HISA's Pre-Budget Submission

HISA has prepared a submission for the Federal Government's Budget Process.

Responding to the Treasurer's request for submissions detailing the high impact issues that should be dealt within the Government's first budget, HISA has provided a pre-budget submission on eHealth.

Australia faces significant challenges in achieving both its short and long term eHealth objectives. Central to this is the lack of a clear and broadly shared vision of the eHealth environment we want to deliver and the lack of a plan to guide our development.

In addition to this, Australia is facing a crippling shortage of skills in health informatics and a lack of attention to some of the more immediate needs of current system implementations.

Click here to download a copy of HISA's submission.

This submission is an important contribution from HISA and should be widely read and supported.

What is important is that it is recognised that NEHTA has not managed to develop a coherent plan - the Australian Health Information Council has vacated the field - and Australian e-Health needs serious planning and investment - made in a coherent and planned way.

Education and sensible Standardization are also critical - but it is not clear NEHTA has got any of that right as yet. I suspect they never will.

As the HISA document says - progress is vital - it is up to Government to listen - despite the economic constraints of the current times.

David.

Mental Illness and the Web – A Canadian View

The following article caught my attention a few days ago.

Treating mental illness over the Web

Don Butler

Canwest News Service; Ottawa Citizen

Saturday, January 12, 2008

OTTAWA -- Sam Ozersky's voice still rings with incredulity when he talks about the American study that changed his thinking about treating patients with mood disorders.

The 1996 study compared two groups of 300 people being treated for depression by their family doctors.

Doctors with one group were given a short depression treatment program that included counselling to improve medication adherence and behavioural treatment to increase the use of coping strategies.

Doctors gave the other group the standard care they normally would prescribe. After seven months, 70 per cent of the group receiving the enhanced care had recovered, compared with just 20 per cent of those who got the usual care.

"This is unbelievable!" exclaims Ozersky, an expert in occupational psychiatry and senior consultant at the Toronto Hospital Mood Disorders Clinic. "In no field of medicine can you get that kind of variance."

The study convincingly demonstrated the benefits when patients and their family physicians -- who provide up to 90 per cent of mental health care -- are armed with and faithfully follow the best evidence-based treatments. The findings helped inspire Ozersky and other leading mental health experts to form Mensante Corp., and develop FeelingBetterNow.com, a Web site that diagnoses and recommends treatment of nine major mental disorders, from depression to post-traumatic stress disorder.

The site was launched in January 2006. After users fill out a detailed online survey, the FeelingBetterNow site determines whether they are at risk of a mental disorder. If the answer is yes, it generates a "care map" listing best-practice treatment options and a "follow-up map" that tracks patients' progress every three weeks. Family doctors use the maps to prescribe treatments.

Mensante's program is the first of its kind in the world, Ozersky said. Like the Canadarm, it has great potential for use beyond our borders.

"It's sort of like the robotic arm for getting your head straight," he says. It's also very much in sync with one of the major trends reshaping the health-care world today -- e-health.

In North America, 80 million people now belong to Web-based illness support groups. Statistics Canada says 35 per cent of Canadians 18 and over searched the Internet for medical or health-related information in 2005. Check Up from the Neck Up, an online mental health diagnostic site created by the Mood Disorders Association of Ontario and several partners, had more than two million hits in six months. Last May, Forrester Research reported nearly one quarter of behavioural health patients use online services for their health problems. Of those, 62 per cent go online daily.

People with mental disorders spend more time online researching and using health sites than patients with other conditions. Internet giants Google and Microsoft are developing strategies to combine their online expertise with computerized personal health records. And North American drug manufacturers now spend $1 billion a year on targeted online advertising, a number that's expected to double by 2011.

Continue reading this long article here:

http://www.canada.com/reginaleaderpost/news/story.html?id=4e82fa20-917c-4234-b7ec-77209ef10c32

The blog reported the Australian work in this area here:

http://aushealthit.blogspot.com/2007/11/on-line-and-no-longer-alone-with-mental.html

It is really good to see how quite simple technologies can help ease the suffering and distress of those afflicted with a mental illness.

More power to the arms of all those working in the field.

David.

A View from An Ex-Pat Working Health IT in the UK

The following arrived in my inbox a few days ago. As the writer needs to keep his job I am publishing it anonymously – but with his explicit written permission. I am sure you will enjoy what he has to say!

-----

Hi David,

I am currently work on the NHS IM and T programme for one of the Local Service Providers assisting NHS organisations in putting new systems in. I'm sure you are probably aware of the e-health insider website -

www.e-health-insider.com

- which reports on the trials and tribulations of the NHS IT programme. It offers relatively fair and balanced view of what we are going through here in the UK in IT health with the reader comments on articles expressing a range of passionate views. I draw your attention to it as while PACS get a good response issues continue to abound on many other systems deployments and overall strategy. The website provides a good view of what is going on not just from the Connecting for Health view point.

I read with interest your article in November on Why Hospital IT is so Hard. Your thoughts on the engagement of clinical staff were spot on. Having been involved in two deployments in London acute hospitals in the past couple of years I can relate to that.

Briefly as I see it in the UK is that the initial IT strategy to replace patient administration systems dealing with Outpatient appointment scheduling and admission and discharge was misplaced. A strategy that focused more on improving clinical decision making - PACS, ordering and receiving test results, patient medical history recording and ease of access to it - would have been more successful and would have improved the level of clinical engagement. Some of these issues have been partly addressed through the 3 or 4 years of the NHS project and the success of PACs there is an increasing focus in some of the LSPs on improving clinical decision making and health recording which will lead to improved patient outcomes.

There is also an increasing trend here to use "organisational change management" techniques to try and improve the success of putting IT systems in the NHS which is what I am involved with. These techniques from the private sector management consulting around benefits management, communications and stakeholder planning plus system process redesign. As a non-practicing nurse I think that these require a bit more of a clinical and health sector bent to them but this is developing as people from a non-health back ground brought in to improve the success of the IT implementation get to know and understand the NHS clinical and managerial culture

As an ex-pat Australian I have only been recently following what is going on in Australia in health IT and information. It seems from your articles that the former government set up an organisation largely based on bringing non health and private sector techniques and management styles to IM and T planning. It can't be done this way alone. You need to join this with insider health knowledge particularly an understanding of the way clinicians (particularly doctors) make decisions, practice and deliver care. They have to be 100% sure that something is viable and safe of they will opt out. I believe this comes from the way clinicians practice and are taught to make individual decisions about their practice.

You also need detailed process knowledge of how hospitals and health systems are run, managed and administrated. How patients are referred through the system, how costs are monitored and funded or paid. And the organisational and political public and private players Gaining this understanding is not easy and needs experience too. It’s not easy but all needs to be accounted for in successful IM and T health deployments.

Sorry your probably a busy man and this is going on too long. Let’s hope that the new Government and advisors adopt an strategic approach to systems that gets clinicians excited, involved and will improve practice. It’s not easy and can't satisfy everyone. But I also hope that strategies are also planned and developed around how to engage clinicians, other staff and patients on how new IT systems will change the way they deliver and receive care. This will make the introduction and the use of the systems easier too. Again from experience you can’t everyone but you have to try very hard.

Best wishes

-----

Many thanks

I think there are some excellent hard won perspectives that entities such as NEHTA should work hard to absorb.

I look forward to any other insights our new UK Correspondent can offer!

David.

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.

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.

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.

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.

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.