ risks the credibility of all attempts to make the sharing of sensitive information possible and makes progress in the e-Health domain just so much harder.

Third we have:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=government&articleId=303858&taxonomyId=13&intsrc=kc_feat

Denmark's Health Portal Reaches 5.3 Million Residents

Mary K. Pratt

November 19, 2007 (Computerworld) Denmark, like most countries, faced a serious health-related quandary: how to deliver efficient, effective and affordable care at a time of escalating costs and increased demand for services.

But unlike many others, Denmark harnessed IT to create a national health portal to help drive improvements in its health care system. This portal, called Sundhed.dk (sundhed means “health”), has increased communication among doctors and between doctors and patients, increased collaboration among health care providers, boosted efficiencies and even improved the quality of care.

The Danish National e-Health Portal is attracting attention from around the globe, thanks to its innovation and success. It’s also the 2007 winner in the health care category in Computerworld’s annual Honors Program.

“There are very few regions or countries of the world that have done anything like what Denmark has done. They’re all talking about it, how nice it would be to have something like this,” says Jonathan Edwards, a London-based analyst at Gartner Inc.

The idea of a portal isn’t unique to Danish health officials. Businesses and other institutions were already using them while Sundhed.dk was still in its infancy in the early 2000s.

Continue reading here:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=government&articleId=303858&taxonomyId=13&intsrc=kc_feat

This is a long and interesting report reviewing the progress the Danes have made with e-Health over the last six to seven years. Very well worth a read.

Fourthly we have:

Medical records pioneer maintains research path

By Sandy Kleffman, STAFF WRITER

Article Last Updated: 11/19/2007 08:16:56 AM PST

WALNUT CREEK — At age 94, Dr. Morris "Morrie" Collen still shows up to work one or two days a week at Kaiser Permanente's Division of Research in Oakland.

At other times, he is busy writing his fifth book.

Collen is so unassuming that fellow residents in the Sunrise assisted-living complex in Walnut Creek probably have no idea of the pivotal role he has played in modern health care. He is considered one of the pioneers of electronic medical records, now being implemented in hospitals and doctors offices throughout the nation.

Collen had a computerized medical record system in use in San Francisco in 1969. It was one of the first in the nation and was developed at a time when computers took up nearly an entire room and the input was done with punch cards.

He also is one of the founding members of the Permanente Medical Group, which later became part of the large Kaiser Permanente health system.

Continue reading this fascinating article here.

http://www.insidebayarea.com/argus/localnews/ci_7504485

The Electronic Health Record of the 1960’s is a fascinating story indeed and well worth a browse!

Fifthly we have:

Survey shows waning support for the UK’s NPfIT

20 Nov 2007

Waning enthusiasm from doctors for the National Programme for IT (NPfIT) is recorded in a Medix survey of medical opinion prepared for E-Health Insider and other media.

Only 30% of GP respondents say the programme is an important priority, compared to an all-time high of 70% in a similar survey in November 2004. A parallel decline is recorded among non-GPs whose rating of the programme as an important priority has dropped from a high of 80% to 45%.

Although 23% and 35% of GPs and non-GPs respectively said they were enthusiastic about the programme, the ratings stood at 56% and 75% four years ago.

Asked to rate the programme’s progress, the vast majority (71%) scored it as poor or unacceptable. No respondent checked the box for ‘excellent’ and only 1% thought NPfIT was making good progress.

Connecting for Health, the agency responsible for the programme, says the results of the survey do not appear to reflect the general picture on the ground or chime with other recent comprehensive surveys.

The Medix survey is the latest in a series that started over four years ago. It was conducted at the end of October and beginning of November, gathering the views of 1,064 doctors - just over 1% of the medical profession in England - comprising 44% GPs and 56% doctors practising in other areas, predominantly hospitals.

Continue reading here:

http://www.e-health-insider.com/news/3228/survey_shows_waning_support_for_npfit

If ever there was a message about the complexity of successful change in large scale projects this is it. This lesson should be noted very carefully by NEHTA as it plans an Australian Shared EHR.

Lastly we have:

Tele-treatment - Monitoring from afar, 'eICUs' fill medical gap

By Liz Kowalczyk, Globe Staff

|

November 19, 2007

WORCESTER - On a recent Saturday night, Dr. Craig Lilly studied a wall of video screens, monitoring the heart rates, urine output, and breaths per minute of fragile patients in the intensive care unit. One patient was clearly in trouble.

Franklin Sisler, a retired Air Force master sergeant, was suffering from an aggressive infection in his left knee that had reached his lungs. A blue line tracking Sisler's kidney function was climbing, a warning that his organs were failing, and Lilly decided he needed an operation right away.

He advised a junior doctor to give Sisler more fluid and antibiotics immediately, call in an infectious disease expert, and make sure Sisler got the next available surgery slot to clean out his knee. "It might make the difference between him walking out of the hospital or not," Lilly told a colleague.

Lilly is an intensive care specialist, but he was seated not in the intensive care unit, and for that matter, not even in Sisler's hospital.

Rather, he was working out of a low-rise office building in downtown Worcester - 3 miles from where Sisler lay at UMass Memorial Medical Center.

From this carpeted, fluorescent-lit support center, called an "eICU," Lilly and nurse practitioner Joanne Lewis were supervising the care of 109 of UMass Memorial's sickest patients, scattered among eight ICUs at three of the system's hospitals. They are part of a new program that aims to cope with the soaring number of ICU patients, a problem exacerbated by a shortage of intensive care specialists.

There are 20 percent more ICU beds nationwide now than there were 10 years ago, and too few doctors trained to care for the patients filling them. The vast majority of hospitals do not have an ICU specialists working at night or on weekends, despite studies showing that when intensive care doctors manage or help manage ICU patients, the patients' chances of dying in the hospital decrease by 30 percent.

Continue reading this interesting article here:

http://www.boston.com/business/globe/articles/2007/11/19/tele_treatment/

As some-one who in a former live spent five years as an intensive care specialist I would make two points. The first, rather self serving one, is that I for one am convinced of the thesis that ICU specialists to make a positive difference for the patients they care for and second that it would be great fun to work in a unit equipped at the level discussed here!

All in all some interesting material for the week!

More next week.

David.

The Federal Election is Over – So What’s Next?

Well it was a long night but at the end of it Mr Howard conceded defeat and Mr Rudd became the next Prime Minister of Australia. What will all this mean for the Health Sector and for e-Health in particular.

Because Mr Rudd has said he is going to appoint his own Ministry we cannot be sure who will be Health Minister, although Nicola Roxon must be a strong favourite or maybe – just possibly – Julia Gillard may decide health would be more fun than IR – she was a well informed and articulate health spokesman in the past and understood e-Health quite well.

Among the key facts are:

1. The Human Services Access Card is now officially not going to happen.

2. We are not going to have 750 hospital boards established around the country.

3. We are not going to have a sudden rash of nursing schools re-established in Hospitals from which they were removed about 30 years ago for very good reason.

What we are going to have – if ALP Policy is to be implemented some important changes in the Hospital, GP and Dental Sectors at least. From the policy speech we have:

“Hospitals

On hospitals, we have put forward a national plan to end the buck-passing between Canberra and the States.

I have a long-term plan to fix our nation’s hospitals.

I will be responsible for implementing my plan, and I state this with absolute clarity: the buck will stop with me.

Mr Howard, by contrast, has put forward no new plan.

He prefers to continue buck-passing to the States, instead of taking responsibility for fixing the system.

Australians are fed up with this tired, old game.

Australians want a long term solution for our hospitals.

They are sick and tired of short term excuses for not fixing our hospitals.

We will deliver 2,000 extra aged care beds to take the pressure off acute hospital beds.

GP SuperClinics around Australia to take the pressure of accident and emergency departments.

A national fund to eliminate elective surgery waiting lists beyond clinically acceptable times.

A massive national investment in the war against cancer.

And 10 years after Mr Howard abolished it, we will re-establish a Commonwealth Public Dental Program.”

More details of Labor’s plans to address the Commonwealth State divide are found here.

The full ALP Policy Platform can be found here – Chapter 10 is the important bit for this blog.

The two relevant sections for e-Health are as follows:

ALP National Platform and Constitution 2007

Tele-health

47. Labor will significantly expand access and improve decision making processes for patients and health professionals through the encouragement of new technologies. The potential applications for tele-health in rural areas are significant, particularly as a means of reducing the level of professional isolation experienced by rural and remote health workers. Labor will provide resources to significantly expand tele-health services. These new technologies will be used to complement the delivery of face-to-face services in rural areas rather than replace them.

And

Harnessing New Technology and Managing Patient Information

“67. Labor sees major opportunities for new technology to make health services more effective, more accessible and more consumer friendly. Technological change needs to be carefully managed with close attention to the social and ethical implications and the need for privacy for personal health records. Labor will ensure that commercial interests do not subvert intended health outcomes and that decisions are made on the basis of clinical and cost effectiveness determined by the best available research evidence.

68. Labor will, in collaboration with State and Territory governments, build information technology and communication infrastructure and systems that improve the decisions made by consumers, clinicians and health service managers about care, service delivery and policy. The purpose of this investment will be to:

• build accessible knowledge bases from quality data systems, libraries of research evidence and the experience of consumers and professionals;

• enhance online communication between consumers and professionals, and primary and acute care settings, regardless of location, to improve health outcomes and service quality; and

• create data management systems that monitor population health and the safety, quality and efficiency of health services.

69. Labor will ensure that appropriate training is undertaken by health professionals to develop and maintain the skills necessary to use these knowledge bases, health records and communication systems.

70. Labor believes the development and implementation of health knowledge management systems that include electronic health records and decision support systems for evidence based practice are central to improving the safety and quality of health services. However, these new tools cannot be widely used until satisfactory arrangements are in place to protect security and privacy.

71. Labor will ensure every Australian has a personal electronic health record that is privacy protected. Labor will develop a strong privacy regime built around a unique patient identifier based on the Medicare card. Legislation will prohibit this number being used for any other purpose and access will depend on authorisation from both the patient and the doctor. A range of other safeguards will be incorporated in legislation, which will be developed after a public inquiry into all the issues.

72. It is critical that health providers can communicate effectively with each other while maintaining patient confidentiality. Labor will provide leadership in the development of national, secure health data standards and will establish a common framework for health record systems. The delay in establishing this infrastructure is inhibiting the delivery of quality health services in Australia and contributing to unnecessary adverse events.

Specifically Labor will ensure:

• the use of tele-health to give rural clinicians direct access to city based specialists and the resources of major teaching hospitals;

• the use of secure electronic networks to give clinicians and pharmacists access to high quality drug information sources; and

• the use of electronic prescriptions to speed up and reduce errors in communications between clinicians and pharmacists.

73. Labor will give Medicare Australia greater powers to analyse data to examine variations in practices, to enable the promotion of professional practice based on the best available evidence from research. Clinicians will be supported in their evidence-based practice through the development of appropriate, accessible clinical guidelines and pathways of care.”

All this is music to those who see further development in e-health as fundamental to better health care safety, efficiency and quality. It must all be followed up and implemented!

What is missing from the policy platform are three things. These also need to happen in my view:

1. There is not a section that makes the link between effective computerisation of General Practice and delivery of consistent quality GP care – which is what is needed to actually have more preventive care undertaken. Intelligent advanced decision support for GPs is a major way to make sure all relevant interventions are scheduled, undertaken and followed up.

An extra sentence or two in this area would have made me a much happy camper – knowing the link between e-health deployment and better preventive care was fully appreciated at the top!

2. There is no commitment to undertake development of the National E-Health Plan most realise is needed urgently and which has been superbly documented by the Health Informatics Society of Australia.

3. There needs to be the onset of openness and transparency – as Labor has proposed – with the release of and actioning of the Boston Consulting Group review of NEHTA.

That is enough to put on the new Minister’s Agenda for the first 100 days of the new Government.

We can hope at last, so let’s get on with it! I hope I will not be disappointed.

David.

Weekly News Bits will be posted tomorrow.

D.

E-Health Reform Might Be Slipping Away.

Just came across the following.

Queensland Health appoints new Director-General

Friday 23 November 2007

Premier Anna Bligh has announced Director-General of Queensland Health Uschi Schreiber would be leaving her position to pursue new career opportunities.

Bligh says Queensland Health Executive Director of Policy Planning and Resourcing Professor Andrew Wilson in Queensland Health will be acting Director-General while the position is advertised.

It has been reported Schreiber will take leave from December 11 and her resignation would be effective from February 29, 2008.

"Since 2005 Schreiber has led the reforms in Queensland Health which have seen the ongoing implementation of the Government's Health Action Plan," says Bligh.

Schreiber is moving to Sydney to take up a partnership offered to her by Ernst and Young earlier this month.

Continue reading here:

http://www.qbr.com.au/index.cfm?storyid=33468&cp=displaystory&type=s

As I have previously said on the blog – leadership instability is death in Health IT! – and that’s just what we have.!

The most recent editorial at of the Chik Newsletter makes the point eloquently.

“Some two and a half years ago, NEHTA was formed. Its Board of Directors consists of the Secretaries and Directors General of Health of Australia's nine jurisdictions (Federal and State/Territory). Now only two of the original NEHTA Board members remain and the loss of corporate memory, experience and intellectual capital this reflects is staggering. With such a degree of churn at the highest level, little wonder that decisions with the potential to involve billions of taxpayer (and voter) dollars have a hard passage to traverse.”

Bad news all round and especially for a decent outcome from the Boston Consulting Group Report.

David.

Interesting Move In Decision Support!

The following article appeared in Healthcare IT News a few days ago.

Diagnosis and treatment now a click-away

By Molly Merrill, Contributing Writer 11/16/07

RESTON, VA - Isabel Healthcare, a provider of diagnosis reminder systems, has partnered with Wolters Kluwer Health to provide clinicians with access to evidence-based medicine for both treatment and diagnosis.

Wolters Kluwer Health's decision-support system, called Clin-eguide, will be integrated with Isabel's Web-based decision-support system. Clin-eguide provides clinicians with evidence-based information on diagnosis, management and treatment. It incorporates content from Ovid, Facts & Comparisons, and Lippincott, Williams and Wilkins, as well as other publishers.

Clin-eguide can be integrated with electronic medical records or used on a stand-alone basis.

"Patients present with clinical features and Isabel is able to uniquely assist clinicians the quality of diagnosis decision making by processing clinical features into diagnoses," said Joseph Britto MD, CEO and co-founder of Isabel Healthcare.

Wolters Kluwer Health, based in Conshohocken, Pa, is a division of Wolters Kluwer, a provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Clinicians who already utilize Clin-eguide to check facts, review evidence, determine treatment and check drug interactions will now have access to Isabel.

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8150

It seems to me this is a substantial addition to the Wolters Kluwer Health product range. Users of many electronic data bases in the health sector will have been familiar for many years with the electronic journal offerings which are available via Ovid, Lippincott and Williams and Wilkins.

Adding the capabilities of Isabel (which provides suggestions, based on patient symptoms, to diagnostic possibilities which may not have occurred to the clinician) to this extensive array of reference sources, within a single portal, is a great idea.

Sadly the provision of these invaluable information services is not free. Can I suggest that whichever party wins the upcoming election – we have a commitment to make these services available to the Australian clinical community via a national license.

I suggest this would do more for patients in Australia in the short to medium term than we are likely to see from initiatives such as SNOMED and so one – while not diminishing for a moment the longer term value of such moves.

This can happen quickly, at relatively low cost, and with the CIAP experience in NSW being positively evaluated, there is no reason to delay.

David.

The Truth Will Out it Seems!

It looks like Dean F. Sittig, Ph.D., in his estimable Informatics Review, has really found a good one this time!

Informatics Review - Nov 15, 2007 : Vol.10 No.22

Mr. HIStalk's universal rules for big EMR rollouts

In case you haven't heard of Mr. HIStalk, here's a link to his blog illustrating his uncanny ability to succinctly say exactly what we all think and are afraid will slip out at the most inopportune time.

Universal Rule #8. You'll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you'll refuse to apply them because you're scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

Continue reading the other finds at:

http://www.informatics-review.com/

This blog is really amazing and there is certainly the ring of truth in the following:

November 16, 2007

From HIT Insider: “Re: Sutter. Haven’t seen this article on Sutter Health wasting millions on its Epic installation yet.” Link. Sutter’s original estimate to install Epic in six hospitals: $150 million. Current estimate: $500 million and going up. Nearly $100 million for one hospital? Says they learned from Kaiser’s mistakes.

Mr. HIStalk’s universal rules for big EMR rollouts:

1. Your hospital will pledge to make major processes changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

…..

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

…..

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

…..

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

For the full 10 rules (and a whole lot more) visit

http://histalk2.com/2007/11/15/news-111607/

None of this will surprise anyone who is familiar with the challenges of Hospital Information System planning and implementation and I think it is vital that these sort of rules be kept in mind to avoid extreme strategic overreach!

No one know better than I how hard all this is – to be warned is to be armed and to have an improved chance of success.

Weep and Enjoy!

David.

The Sad Joke of Public Accountability and Transparency in Australia.

Regular readers of the blog will be familiar with my frequent complaint about the secrecy and lack of transparency we all see from NEHTA.

Despite the following comments in the recent annual report suggesting possible change a close read makes it perfectly clear that the situation is not about alter.

“This new phase will see a more transparent and consultative approach from NEHTA to its work with the vendor community, jurisdictions and other interested parties. The current review of NEHTA, which was built into NEHTA’s constitution as a requirement, is an independent assessment of and

status report on NEHTA’s progress to date. This process will assist the Board in better evaluating key decisions and framing more precisely the future evolution of e-health for Australia.

We have greatly welcomed input by interested stakeholders into the review process and look forward to the outcomes and recommendations later in 2007.”

What do you reckon is the chance of the Board making the review public and responding openly to the recommendations. My answer is (remembering the Board have had the final report for over a month now), two – Buckley’s and none!

What saddens me more is that NEHTA is typical of much of current public administration these days. My evidence is derived from the recent Moss report.

This report is covered in the following reports:

Secrecy, spin and the right to know

November 7, 2007

It's a boutique issue, but Australian governments are increasingly secretive, to the detriment of democracy, writes Michelle Grattan.

A COUPLE of days before the election was announced, Gough Whitlam and Malcolm Fraser, old foes who now think alike on many things, made a joint call for ministerial accountability to be an election issue.

No one took much notice. But it is surely significant that men who have led the country believe this is important — even if the cynics would say it is a bit after the event in their cases.

Accountability, at all sorts of levels, has clearly declined over the Howard years. The ministerial code of conduct, which claimed some eight ministerial and parliamentary secretary victims in the first Howard term, was soon honoured more in the breach.

Secrecy, control and spin have become more pronounced. They are not unique to this Government; the same thing has happened at state level, where Labor administrations have been highly manipulative. The rise and rise of security has been a convenient excuse, especially at federal level.

The pursuit of greater accountability is a boutique issue. Labor pledges more openness and better behaviour, but the test would be what actually happened in office.

Length of time in power and, most recently, Government control of the Senate have been critical to the decline of accountability. The Senate committee system has been one of the best checks on government and a proven mechanism for getting information. When the Coalition won a majority at the last election — which took effect in mid-2005 — it soon whittled away the Senate's scrutiny powers.

Senate clerk Harry Evans says that since mid-2005 the Senate's accountability function has virtually disappeared. "Nothing gets referred to committees without the Government approving. No resolutions for documents to be tabled get passed (with one minor exception)." Requiring the tabling of documents was one of the methods by which the Senate extracted information.

Mr Evans also observes that in estimates and other committee hearings, ministers and public servants have been more inclined to refuse to answer questions. "They know nothing can be done in the chamber. The classic case was AWB. At the first estimates hearing a statement was made that no one would answer questions, full stop." The Government's defence was that the Cole commission into the affair was under way.

It is salutary to remember that while the truth took a long time to come out in the "children overboard" affair, it might not have emerged at all if the Government had then had control of the Senate.

Continue reading this excellent article here:

http://www.theage.com.au/news/federal-election-2007-news/secrecy-spin-and-the-right-to-know/2007/11/06/1194329225660.html

and here:

Lid lifted on politics of secrecy

Matthew Moore Freedom of Information Editor

November 6, 2007

Latest related coverage

• Matthew Moore: Over the first hurdle, now for the hard bit
• PDF: The full Moss report

THE major media companies have attempted to make access to government information an election issue by releasing a damning report on the topic just three weeks before the federal poll.

The companies, which formed a lobby group in May called the Right to Know Coalition, launched the report, which attempts to audit the problems faced by the media in getting access to information held by governments and courts.

The Independent Audit of the State of Free Speech in Australia says governments have continued to impose barriers which are "whittling away the notion of open and easy access" to information.

It highlights secrecy provisions in 335 separate state and federal acts of Parliament, and the fact there are more than 1000 court suppression orders in force at any one time as examples of the difficulties the media have in providing information to the public.

Much of the report is devoted to problems with freedom of information laws including:

■ A 1993 request to the Queensland Treasurer for information about Jupiter's Casino which took 12 years to answer.

■ A $1.25 million fee quoted to Melbourne's Herald Sun newspaper for access to information about travel by federal MPs.

■ A refusal by the NSW and SA governments to reveal which clubs and hotels make the most money from poker machines because this information would "endanger lives".

The former NSW ombudsman and head of the coalition, Irene Moss, said she originally thought media complaints about lack of access to information were something of "a beat-up" but soon changed her mind when she saw the findings from a survey of more than 300 journalists.

She pointed to a "culture of secrecy, defensiveness and mutual mistrust" on the part of government and other public bodies.

Continue reading here:

http://www.smh.com.au/news/national/lid-lifted-on-politics-of-secrecy/2007/11/05/1194117959737.html

Frankly, there is no real need to go on about all this, other than to point out that if this sort of behaviour becomes entrenched we will only have more of the sort of corruption emerge that is now being exposed by the Auditor General in such activities as the Regional Grants Scheme and in the various state entities such as the ICAC, CJC, and CIC.

NEHTA should know that ultimately the Auditor General will (if only to check on the fate of the Commonwealth Funds provided) come knocking and if they have failed to meet acceptable standards of public transparency and disclosure they will be called to account. It is certain the Auditor General will not be intimidated by NEHTA when he happily sends the Prime Minister news he really did not want in the middle of an election campaign.

That I have to write a blog like this makes me sad, very sad – and afraid ultimately for our basic rights and freedoms.

David.