Last Chance to Contribute to the HISA Submission on Privacy.

Submissions to the Australian Law Reform Commission (ALRC) review of the Commonwealth Privacy Act are due by Friday 7 December, 2007.

The Health Informatics Society of Australia (HISA) has reviewed the suggestions from the ALRC and formed a view regarding the suggestions made by the ALRC in the Health Information Domain.

This review was conducted by a special interest group, HISA's Health Information Privacy and Security group (HIPS), which looks at the issues of privacy and security in the area of health information. HIPS holds seminars, conducts surveys and develops position papers for government consideration. HIPS is chaired by Prof. Peter Croll of the University of Queensland.

Its most recent activity has been the HISA submission to the Australian Law Reform Commission relating to the commission’s review of the Australian privacy laws.

Following a seminar in November a position paper has been developed.

The key points are as follows (to quote the web site):

The view of the Health Information Privacy and Security Group is that

1. We seek national consistency with the proposed privacy laws across State/Federal Public/Private sectors. The current proposals do not go far enough to resolve this by allowing state exceptions and complex rules regarding when those exceptions apply. Furthermore, a well resourced nationally consistent process for managing privacy complaints (i.e. not delegated to state/territory as proposed in 56-1) would be more appropriate considering today's ubiquitous technology.
2. Greater reliance on referral to the Human Research Ethics Committees (HREC) is being proposed for interpreting research, quality assurance, audit etc. Will there be sufficient consistency across the various HRECs and do they have the necessary skills and resources to carry out the proposed functions? Concern has been raised about how to avoid the inevitable bureaucratic backlog associated with HRECs unless these issues are adequately addressed?
3. In health we have witnessed changes in people's (clients) expectations and behaviour brought about by the advances in technology. That is their ability to access health knowledge and to take greater personal control over their health to include user controlled internet content (e.g. Web 2.0). Furthermore, personal access to medical devices, assistive technologies and ‘smart home' environments are causing a shift towards data being held by non traditional healthcare providers. Although the proposed privacy law changes intend to be ‘technology-neutral' they need to recognize this shift in behaviour brought about by technology. Current proposals focus on ‘health service' and ‘health service providers' and not the individuals.
4. Technology changes rapidly and hence any ‘technology neutral' proposal must therefore rely on the basic principles (UPPs) set down in the Act. Are sufficient provisions being made to accommodate how any technology changes need to be interpreted as being compliant with the UPPs in the Act? Too much damage can be done if we have to wait for case law hence, more regular periodic risk assessments of new technologies and interpretive guidelines would greatly assist in maintaining people's trust with technology.
5. There is a proposal to develop guidelines that relate to the "handling of health information under the Privacy Act" (56-4). The stakeholders involved will be at the discretion of the Office of the Privacy Commissioner with only DoHA being specifically mentioned. The range and types of stakeholders need to be specified to ensure industry and professional society representation.
6. National guidelines on obtaining individual's consent are crucial. This would permit unified approach to recording client's preferences and ensure technological compatibility for sharing and linking health information.
7. Common platforms for the application of privacy to take into account cross border data flows. Many of our industry partners are requesting a ‘global' approach to ensure a baseline standard across the industry and organizations.

I have provided some commentary on the web site to some of the points raised.

HREC

On December 1st, 2007 DGM says:

HRECs have been around for many years and there is considerable concern about the mode of interaction between lay advisers, clinical professionals and non clinical professionals. Expertise of a high level is vital if 'group think' and power dynamics are not to distort outcomes and adequately protect patients and subjects.

Adequate and skilled resources are crucial as researchers livelihoods depend on efficient and reliable responses

Technology Neutrality

On December 1st, 2007 DGM says:

There needs to be a careful distinction drawn between privacy principles - which must be technologically agnostic - and just serve the need for privacy - and the implementation of privacy - be it in paper, technical or organisations and their systems. Each implementation has different issues to be addressed to ensure the principles are met.

Consent

On December 1st, 2007 DGM says:

The suggestions made do not to my mind come near addressing the complexity of how consent should be obtained, managed, refreshed and how the legion of different types of primary, secondary and even tertiary information should be treated. As soon as you move from the individual rational and competent individual freely giving informed consent for a specific act or treatment you move into areas where judgment and balance are required - e.g. all secondary data use etc etc.

The differential sensitivity of varieties of health information adds an additional layer of complexity that needs consideration as well.

General

On December 1st, 2007 DGM says:

Obviously there needs to be full stakeholder consultation and consensus building with item 5 and there must be appropriate protections with cross border flows of sensitive information (I suggest must have as good a regime or better before data moves OS)

Others have also provided some commentary and a few corrections.

If you have any interest in the area it would be invaluable if you were to go to the site, review all the information provided and maybe leave a comment or two.

Access the site here.

This needs to be done by close of business Wed 5 December, 2007 to give the team time to consider the suggestions.

I hope some extra input if forthcoming. This is important stuff!

David.

The news summary will appear later in the week!

D.

What Should be the Top Items on the New Health Ministers E-Health To-Do List?

Well, it seems we now have Ms Nicola Roxon as the new Federal Health Minister. Also in the health frame is Justine Elliot as Minister for Ageing. Sadly, and worryingly, it seems Health has lost its Parliamentary Secretary. With all that Hospital reform Ms Roxon will be a busy lady!

Correction - 2:15pm 30/11/2007. Somehow I missed that in fact we do have a new Parliamentary Secretary for Health and Ageing - Senator Jan McLucas from Queenland! The Australian and the SMH some how seemed to have missed the fact yesterday - .

What are the big things that should be on Ms Roxon’s E-Health to-do list.

First all the memberships of all advisory committees that have any involvement in E-Health should be reviewed and the practical outcomes achieved by each of these committee members be the key criterion to be applied to decide if their ongoing contribution is to be invited. Advice, if needed, can be obtained from a range of independent, academic and industry sources. The Health Information Society of Australia would be a particularly useful source of input as would the members and fellows of the Australian College of Health Informatics who are not directly affected.

I am strongly of the view that there is need for significant generational change in the composition of these committees if we are to move forward.

Second the report of the Boston Consulting Group reviewing NEHTA should be made public and comments sought from interested parties for a 30 day period and then decisions should be taken on how NEHTA, or its various necessary functions, should continue.

Third to avoid any possibility of political ‘blowback’ the Auditor General should be invited to review the value for money and delivery aspects of NEHTA’s performance.

Fourth the incoming minister should have the Department release all the evaluation reports of all the various e-Health Projects conducted under the previous Government so for the first time we will be able to be had some real learning as to what actually worked and what did not. The formal evaluations of the various HealthConnect trials are crucial in this respect.

Fifth the incoming minister should request a full update on the status of all Commonwealth / State co-operative e-Health projects and initiatives and determine how much more investment is appropriate in which of them.

Sixth the incoming minister should review the current e-Health policy platform from the April Labor National Conference and determine the overarching implementation priorities.

Seventh the incoming minister should determine a Interim National E-Health Governance Framework to operate and assist with the delivery of the last item on the list.

Last the incoming minister should commission and sponsor the National E-Health Strategy, Business Case, Implementation Plan and Benefits Management Plan.

Frankly getting all that done that would make a great first year e-Health Plan.

Ms Roxon needs to remember that inactivity is death – and can lead you to be saying you failed utterly after four years as former Health Minister Abbot said just a few short days ago.

“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.”

See the full article here

Not that I have ever suggested the idea before but it might just be a really good idea to, when next there is a re-shuffle, to consider having a Parliamentary Secretary / Minister for Patient Safety, Healthcare Quality and E-Health. Wouldn’t that be a great idea!

Good luck to all the new appointees!

David.

------

This little extra on the perils of over-promising I could not resist!

I just came upon this classic on the Departmental Web Site. As such pages are likely to vanish quickly – and I thought this one was quite apposite – I pass it on. Note the Date! (14/10/2005)

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/factsheet-e-health.htm

Fact Sheets

e-Health: better information for better health

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What is e-health?

Information and communications technology can be used to improve health services for the benefit of both consumers and health service providers such as doctors, by enabling more efficient management of vital health information.

E-health is the collection, transfer and storage of health-related information such as patient medical histories or test results using computers and Internet technologies.

What are the benefits of e-health?

More accurate and complete medical documentation and better communication among health care providers enables them to respond more quickly to patient needs, with less risk of mistakes. In an emergency, instant access to up-to-date patient information – for example allergies or current medications - can save lives.

The result is better care for patients, and greater efficiency and better informed decisions by doctors, pharmacists and nurses. Consumers will have access to more information about their health, so they can understand and help manage their own health care needs.

What is the Australian Government doing to advance e-health?

The central plank of national e-health will be a system known as HealthConnect, which is being jointly developed by the Australian Government and all states and territories.

HealthConnect is a major change management and e-infrastructure project which will link health information systems in hospitals, pharmacies, GP and specialist surgeries to enable secure access and instant availability of important medical information.

Over time, HealthConnect will also build up comprehensive patient medical histories which will be available on line to patients and, with patient consent, their doctors, at any place or time.

What will it cost?

The Australian Government has committed $128 million over four years to commence the national introduction of HealthConnect. State and territory governments are also contributing.

Around $50 million will be spent on subsidies to assist all general practices, Aboriginal health services and community pharmacies to adopt broadband Internet technology, to prepare them for HealthConnect and other uses (through the Broadband for Health initiative). Another $48.2 million will be spent to secure electronic links between health funds, hospitals and doctors.

How will HealthConnect affect consumers?

As HealthConnect develops, consumers will have the choice of storing their health information – conditions, treatments, medicines, and other relevant information –in a central repository. This summary record will be accessible only to health professionals authorised by the consumer. Consumers can also look up their own records, so they can make better informed decisions about their health care needs.

When will it start?

HealthConnect implementation began in 2005 in Tasmania, South Australia and the Katherine region of the Northern Territory. Other e-health projects which will link into the system will commence later this year in New South Wales, Queensland, Western Australia and the Australian Capital Territory.

Where can I get more information?

For more information, see the HealthConnect web site at www.healthconnect.gov.au.

Page last modified: 14 October, 2005

-----

I leave it as an exercise for the reader to consider the level of truth (or not) in this ‘Fact Sheet’.

We have been ‘a good and competent government’ Mr Abbott has been fond of saying recently – bah humbug say I!

I sure hope in two years time we won’t look back on a page like this and say ‘a pox on all their houses’, they all the same! Ms Roxon you ignore e-Health at your peril!

D.

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.