Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, January 14, 2008

Useful and Interesting Health IT Links from the Last Week – 13/01/2008

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

These include first:

Microsoft admits Office 2003 'mistake'

By Richard Thurston

Story last modified Mon Jan 07 10:41:01 PST 2008

Microsoft has acknowledged it made a mistake over a security advisory it released concerning Office 2003.

The advisory, posted in December, told users that dozens of file formats had been blocked in the latest service pack for Office 2003--Service Pack 3 (SP3)--because they were insecure.

It provided a workaround for users who wanted to unblock the formats, but made the process complicated, requiring changes to the registry which could have made users' PCs inoperable if they were applied incorrectly.

On Friday, Microsoft admitted that the information it had provided was wrong, and that it had underestimated how many users had been affected. It now says that, instead of the file formats themselves being insecure, it is the parsing code that Office 2003 uses to open and save the file types that is less secure.

Speaking to ZDNet.co.uk on Friday, Reed Shaffner, worldwide product manager for Microsoft Office, confirmed that the advisory provided by Microsoft was incorrect, and that manual registry fix which Microsoft had provided had been difficult to implement by end users.

Continue reading below

http://www.news.com/Microsoft-admits-Office-2003-mistake/2100-1012_3-6224917.html

Can I say this sort of monopolist behaviour really got up my nose. Especially so as I have considerable archives of older Powerpoint and occasional MS Word files that I can now no longer access in Office 2007.

This sort of behaviour should be easily managed at the level of user options. I resent having to muck around with ‘trusted directories (which do not seem to solve the problem) and such like workarounds.

Frankly one more reason to hope OpenOffice or Google can knock the arrogant jerks off their dominant spot.

Note also

Microsoft: No new tools to unblock files in Office 2007

'Trusted locations,' other work-arounds, are sufficient, says Microsoft manager

Gregg Keizer 11/01/2008 08:33:59

Microsoft will not post new tools that would allow users of Office 2007 to access blocked file formats, as it has done for customers running Office 2003 Service Pack 3 (SP3). It cited a lack of interest in such tools and said existing work-arounds accomplish the same thing.

Last week, after some users complained that Office 2003 SP3 had changed the suite's security defaults so that applications would no longer open numerous file formats -- including one used by Corel's CorelDraw graphics software -- Microsoft apologized to Corel and posted downloads that let users unblock formats without manually editing the Windows registry.

The company also said it was sorry. "We recognize that we have not made any of this as usable as we'd like, and we apologize that this hasn't been as well documented or as easy as you need it to be," David LeBlanc, a senior software development engineer with the Office team, said last Friday.

Continue reading here:

http://www.computerworld.com.au/index.php/id;1450884221;fp;;fpid;;pf;1

Second we have:

Technology that exposes your dirty linen

January 7, 2008

Once-wary Australians accept their daily lives being monitored, writes Damien Murphy.

BIG BROTHER is washing you.

The washing machine of the future may not only wash garments according to the instructions on the clothes but secretly collect information for telemarketers, political parties and anybody else with an interest in people's dirty linen.

The Australian Law Reform Commission says washing machines could be fitted with radio frequency identification equipment, known as RFID, which stores information and transmits it to a data-processing system.

A discussion paper by the commission on a review of Australian privacy law lists the "bugged" washing machine as one of the myriad controversial technologies that are stealthily shaping the way we live.

Continue reading here:

http://www.smh.com.au/news/national/technology-that-exposes-your-dirty-linen/2008/01/06/1199554485298.html

This is quite a useful review of all the ways we are all now being tracked and monitored. I suspect that a backlash against all this is not far off.

As I have remarked previously a gradually eroding sense of control of one’s personal information is not likely to assist develop the trust required for e-Health initiatives to succeed.

Third we have:

Doctors 'failing to use' report system

Natasha Wallace Health Reporter
January 12, 2008

A STATEWIDE incident reporting system designed to improve patient care in public hospitals is barely used by doctors and only a fraction of adverse events or "near misses" are even recorded, the NSW branch of the Australian Medical Association has said.

Failings in the system were raised at the recent inquiry into the Royal North Shore Hospital.

The president of the NSW AMA, Andrew Keegan, said he strongly supported the system, but said most doctors did not know how to use it or, if they did, did not have the time to make entries or could not get access to a computer.

"Only about 5 per cent of the reports were from doctors," Dr Keegan said. "The rest are from all the other staff - the nurses, administrative staff. But if it's something that's supposed to be helping the patient quite often the only people who know what's going on with the patient, from a medical point of view, are the senior registrar and the consultant."

Continue reading here:

http://www.smh.com.au/news/national/doctors-failing-to-use-report-system/2008/01/11/1199988590143.html

This is hardly a surprise. Not only is there not easy access to the systems to undertake the reporting but NSW Health is hardly famous for the way it treats those who suggest there may be systemic problems that need to be addressed.

The mechanisms for reporting I would suggest are much less important that fostering a learning and supportive culture within NSW Health – something the recent RNSH inquiry suggested was not even being seriously attempted.

Interestingly the same topic is being addressed in the US in the same week with similar conclusions.

Physicians find medical error-reporting systems inadequate

By Molly Merrill, Contributing Writer 01/10/08

Physicians are willing to report on medical errors, but find current error-reporting systems inadequate, according to the Agency for Healthcare Research and Quality.

A new AHRQ study says poor error-reporting systems lead physicians to depend on discussions with colleagues rather than reporting to the hospital or health organization, and important information regarding medical errors and prevention is lost.

The study was funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality and appeared in the January/February issue of Health Affairs. Between July 2003 and March 2004, authors polled more than 1,000 physicians and surgeons practicing in rural and urban areas in Missouri and Washington State.

The survey reported that 56 percent of physicians had prior involvement with a serious error, 74 percent were involved with a minor error and 66 percent reported a "near miss." More than half, 54 percent, agreed with the statement that "medical errors are usually caused by failures of care delivery systems, not failures of individuals."

According to the survey, few physicians believe they have access to a reporting system designed to improve patient safety, and 45 percent don't know if one exists at their organization. Only 30 percent of those surveyed agree that current systems to report patient safety events are adequate.

Physicians said that in order to formally report error information, the following would be needed:

• Information must be kept confidential and non-discoverable (88 percent);

• Evidence should be made available that such information would be used for system improvements (85 percent) and not for punitive action (84 percent);

• The error-reporting process must take less than two minutes (66 percent); and

• The review activities must be confined to their department (53 percent).

Continue reading here:

http://www.healthcareitnews.com/story.cms?id=8377

Fourthly we have:

http://biz.yahoo.com/bw/080107/20080107005539.html?.v=1

Spectrum Health Collaborates With Cerner and Microsoft to Implement Technologies That Empower Patients


Monday January 7, 8:30 am ET

Innovative System Allows Patients to Access Personal Health Information, Entertainment at the Bedside

GRAND RAPIDS, Mich. & KANSAS CITY, Mo.--(BUSINESS WIRE)--Spectrum Health announced today its strategic relationship with Cerner and Microsoft Corp. in developing the Cerner Care Console™ solution, a consumer-centric technology that empowers patients to take an active role in their care. The new technology will be displayed today in the Microsoft booth at the Consumer Electronics Show in Las Vegas, Jan. 7-10.

By integrating Spectrum Health’s knowledge about the patient experience with the Cerner Millennium® healthcare information technology (HIT) computing platform, and Microsoft Windows Media Center, the Care Console system keeps patients informed about their condition, medical care and provider team during their hospital stay. In addition, Cerner also has incorporated separately the use of Xbox 360 retail consoles into this system to offer patients gaming and entertainment experiences. Spectrum Health is piloting implementation of the Care Console system in one of its units at its 750-bed Butterworth Hospital in Grand Rapids.

“Our goal is to engage patients in a full partnership with us so we can provide the highest quality care and best experience possible,” said Matt VanVranken, executive vice president, Spectrum Health System/president, Spectrum Health Grand Rapids. “Informed and involved patients are essential to providing exceptional experiences in our hospitals.”

With input from patients, nurses and physicians, Cerner worked with Spectrum Health to develop a consumer-oriented system that allows patients to actively participate in their care. Cerner and Spectrum Health found that patients could benefit from communication tools easily accessible at the bedside that range from access to their daily care plan to reviewing radiology images to diversional activities such as e-mail, movies and video games.

“Our strategic relationship with Spectrum Health and Microsoft utilizes the power of healthcare information technology to deliver a better patient experience,” said Trace Devanny, Cerner president. “By pulling information from the Cerner Millennium computing platform to educate patients about their care, we’re able to improve satisfaction, and create an informed dialogue between patients and providers.”

Continue reading here:

I found this quite a surprising press release. We must assume the motivation is to try and improve profitability in ‘for profit’ hospitals in the US – rather than any obvious need for such technology. With the patient turnover being what it is in most hospitals it is hard to imagine just how much use a Hospital Information Connected X-box would receive!

That said I am aware of such facilities in organisations trying to attract rich medical tourists to come to places like Thailand and Malaysia for their elective surgery!

Fifthly we have:

Taunton go-live with Cerner Millennium

07 Jan 2008

Taunton and Somerset NHS Foundation Trust has become the eighth site in the South of England to go-live with the Cerner Millennium patient administration system under the National Programme for IT.

The trust went live with Millennium Release 0, delivered by local service provider Fujitsu, on the weekend of 15-16 December.

In a statement the trust said the software has now “been successfully introduced at Musgrove Park Hospital, Taunton.”

Musgrove Park is the largest general hospital in Somerset, serving a population of over 340,000. The hospital has over 700 beds and employs around 4000 staff.

The trust is the first site to go live with a version of Millennium which is compatible with direct booking to the national Choose and Book electronic appointments systems.

In a statement to E-Health Insider the trust said: “Cerner Millennium updates the old system and forms a secure base for future developments. It makes patient information even safer than before and will allow for much quicker and efficient use of information.”

Hospital consultant, Dr Tim Jobson, said: “This paves the way for the implementation of sophisticated clinical systems, which will bring about significant improvements in patient care. We have transferred over 660,000 sets of patient records, over 60,000 future appointments and all our waiting list information.

Continue reading here:

http://www.e-health-insider.com/news/3357/taunton_go-live_with_cerner_millennium

This seems to be further evidence that we are seeing major infrastructure being progressively phased in within the UK NHS with quite large organisations now being addressed.

Lastly we have:

Strengthen privacy protections for e-health data, top panel recommends

By Nancy Ferris
Published on January 7, 2008

In a new report, the National Committee on Vital and Health Statistics calls for stronger privacy protections for individuals’ health records as those records are digitized and delivered over networks.

It recommends less reliance on the Health Insurance Portability and Accountability Act of 1996 and the rules issued to implement HIPAA. Instead, the committee calls for “a transformation, in which the focus is on appropriate data stewardship for all uses of health data by all users, independent of whether an organization is covered under HIPAA.”

The committee, a longstanding advisory committee to the Health and Human Services Department, prepared the report in response to a request from the Office of the National Coordinator for Health Information Technology.

The report was supposed to examine issues relating to secondary uses of health data – that is, uses other than caring for the patient. But the committee determined that “secondary uses” was an often-misunderstood label and also potentially a pejorative. The report uses it only sparingly.

The report, “Enhanced Protections for Uses of Health Data: A Stewardship Framework for ‘Secondary Uses’ of Electronically Collected and Transmitted Health Data,” offers more than 20 specific recommendations, most of them for HHS officials.

It notes that careful use of health data can increase patient safety, improve coordination of patient care, increase understanding of diseases and drugs, and have other benefits for patients and society. At the same time, it states, “there is potential for harms that may arise from uses of health data enabled by” health IT and the exchange of health records.

Continue reading here:

http://www.govhealthit.com/online/news/350163-1.html

The useful report can be downloaded from here:

NCVHS report

This report will be mandatory reading for all those interested in ensuring patient information is properly protected no matter who has to use it and for what purposes

More in next week.

David.

Sunday, January 13, 2008

NEHTA Signs a Really Huge Contract – Not Quite!

I had a number of alarmed e-mails yesterday – when the ABC posted the following in their News Justin Section!

Contract signed for national health ID system

Posted 1 hour 15 minutes ago

The Federal Government says a new national healthcare identifier service is one step closer, after a contract was signed to develop and test the scheme.

The service is designed to improve the transfer of patient information between health providers.

It will identify a person's name, date of birth, address and the names of their practitioners, and is the first step towards establishing a shared electronic health records system.

The $51 billion contract between Medicare and the National E-Health Transition Authority will take around two years to implement.

Federal Minister for Human Services, Joe Ludwig, says it is not an access card and people can decide whether or not they want to be part of the service.

"Privacy is a great concern to Australians, particularly in relation to the collection and handling of personal health information. A new regulatory framework would be required," he said.

Continue reading here

http://www.abc.net.au/news/stories/2008/01/12/2137148.htm?section=justin

To everyone’s relief the ABC quickly noticed the $51 Billion was a mistake (It’s more like $51 Million) and corrected the web site.

It now reads:

“The contract between Medicare and the National E-Health Transition Authority will take around two years to implement.”

The announcement also got coverage in The Age

http://news.theage.com.au/medicare-to-develop-identifier-service/20080112-1ll8.html

Medicare to develop identifier service

January 12, 2008 - 1:57PM

Medicare has signed a contract to develop a service which electronically identifies patients and healthcare providers, the federal government says.

Known as the unique healthcare identifier (UHI) service, the program is being developed as part of a proposed national system of sharing health records.

The Shared Electronic Health Records system would make an individual's medical details accessible online to doctors and the patient concerned.

Federal Health Minister Nicola Roxon and Human Services Minister Joe Ludwig said UHI will identify people who receive health care and the people and places providing it.

"One of the key building blocks for the establishment of this system is the means for uniquely identifying patients and health professionals, which will ultimately reduce the possibility of information being sent to the wrong health professional or being assigned the wrong patient," Ms Roxon said in a statement.

Under the contract with the National E-Health Transition Authority (NEHTA), Medicare will design, build and test the UHI service.

….

There are some major concerns I have about all this.

First the timing of the announcement (Saturday afternoon) always makes one wonder what is being hidden etc.

Second and much more substantively there seem to be all sorts of important aspects that are not worked out or thought through. One would have imagined that to award a $51 Million contract all this would be totally clear.

It’s amazing just how many issues are yet to be resolved. A review of the V2.0 UHI Concept of Operations for example can find the following selected quotes:

“Editorial note: Policies to safeguard the use of the IHI and HPI within the healthcare sector are still to be determined.”

“Editorial note: Examples of non-clinical and non-identifier contact information essential to providing healthcare might be: next of kin, previous address, emergency contact and authorised representative.”

“Editorial note: Processes will be established to ensure that recognised healthcare systems will conform to NEHTA e-health policies.”

5.5 Privacy Framework

The privacy framework will determine how privacy rights and responsibilities between UHI participants will be established and maintained, and therefore underpins privacy aspects of the service. It will apply to providers’ access and use of individual personal information, and providers’ use of provider information. Individuals cannot access other individuals’ information.

Trust is critical to the success of the Unique Healthcare Identification Services because the overall benefits of e-health cannot be achieved without a high rate of adoption. That high rate of adoption will not be achieved without an efficient, effective and enforceable privacy framework.

The UHI privacy framework is currently under development.”

End Quotes.

Third – while it is true the e-Health community are keen to see a usable Health Identification System there is no evidence that the sector and e-health providers are in a position to undertake the extra work involved in change to systems, procedures and policies that will be required by all the users of the systems.

Recent experience with the Medicare Medclaims system suggests reception staff are hardly going to be updating patient demographic details without some financial compensation. I bet these ongoing costs are not factored in.

Fourth it is an odd situation where a private company (NEHTA) non-competitively contracts with Medicare Australia to deliver a service that, on the basis of various other projects they have conducted, might not be the best partner. Just how the public can know they are receiving value for money eludes me.

Fifth to commit a sum of this size without a proven working demonstrable implementation of the planned technologies at a sensible scale would seem foolhardy at best and profligate at worst.

Sixth there seems to be a set of strategic assumptions about who is going to do what in e-Health in Australia that have not been properly surfaced and discussed before a large amount of public money is committed. As Sir Humphrey would say – that is pretty ‘courageous’!.

Seventh the lack of a finalised and agreed privacy framework and privacy impact assessment before contract signing is very poor.

Eighth the plan to have gradual adoption of the service over five to ten years seems hopelessly slow.

Ninth there seems to be no evidence I can find that the proposed concept of operations and technologies are indeed the best and most cost effective to address the identifier requirements – again we have NEHTA saying trust us.

Tenth, I cannot find anywhere the NEHTA plan that is going to prevent a few bad eggs among those with access to the identifiers and demographics of 21 million souls from exploiting this access for crime and profit. This service is at risk of becoming the ID theft database of choice for Australia if not carefully managed.

Eleventh there seem to be aspects of all this that will require legislation at possibly both state and federal level – at least the principles of this should have been available before a contract was signed

Last, the total lack of real public consultation on this proposal is really outrageous. All there has been are long and complex documents published in the NEHTA web site and zilch in the way of public discussion and review. I am sure there are many stakeholders in the health system who would like some input into the final shape of all this

This seems to me to be more of the NEHTA ready, fire, aim approach and to flag a continuing failure to learn the lessons of the BCG report.

The public does not have the information to know if it is buying a ‘pig in a poke’ or not!

A national health ID system is badly needed – but there have to be a lot of questions regarding the approach NEHTA is adopting

David.

Note: Because of breaking news the News Update will be published tomorrow.

D.

Thursday, January 10, 2008

Sad Loss of a Good Advocate for Personal Privacy.

The following article appeared a few days ago.

Privacy catching up to the information age

By Natasha Stott Despoja - posted Wednesday, 9 January 2008


When the Coalition was elected on March 2, 1996, few would have anticipated the intensity of the information revolution that lay ahead for the Howard government in its 11½ years at the helm.

Many considered themselves “computer literate” by then, but in reality this meant little more than the ability to tap out a letter on a word processor - at that stage it could even have been the archaic WordPerfect, long since consigned to the programming archives.

In March 1996, only the lucky few had access to the Internet at home. Google was in its infancy as a research project at Stanford University, the launch of Hotmail was months away and online banking would not be introduced by the Commonwealth Bank for another year. The likes of YouTube and Facebook were almost a decade away.

The primary instrument that protects the privacy of users in an on-line environment is the Privacy Act. It was enacted by the Hawke Labor government in 1988, the product of a seven-year research effort by the Australian Law Reform Commission (ALRC) which gave effect to Australia’s obligations to implement the OECD Guidelines for the Protection of Privacy and Transborder Flows of Personal Data.

Since our formation in 1977, the Australian Democrats have led the way on developing privacy law. It was through the use of our balance of power that we managed to defeat the Australia Card, paving the way for the formation of the Privacy Act. Our other major achievements include introducing a Private Senator’s Bill to extend the coverage of the Privacy Act to the private sector; long campaigning for the removal of several exemptions from privacy laws; and initiating the wide ranging Senate Legal and Constitutional Committee Inquiry into the effectiveness of privacy laws.

Continue reading here:

http://www.onlineopinion.com.au/view.asp?article=6850

I must admit to a little sadness to see the loss of the Democrats from the Senate as, in my view, they did some useful things over the years – except, of course, their decision to support Howard on the GST without ensuring there was an election to confirm we wanted a GST, after during the earlier election they vehemently opposed the GST and were elected to the Senate on that basis.

Despite the claims of all sorts of policy ‘wonks’ there are practical differences in the way private information (especially health information) should ideally be handled depending on whether it is held on paper or electronically. The policy outcomes (proper protection and control) should be identical – but we need to be clear the methods of implementation required to achieve those goals are often different.

I commend a browse of the article to those interested in the area.

Thanks for your efforts Senator!

David.

Wednesday, January 09, 2008

Nurses Often Left Out of Health IT Initiatives.

This article is quite a nice follow up to the point I made about nursing involvement recently.

See the following for details of that blog.

http://aushealthit.blogspot.com/2007/12/technology-and-nursing-good-fit.html

Nurses Often Left Out of Health IT Initiatives

by Bryn Lansdowne

For years, health IT has been touted as a means to improve documentation, ease the administration of medication and generally boost patient care delivery and coordination. Yet for many nurses, the adoption of health IT in hospitals is not a smooth road to improved efficiency.

Federal incentives for IT adoption have mostly been aimed at hospitals and physicians, not nurses. Also, most health care facilities direct their IT adoption efforts toward physicians because nurses are almost always employed by the institution where they practice, whereas most physicians are not. Many hospital administrators fear that if they force IT adoption on physicians, those physicians may take their business elsewhere.

But however slowly, the health care industry is shifting its focus to assisting nurses in the implementation of health IT. Of 150 CIOs surveyed by Health Data Management this year, 55% agreed and 29% strongly agreed that providing nurses with IT is an increasing focus of their IT initiatives. Further, the Joint Commission, the Institute for Healthcare Improvement and the Institute of Medicine all have issued patient safety mandates that call for enhanced nurse involvement with IT.

Working With Vendors

Experts have suggested that health IT vendors solicit feedback directly from nurses and work with them during the initial design process.

Pam Cipriano, chief clinical officer of the University of Virginia Health System and chair of the American Academy of Nurses Workforce Commission's Workforce Commission, has said that involving nurses in the IT development process can reduce the potential for error and ensure that vendors' products are user friendly.

Many vendors already consider real-world implications during the design phase of IT development, according to Reed Gelzer, COO of Advocates for Documentation Integrity and Compliance. According to Gelzer, "Vendors often make a valiant effort to improve their" products by soliciting input from the users themselves, "but then they discover that the message was coming from only a subset of users," leaving the vendor to ask, "'Who do I listen to?'"

Gelzer recommended that vendors make a more concerted effort to incorporate nurses' suggestions into their offerings, but only after they first develop an input plan that will ensure the recommendations are valid and transparent to designers. Further, Gelzer said that suggestions can't come from just one component of users; instead, they have to represent all potential operators of the technology: physicians, administrators and ambulatory care workers, among others.

…..

MORE ON THE WEB

  • AAN Commission on Workforce
  • CDW, "Nurses Tech Talk 2007" (.pdf)
  • Rebillot, "Nurses Push for Input Into Clinical Health IT Design To Boost Hospital Workflow," iHealthBeat, 12/3
  • "Hospitals Work To Make Health IT More Nurse Friendly," iHealthBeat, 12/5

Read the full article below:

http://www.ihealthbeat.org/articles/2007/12/14/Nurses-Often-Left-Out-of-Health-IT-Initiatives.aspx?a=1

I can do little better than refer the interested reader to the links above for more information and ideas on how the manage this critical issue.

David.

Tuesday, January 08, 2008

Malaysian Hospital Develops its Own Hospital Information System!

I came upon this a few days ago and was intrigued.

HUKM Develops Own Total Hospital Information System

By Mohd Arshi Daud

KUALA LUMPUR, Dec 31 (Bernama) -- Hospital Universiti Kebangsaan Malaysia (HUKM) is developing its own Total Hospital Information System (THIS), the first by a government hospital in Malaysia and possibly in Asia.

Built up from scratch entirely by its staff, the hospital's THIS initiative has already attracted interest from distributors keen to market the system to both government and private hospitals in the country.

THIS costs million of ringgit to implement but the market for such a system in Malaysia is huge, given that there are over 100 public hospitals and a large number of private hospitals.

In addition, the HUKM-developed THIS, called Caring Hospital Enterprise System (C-HEtS), is expected to be cheaper than similar systems available in the market.

"HUKM is still looking at the business model on how to go about providing C-HEtS to others," said Dr Ahmad Taufik Jamil, head of HUKM's information technology (IT) department.

"For example, one government specialist hospital spent more than RM50 million for its total hospital information system. We have so far spent only about 10 million," he told Bernama in an interview recently.

Dr Taufik said the huge savings was a result of HUKM itself holding the copyright for C-HEtS (created 100 percent in-house) and the system was developed using a free software from US-based software firm Oracle Corp.

"It's free. The tool is JDeveloper 10g, which is based on Java technology under Java 2 Enterprise Edition," he said.

Dr Taufik, who holds a BSc (Medicine), MD (Doctor of Medicine), M.Sc (IT), and MPH (Master of Public Health) majoring in hospital management, is leading a team of about 80 people in the project, with half of them technical and IT personnel and the rest comprising C-HEtS users like doctors and nurses.

Continue reading here:

http://www.bernama.com.my/bernama/v3/news_lite.php?id=305217

The first thing is to consider the exchange rate. As it turns out as of the time of writing it is 1.00 AUD = 2.86859 MYR so the planned budget is of the order of about $A7.0 million for a full scale hospital information system developed with quality tools and appropriate standards.

It seems to me this is very good thing to be happening – but that there are quite substantial risks also.

First it is clear the hospital is lucky enough to have a really skilled leader to steer and drive this project forward. I hope they have both ‘key man insurance’ and a well considered succession plan as I am sure if this project continues to be successful someone with these capabilities will be snapped up by the Epics or Cerners of the world.

Second, as history has shown, when a hospital develops a system for itself there is usually not the planning done to ensure there is the flexibility built in to permit implementation in other organisations. IBM, among others, have be caught by this issue and have found it very complex to render transportable some advanced self developed US systems – even to other similar organisations within the same country.

Third experience has often shown self developed systems become progressively more difficult to maintain as development staff move on and it is then discovered that the documentation for important areas of the system is quite up to scratch. This was a lesson I learnt very early when I found myself looking after home developed systems at Royal North Shore in the late 80’s

I wish Dr Taufik well and I hope he has read up on the traps he might encounter that can render an apparent bargain a major nightmare in the years to come.

David.

Monday, January 07, 2008

Progress Seems to be Happening with the UK National Program for Health IT.

A press release arrived from the NHS Connecting for Health Program a few days ago.

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/awards191207

PACS and Choose and Book win Health IT honours

The Picture Archiving and Communications System (PACS) and Choose and Book programmes have both been honoured at the Health Business Awards.

Just weeks after winning the title of 'Public Sector Project of the Year' in the Computing Awards of Excellence, the PACS programme has landed another major accolade.

Representatives from the PACS team were at the Health Business Awards in London to pick up the 'Healthcare IT award', which recognises the programme's role in the 'innovative introduction of new technology for storing, retrieving and distributing data throughout the NHS'.

Receiving the award for the PACS programme were programme director Mary Barber, London programme manager Luke Davie and Dr William Saywell, PACS clinical lead for the South and one of the many clinicians who have been working with the programme.

On collecting the award, Davie said: "It was an honour to receive this award and to be part of a programme that has delivered such tangible improvements to the NHS.

"The award recognises the commitment of all those involved in delivering the PACS service, including the NHS trusts who have put in so much effort to making this a success. I know all the team look forward to delivering further improvements to PACS, to support NHS staff in providing care to patients."

Choose and Book

Alongside PACS at the Health Business Awards, the Choose and Book programme was commended for its website www.chooseandbook.nhs.uk.

It was a runner up for the 'NHS website of the year' award, which recognises NHS websites that provide a comprehensive and easy to use communication channel aimed at either the public or internal NHS. Criteria includes design, accessibility, usability, take up and cost effectiveness.

The Choose and Book programme was represented at the awards event by web development team leader Beth Johnson, web developer Alex Thomas, senior communications officer Liz Kalaher and training analyst Julie Taylor, who collected the commendation at the Royal College of Physicians.

Beth Johnson commented: "The NHS CFH web development team and members of the Choose and Book programme have invested considerable time and effort in making the Choose and Book website as accessible and user-friendly as possible.

"It has been important for us all to ensure that Choose and Book users can access this resource for information, guidance and training easily and quickly. So it is great that the team's hard work has been recognised in this commendation".

A little later there was this release

http://www.connectingforhealth.nhs.uk/newsroom/news-stories/pacs-rollout

Roll out of digital technology revolutionises NHS patient care in England

State of the art digital technology that has revolutionised the way the NHS captures, records and uses patient x-ray and scans is now being used in every hospital trust in England, the Department of Health said today.

Picture Archiving and Communications Systems (PACS) are replacing the old way of capturing x-rays and scans on film and paper enabling clinical images to be stored electronically and viewed on screen.

The roll-out of PACS has been a major element in the National Programme for IT (NPfIT), which is helping the NHS to deliver better, safer care to patients via new computer systems and services.

Using this technology, healthcare professionals can look at images at the touch of a button. X-rays and scanned images are available to view on screens in different locations such as x-ray departments, out-patients clinics, operating theatres and in-patient wards simultaneously.

The system also gives clinicians instant access to old x-rays and scans, enabling the comparison of old images with new. This is especially useful when treating long-term conditions. Images can also be rotated, enlarged and manipulated in other ways, helping clinicians diagnose conditions more quickly and accurately.

More timely reporting and clinical decision-making, and more efficient ways of working, mean that PACS is making a major contribution to the delivery of a maximum 18-week wait for patients from referral to start of treatment.

Health Secretary Alan Johnson said:

"The benefits of the introduction of PACS in terms of improved patient care are massive. This innovative technology speeds up and improves the accuracy of diagnosis, saves time and improves the quality of care. Trusts are reporting that the time taken for radiologists and radiographers to issue reports to clinicians have typically been halved from more than six days to less than three and these report turnaround times continue to fall with some hospitals reporting all imaging within 24 hours.

"This year marks the 60th anniversary of the NHS, an ideal time to reflect on how the service has evolved using the skill of its dedicated staff and technological advances together with record investment to continually improve the standards and quality of care for millions of people. The NHS is the envy of the world, which is something we should never lose sight of."

As well as improved patient care, the introduction of PACS is also saving money with trusts reporting an average saving of £250,000 in their first year of using the technology.

In 2004 the Government introduced the programme to implement PACS in all English trusts. The final trust to receive a PACS as part of NPfIT was Leeds Teaching Hospitals Trust on 10 December 2007, marking the completion of a three year process that has seen 127 trusts across England receive PACS.

PACS medical director Erika Denton, a practising radiologist, said:

"We all recognise the role that PACS is playing in improving patient care. Prior to the advent of NPfIT it had taken 50 trusts some 14 years to implement PACS. But in the last three years, the pace has accelerated massively; the speed and scope of the roll-out has been an incredible achievement. It's a credit to the way that NHS Connecting for Health, strategic health authorities, trusts and IT service providers have worked together."

Notes for editors

  • NHS Connecting for Health supports the NHS in providing better, safer, care by delivering computer systems and services which improve the way patient information is stored and accessed.
  • 127 trusts have implemented PACS as part of NPfIT. This three year roll-out contrasts very favourably with the 14 years taken to implement those PACS which pre-dated the programme.
  • As a result of the efforts of the PACS programme there is now a firm foundation for further technical developments, such as improved sharing of images and reports across trusts and regions, and links with independent sector treatment centres and the extension of PACS into new clinical specialties.
  • Clinical engagement has been crucial to the success of the programme, and will continue to be so in the future. A number of clinicians have important roles within the programme's management and governance structure and the programme has worked closely with the relevant professional bodies including the Royal College of Radiologists and Society of Radiographers.
  • The success of the PACS programme has been widely recognised by clinicians, professional bodies and industry commentators. In recent months the programme received the accolade of 'Public Sector Project of the Year' at Computing Magazine's 'Awards of Excellence', and the ‘Healthcare IT award' at the Health Business Awards.
  • Over 473 million images have been stored so far using PACS supplied as part of NpfIT.

This scale of activity suggested it might be an idea to see where things are up to – from the perspective of those delivering the program.

The status is summarised thus:

http://www.connectingforhealth.nhs.uk/newsroom/latest/factsandfigures/deployment

Latest deployment statistics and information

The facts and figures below are correct as at 14 December 2007, unless stated otherwise.

Choose and Book

  • Over six and a half million (6,538,938) bookings have been made to date.
  • Choose and Book has achieved over 20,000 bookings in a single day.
  • Choose and Book is being used for over 45% of NHS referral activity from GP surgery to first outpatient appointment.
  • Over 85% of all GP practices have used Choose and Book to refer their patients to hospital in the last week
  • The number of bookings made last week was 90,516.

Electronic Prescription Service (EPS)

  • Over 56 and a half million (56,597,355) prescription messages have now been transmitted electronically.
  • 1,688,723 prescription messages were transmitted electronically in the last week.
  • 6,756 GP practices have had technical upgrades to the new system. 4,894 of these practices are actively operating the Electronic Prescription Service (EPS).
  • 7,376 pharmacy systems have had technical upgrades to the new system and 5,538 are actively operating EPS.
  • EPS is being used for over 17% of daily prescription messages.

GP2GP Transfer

  • GP2GP has now been used for 49,086 medical record transfers.
  • 4,042 GP practices have had technical upgrades to the new system. 2,850 of these practices are now actively operating GP2GP.

National Network for the NHS (N3)

  • Approximately 1.2 million NHS employees now have access to the new broadband network N3.
  • N3 can save the NHS an estimated £900m over seven years, relative to previous NHSnet contracts.
  • There have now been 21,373 connections to N3 and over 99% of GP practices are connected to the network.
  • N3 is one of the largest Virtual Private Networks (VPN) in the world.

NHSmail

  • An average of 983,152 messages are sent/received across the NHSmail platform daily.
  • When migration is complete NHSmail will have over one million users - the largest private, fully-featured, secure, single-domain e-mail service in the world.
  • The number of users registered for NHSmail, the national NHS email and directory service is increasing every week.
  • There are now 309,844 registered users.
  • NHS CFH staff have migrated to NHSmail.

PACS

  • There are 121 Picture Archiving and Communications System (PACS) from NHS Connecting for Health now live across England.
  • Over 437 million images have been stored using PACS from NHS CFH.
  • PACS has been used for over 20 million (20,020,136) patient studies.

NHS Care Records Service

  • 133,120 Summary Care Records have now been uploaded to the Spine.
  • There are 428,323 Smartcard holders who are registered and approved for access to the Spine.

Overview

  • There are approximately 1,700 visits to sites to plan deployments every month.
  • 200 NHS sites have systems upgraded every month under the National Programme for IT.

It is clear from this that there is a great deal happening on a range of fronts and there is no way it is stopping now. Barring some unexpected accidents or interventions it now looks likely that by 2010 or so the NHS in England will have an ICT Infrastructure and an operational Application Set that is going to make it the envy of most public health systems around the world. As far as I know only Kaiser Permanente has got this far to date at a comparable scale.

It hasn’t been perfect and there have been many mid-course corrections but – allowing for the inevitable spin contained in such releases - it really seems some progress is being made.

I think we can be cautiously hopeful it might all work out in the end!

David.

Sunday, January 06, 2008

Useful and Interesting Health IT Links from the Last Week – 06/01/2008

Welcome to the New Year!

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

These include first:

Porn filter fails, say web experts

By Karen Dearne and Fran Foo

January 03, 2008 12:10am

Article from The Australian.

CleanFeed system can be circumvented

Filter reality never matches hype

Most porn filters 'too expensive'

THE "clean feed" filtering system Communications Minister Stephen Conroy hopes will halt internet porn has already been defeated by British researchers.

Richard Clayton, of the University of Cambridge's Computer Laboratory, said the innovative blocking system CleanFeed, devised by British internet service provider BT, could be circumvented in a number of ways.

"At first sight, it's an effective and precise method of blocking unacceptable content," Mr Clayton said. "But there are a number of issues to address as soon as one assumes that content providers or consumers might make serious attempts to get around it."

The report is more bad news for those hoping to block violence and pornography from their internet. Although filter salesmen talk up their wares, the reality has never quite matched the industry hype.

Former communications minister Helen Coonan moved away from insisting internet service providers offer filtering after a 2006 NetAlert study showed the filters were expensive, difficult to set up, frequently inaccurate and drastically slowed the network performance.

Continue reading below

http://www.news.com.au/story/0,23599,22999659-2,00.html

Further coverage of the same issue is found here:

http://www.australianit.news.com.au/story/0,24897,22997280-15306,00.html

Labor online strategy slammed

Galen English | January 02, 2008

opinion IT SOUNDS entirely defensible, at first. The federal Government plans to protect unwary children by blocking violence and pornography on the internet.

The Rudd government's plans to protect unwary children by blocking violence and pornography on the internet is riddled with technical, financial, moral and social complexities

Yet this simple sounding initiative - barely discussed during the election - is riddled with technical, financial, moral and social complexities.

The Government's plan, overseen by Communications Minister Stephen Conroy, would require internet service providers (ISPs) to block undesirable sites on computers accessed by all Australians.

A seething Dr Roger Clarke, chair of the Australian Privacy Foundation, bluntly described the proposal as "stupid and inappropriate".

…..

And here:

http://www.smh.com.au/news/national/minister-warned-on-porn-filters/2007/12/31/1198949746454.html

Minister warned on porn filters

Yuko Narushima

January 1, 2008

LABOR'S plan to introduce mandatory internet filters will send Australia down a censorship path similar to China's and Singapore's, but will not stop computer-savvy children looking at banned sites, according to the NSW Council for Civil Liberties.

The council's vice-president, David Bernie, said the Federal Government plan was political grandstanding. It would force users to ask internet service providers to lift a block on extremely violent and pornographic sites.

"It is a gimmick," Mr Bernie said. "It's been sold to the public as protecting children from pornography but what is dangerous about these filters is that parents will think their children can't access pornography on the internet when in fact they can.

"Anybody who's computer-savvy can work their way around these filters in about two minutes maximum," he said.

…..

I wonder has anyone thought about the potential for having access to health information from overseas blocked by some simple minded filter imposed by Government. I had not thought we would find our new Labor Government trying to out ‘socially conservative’ the previous one. I certainly think this is lousy policy.

Second we have:

The 2007 International Privacy Ranking

The full report is to be found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559597

The small part in the main article on Australia shows how we compare with the rest of the world.

AUSTRALIA

  • No right to privacy in federal constitution, though one territory now includes the right to privacy within its bill of rights
  • Comprehensive privacy laws at federal level and others within some states and territories, but there are broad exemptions that have precluded action by the privacy commissioner against small businesses and political parties; and does not meet international standards
  • Power of commissioner diminished because determinations are not legally binding
  • Numerous reports of data breaches, including at the taxation office, child support agency, and even amongst the police
  • High level of interception activity; no notification requirement to innocent participants to communications
  • Expanded surveillance powers in 2004
  • Movement towards electronic medical records but no opt-in protections as yet
  • De-identified medical data has been approved by the privacy commissioner for sale to pharmaceutical companies, despite protests
  • Expanded financial surveillance and secret reporting
  • DNA collection only for serious crimes at the moment
  • Made preliminary steps to secure passports in 2006
  • New government promised to abandon ID card plans; the office of access card has been closed but senior staff have moved to other department hinting at possible proposals to emerge
  • Document verification service for use by public and private sector is being implemented despite lack of privacy considerations
  • Abusive case of visa revocation of individual related to suspects in UK anti-terrorism case

The detailed review on Australia is found here:

http://www.privacyinternational.org/article.shtml?cmd%5B347%5D=x-347-559550

Of special interest is the Australian Health Privacy Section.

Health privacy

The National E-Health Transition Authority (NeHTA) was created in July 2005 to develop national health information management and information and communication technology standards and specifications. NeHTA is jointly funded by the States, Territories and Australian Governments, and its governance ensures equal participation by all jurisdictions.[53]

NeHTA is working on a number of initiatives, many of which are the necessary first steps towards a national electronic health records system – things like ensuring different IT systems are interoperable, that there is a system for identifying patients and clinicians accurately and uniquely, and that everyone uses the same ‘language’ when describing medical conditions and medicines. One of NeHTA’s projects is to develop a national model of E-Health Consent for the States and Territories to follow when implementing their systems. That model has not yet been finalised. A key question will be whether the model will follow an "opt in" or an "opt out" model of consent

Meanwhile the New South Wales State Government has been working on its own electronic health records project, Healthelink.[54] Despite the NSW health privacy law requiring express consent before a patient is placed on a system to link electronic health records across organizations, it was revealed in June 2005 that pilots planned for late 2005 were being developed instead on the basis of a compulsory record, with only an "opt out" choice as to the sharing of the record with other health service providers.[55] The Government exempted itself from the "express consent" requirement by way of regulation, and began the pilots in 2006. Participation by General Practitioners has been low because of their privacy concerns about the system’s design.[56]

An emerging health privacy issue is the use of software in General Practitioners’ offices, which automatically extract patient data, for sale to pharmaceuticals companies. The Federal Privacy Commissioner dismissed a complaint because the patient data was being de-identified.[57] However, the political reaction to the Commissioner’s decision was strong enough that she made a clarifying media statement.[58] The federal Minister for Health, the Opposition’s Shadow Minister, and minor parties, all criticized the practice based on the risk of de-identification.[59]

A major report on genetic privacy was issued in March 2003 by the Australian Law Reform Commission and the Australian Health Ethics Committee of the National Health and Medical Research Council. "Essentially Yours" makes 144 recommendations about the ethical, legal and social implications of genetic privacy.[60] The report recommends that privacy laws be harmonized and tailored to address the particular challenges of human genetic information, including extending protection to genetic samples, and acknowledging the familial dimension of genetic information. Employers should not be permitted to collect or use genetic information ­– except in those rare circumstances where this is necessary to protect the health and safety of workers or third parties, and the action complies with stringent standards set by a new Human Genetics Commission of Australia (HGCA). The insurance industry should be required to adopt a range of improved consumer protection policies and practices with respect to its use of genetic information (including family history) for underwriting purposes. A new criminal offense should be created to prohibit someone submitting another person's sample for genetic testing knowing that this is done without consent or other lawful authority. DNA parentage testing should be conducted only with the consent of each person sampled (or both parents in the case of young children), or pursuant to a court order

The Australian Government is preparing a response to the "Essentially Yours" report, although a number of recommendations have already been acted on.[61]

---- End Quotation

I think we can safely summarise this as suggesting that Australia is an EHR Privacy Policy Free Zone for now. Hopefully this can be remedied soon.

As far as the comparison with the rest of the world ranking is concerned we are in the 2.1-2.5 out of 5 band. This means we have “systemic failures in upholding safeguards” regarding surveillance and privacy. Not good!

There is press coverage here:

Australia lags on privacy front

Jill Lawless in London | January 02, 2008

INDIVIDUAL privacy is under threat around the world as governments continue introducing surveillance and information-gathering measures, according to an international rights group.

Will Australia rank better on privacy under Kevin Rudd?

Greece, Romania and Canada had the best records of 47 countries Privacy International surveyed. Australia is ranked 19th, higher than Slovakia but lower than South Africa and New Zealand.

"The general trend is that privacy is being extinguished in country after country," said Simon Davies, director of London-based Privacy International, which recently released a study on the issue.

Continue reading here:

http://www.australianit.news.com.au/story/0,24897,23001719-5013040,00.html

Third we have:

The Da Vinci Robotic Surgical System at SJOG Hospital

Article from: PerthNow

Narelle Towie

January 03, 2008 12:23pm

FOR the first time revolutionary robotic surgery is available in WA - but it's only an option for a select few.

The Da Vinci Robotic Surgical System is a surgical breakthrough. It takes the surgeon's tiny hand tremors out of the operating room by allowing doctors to use four robotic arms to do their work while the procedure is magnified on a screen.

As a result of the hands-free approach, patients suffer from less scarring, infection and pain and they recover faster.

But unless WA people are privately covered -- and insurance companies don’t pay the full costs -- it can cost up to $10, 000 to fund the procedure.

Perth’s Keith Bales is spearheading a campaign to bring the robot to everyone. As the first Australian to be operated on using the machine in Sydney, he says the exclusive system is not fair.

“Everyone should have access to the machine, not just private patients,” said Mr Bales.

“There are a huge number of children that are born with a hole in their heart and they are really hard to operate on. This would be perfect for that.”

Continue reading here:

http://www.news.com.au/perthnow/story/0,21598,23002242-2761,00.html

It is good to see this technology is now spreading out across Australia. There is now enough experience available with this system to be sure that, in selected cases, this robotic surgery is the procedure of choice. With the improvements in surgical access technologies that are currently in late development / early use we can expect to see surgery transformed over the next decade.

For extra details go here:

http://news.bbc.co.uk/2/hi/health/7155635.stm

i-Snake 'will transform surgery'

Experts are developing a flexible surgical robot, known as the i-Snake, which they say could revolutionise keyhole surgery.

Fourthly we have:

A New Approach to Medical Education

By Charles J. Shanley, M.D., and David Ellis
Medical schools need to abandon the concept of medicine as art and begin training students to function in a rapidly evolving, team-oriented, science-based field.

The acceleration of biomedical understanding—and everything that follows in diagnosing and treating human illness—is now so rapid that by the time a student graduates from medical school, much of what he or she learned may be outdated or even irrelevant. The implication is that effective medical education reform requires much more than a superficial “nip and tuck” strategy; it needs an extreme makeover.

Modern science is team-oriented, technology-facilitated, informatics-supported and evidence-based. Modern medicine, like any other science-based profession, must adopt these practices and principles if it is to provide safe, effective and accessible care to an increasingly mobile society in the information age. For this reason, we expect that the art- or craft-based model of medical practice will trend inexorably toward a postmodern paradigm dominated by applied “medical” science.

We acknowledge that the modern practice of medicine is much more than applied science (at least not science in it purest form). But if medical schools are to prepare students for a 21st-century, science-based health care system, it is imperative that we challenge some of the assumptions underlying the traditional paradigm of medical practice as an art.

Continue reading here:

http://www.hhnmag.com/hhnmag_app/jsp/printer_friendly.jsp?dcrPath=HHNMAG/Article/data/12DEC2007/071218HHN_Online_Shanley&domain=HHNMAG

This is an important article that recognises that there needs to be fundamental change in the way medicine is practiced and the way clinicians are trained to deliver optimum care. Technology is clearly a major component that has to both better integrated and better deployed to support the new generation physican.

Fifthly we have:

Magnet Hospitals Rely on I.T.


HDM Breaking News, December 28, 2007

When it comes to nurses, a magnet can indeed be a powerful attraction. Only about 263 hospitals nationwide have earned recognition for nursing excellence by achieving the designation as a magnet hospital. These facilities use their magnet status as a powerful nurse recruiting tool.

Although the magnet program does not explicitly require that hospitals use information technology, many of the organizations that have achieved magnet status are making extensive use of I.T., especially electronic charting for nurses.

The magnet designation from the American Nurses Credentialing Center, a unit of the American Nurses Association, recognizes quality patient care, nursing excellence and innovations in professional nursing practices. But the program stops short of requiring that hospitals use information technology because “we don’t want to lock out some smaller hospitals that lack funding to support technology,” says Cynthia Hagstrom, an outcomes analyst with the Magnet Recognition Program.

Continue reading here:

http://www.healthdatamanagement.com/news/25418-1.html

This is interesting in that what is being increasingly recognised is that advanced IT actually improves the quality of working lives for nurses and for that reason having such systems in place can assist with nursing recruitment and retention. Another part of the value case for Health IT!

Lastly we have:

Medical records go online

Article from Adelaide Advertiser:

TORY SHEPHERD, HEALTH REPORTER

December 27, 2007 12:10am

ONLINE medical records allowing access to personal files will revolutionise the health system, the Government says.

An electronic system accessible via a website is expected to be in place by early 2009.

Under the new "e-health" system, patients will be given a unique number to allow them, their doctor and other health specialists to access their medical history.

Patients will no longer have to transfer records when switching doctors and emergency departments will have access to a patient's medical history.

Some European countries already have such a system in place.

"It's the direction we need to go," Health Minister John Hill said. "It'll produce an enormously more efficient system."

Health Department chief executive Tony Sherbon said people would opt to join the program, which would allow for better coordination of care.

Continue reading here:

http://www.news.com.au/adelaidenow/story/0,22606,22975030-5006301,00.html?from=mostpop

This article is yet another opportunity for us all to say loudly to Messrs Hill and Sherbon “In your dreams”! Let’s give them the a bit of slack and say early 2009 is April 2009. Will they meet this time line. Not a chance… Can I suggest it will be more like 2019 with the assembled skills of this lot!

Really it is this sort of commentary and unrealistic setting of expectations that gives e-Health a really bad name. The rule is to under promise and over deliver!

More in next week.

David.