It’s Official - Australia Has Lost the e-Health Plot!

The Australian Financial Review has published 2 articles on e-Health today.

The first is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020767467&magsection=news-headlines-home&portal=_misnews&section=news&title=National+health+records+plan+in+disarray

This article reveals e-Health in Australia to be a headless chook and the Federal Health Minister is unable to commit to any real progress before 2012.

That a National E-Health Strategy is being developed somehow is not mentioned! The left and right hands clearly have no idea what each is up to and neither is the Minister!

The second is here:

http://www.misaustralia.com/viewer.aspx?EDP://20080610000020766889&magsection=news-headlines-home&portal=_misnews&section=news&title=AMA+diagnoses+Google+Health+reports

This provides a discussion of the AMA’s cautious support of Google Health.

Both are must not miss bits of reading.

Sadly it is also pretty depressing.

David.

The UK National E-Health Program – A Lot is Going On!

Two major items of news regarding the NHS program in the last couple of weeks.

First we had

NHS IT four years late and over budget

OUT-LAW News, 16/05/2008

The NHS IT project, one of the world's largest public sector IT programmes, is already four years late.

By John Oates for The Register. This story has been reproduced with permission.

Parts of the project are progressing well and some savings have already been seen but Summary Care Records, a key part of the project, are now unlikely to be widely rolled out until 2014 or 2015, rather than the original target of 2010.

Progress has been measured by the National Audit Office. It warned: "The scale of the challenge in developing and deploying these systems in the NHS has proved far greater than expected, and the timescales... originally agreed... proved unachievable."

The Report said: "For the Care Records Service, the original timescales proved to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk." It said the project still "appears feasible".

Two of the five early adopter Primary Care Trusts have begun uploading patient records, two years late. The other three are running publicity campaigns to inform patients, but have not yet started uploading data.

In the North, East and Midlands Summary Care Records will be run using iSOFT's Lorenzo software - which is not yet available.

Lorenzo should get its first release this summer before a full roll-out in autumn of this year. The NAO warned: "Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East."

The NAO also warned that these plans to roll out Lorenzo "may prove over-ambitious" and called for rigorous testing in pilot areas before wider deployment. The NAO also called on the Department for Health to develop better reporting on how the programme is progressing and how much it is costing.

More here:

http://www.out-law.com/page-9125

The full report is available as a pdf here.

There is also a very detailed discussion of all the points made found here:

Highlights of National Audit Office NPfIT report

These are excerpts from today's report [16 May 2008] by the National Audit Office on the NHS's National Programme for I.T

Much has been published by Connecting for Health on the achievements so far of the NPfIT. The excerpts here highlight some of the important lessons to be learned from the challenges of implementing the NPfIT.

Full text here:

http://www.computerweekly.com/blogs/tony_collins/2008/05/highlights-of-national-audit-o.html

Finally there is also a fully referenced article available.

National Audit Office reviews the NHS National Programme for IT

16 May 2008

The National Audit Office (NAO) has published a review of progress in the NHS National Programme for IT since 2006 [1].

The NAO says that all elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk.

The report concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS trust in England has fully deployed the care records systems, four years later than planned.

In the North, Midlands and East area, the software has taken much longer to develop than planned, so some trusts have had to take an interim system. Completing development and deployment of the system and introducing it in this area "are significant challenges still to be addressed". In these regions the software to be deployed is iSOFT’s Lorenzo. The NAO says the the delays are attributed in part to an underestimation by all parties of the scale and complexity involved in building a new system from scratch.

Full article here:

http://www.bjhcim.co.uk/news/2008/n805023.htm

References

1. The National Audit Office. The National Programme for IT in the NHS: Progress since 2006. London, The Stationery Office. May 2008.
(Vol 1) : www.nao.org.uk/publications/nao_reports/07-08/0708484i.pdf

The National Audit Office. The National Programme for IT in the NHS: Project Progress Reports. London, The Stationery Office. May 2008.
(Vol 2): www.nao.org.uk/publications/nao_reports/07-08/0708484ii.pdf

2. NHS Connecting for Health Additional Supply Capability and Capacity (ASCC) website: www.connectingforhealth.nhs.uk/industry/ascc

Other valuable URLs are as follows

Patient records cause four-year NHS IT delay

http://www.computing.co.uk/computing/news/2216788/nao-care-records-holding-npfit

and

NHS must learn lessons on centralised patient records

http://www.computing.co.uk/computing/news/2215906/connecting-health-learn-lessons

Second we have the news that the almost £ One Billion contract to deliver systems has been cancelled.

See the following reports:

Cerner watches as England cancels Fujitsu contract

By JULIUS A. KARASH

The Kansas City Star

England’s National Health Service is terminating a contract with FujitsuServices Ltd. that includes North Kansas City-based Cerner Corp. as a subcontractor.

“Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties,” NHS said on its Web site. “The NHS will therefore end the contract early by issuing a termination notice.”

Fujitsu in 2005 named Cerner to replace IDX Systems Corp. as a subcontractor on the southern England segment of a $24.5 billion project to computerize English health records. The deal was expected to provide Cerner with $410 million to $490 million in sales.

More here:

http://www.kansascity.com/382/story/640829.html

and here:

Fujitsu’s £896m NHS IT contract to be terminated

28 May 2008

NHS Connecting for Health is to terminate the £896m contract with Fujitsu to upgrade NHS IT systems across the South of England after the IT services giant withdrew from contract re-set negotiations.

Negotiations to 'reset' the Fujitsu local service provider contract have been underway since July 2007 but broke down.

Senior NHS staff in the South of England were told of the news today, after last ditch attempts to broker a deal failed last Friday with a final unsuccessful effort made on Tuesday. By withdrawing from the contract re-negotiations Fujitsu placed itself in breach of the original CfH contract.

In a statement NHS CfH told E-health Insider: "Regrettably and despite best efforts by all parties, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice."

More here:

http://www.e-health-media.com/news/3798/fujitsu%E2%80%99s_%C2%A3896m_nhs_it_contract_to_be_terminated

Comment.

It is hard to know what the fuller implications of all this is. The current Prime Minister is under some political pressure at present and this sort of instability cannot be helping him and more importantly assuring that there is continuing commitment to getting this done – despite the problems.

We will have to wait and see how this play out over the next few months.

David.

Useful and Interesting Health IT Links from the Last Week – 08/06/2008

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

These include first:

Draft of major health IT bill unveiled in House

Nancy Ferris

Leaders of the House Energy and Commerce Committee and its health subcommittee have released a draft of a major health information technology bill that has several parallels to the Wired for Health Care Quality bill pending in the Senate.

The House bill’s backers are the full committee's chairman, Rep. John Dingell (D-Mich.); ranking Republican, Rep Joe Barton of Texas; subcommittee's chairman, Rep. Frank Pallone (D-N.J.); and subcommittee’s ranking Republican, Rep. Nathan Deal of Georgia.

Most of the legislative action on health IT so far in this session of Congress has taken place in the Senate. A couple of health IT bills in the House have languished without a hearing.

However, the health subcommittee has scheduled a June 4 hearing on its draft , and there were indications the measure could then move swiftly. Although its backers stressed the unfinished nature of their draft and expressed the desire to hear from stakeholders about ways to improve it, Dingell said in a statement that “it was developed with strong bipartisan cooperation, and I look forward to working with my colleagues to craft legislation that can be moved swiftly through the committee.”

With time running short in this Congress, which will be preoccupied with November's national elections, having House and Senate bills with many similarities could ease passage of a health IT act.

Like the Wired bill in the Senate, the House draft would codify in law the Office of the National Coordinator for Health IT (ONCHIT), establish committees to advise on the development of health IT policy and standards, authorize a voluntary product certification program similar to the one now in operation at the Certification Commission for Health IT, provide loans and grants to support health IT adoption by doctors and clinics, and update the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.

More here:

http://www.govhealthit.com/online/news/350386-1.html

This is good news that the US Congress is trying to provide an impetus to e-Health and get some of the basics in place. I hope something worthwhile gets to President Bush’s desk sooner rather than later.

Second we have:

Service to warn of e-crimes

Karen Dearne | June 06, 2008

THE Rudd Government will today launch a no-cost, no-jargon internet service that alerts computer users to cyber threats.

The plain-English Stay Smart Online alerts service, provided by the nation's Computer Emergency Response Team, will help home and small business users secure their own PCs against rising levels of cyber-scams and fraud.

It is the first time ordinary computer users have been offered access to information about local and global threats through a government agency.

"While the internet is fascinating and useful, people have to be smart about online safety," Communications Minister Stephen Conroy told The Australian.

"We're wanting to fire out warnings on the latest risks, and give people the information they need to protect themselves.

More here:

http://www.australianit.news.com.au/story/0,24897,23819648-15306,00.html

People can sign up for the new alerts service at www.staysmartonline.gov.au.

This seems like a very sensible initiative. Will be interesting to see how it works out in practics

Third we have:

Ambos get world first mobile data app

Australia's state ambulance services break silos to share knowledge

Darren Pauli 03/06/2008 13:40:20

Ambulance services across Australia are rolling out a new laptop data application to store clinical information on thousands of patients to improve paramedic training, patient care, industry standards and research.

The multi-million dollar Victorian Ambulance Clinical Information System (VACIS) is the latest in a series of initiatives across Australia to improve patient care in hospitals, surgeries and now ambulances.

It captures standard clinical information during paramedic emergency call-outs to provide an evidence base for clinical practice and training.

The project is the only system in the world that identifies a standard process for paramedics and supports information sharing with hospitals.

VACIS manager Noelle McCabe said the project will improve emergency care nationally by encouraging normally siloed ambulance services to share techniques and protocols with their interstate counterparts.

"Research on the data collected assists in improving techniques in clinical practice," McCabe said.

The research has led to improvements in the consistency of pain management, and dispatch protocols have also been changed to make better use of Mobile Intensive Care Ambulance (MICA) paramedics.

More here:

http://www.computerworld.com.au/index.php?id=751341086&eid=-6787

This is a project that has been underway for a few years. It is good to see some progress is being made. It would be good to see some appropriate evaluation of the real-world outcomes in terms of waiting times to get to relevant treatment in hospital as a result of this system.

Fourthly we have:

Email leaks lead to increase in sackings

Karen Dearne | June 03, 2008

MORE workers are being fired for leaking company secrets via email, with a local survey showing one in five businesses terminated an employee for email breaches in the past year.

Outbound email is now a common avenue for data leakage, with 23 per cent of Australian respondents to a Proofpoint/Forrester survey saying their business had been harmed by exposure of sensitive or embarrassing data in the past year.

Proofpoint regional head Gerry Tucker says the number of organisations that had disciplined employees (almost 50 per cent) was on the increase.

"What's surprising is that it's often hard to get a complete picture of the cost of each instance of data loss," he says.

"But the cost of going through an investigation, a disciplinary process and finally termination can be quite significant. So it's a fair assumption that someone is not going to do all that unless the breach has been serious."

Tucker says 62 per cent of respondents listed corporate email as the main avenue for data leakage; 18 per cent were more concerned about web-based email; 15 per cent cited other messaging systems; and 5 per cent mentioned blogs and message boards.

More here:

http://www.australianit.news.com.au/story/0,24897,23798577-5013044,00.html

This is a reminder of just how careful we all have to be with our use of e-mail. I like the thought of only putting in an e-mail what you would but on a post-card without an envelope of a good standard to adopt. Has kept me out of trouble so far!

Fifth we have:

Safety plan to tag dementia patients

Patricia Karvelas, Political correspondent | June 02, 2008

OLD people who have dementia or Alzheimer's would be electronically monitored with devices implanted in their wristwatch or ankle bracelet under a radical plan by the Rudd Government.

Nursing homes would have to report any case of a missing resident, while those with dementia or Alzheimer's might be forced to wear identity bracelets, engraved with a dementia symbol and other information to ensure they could be tracked more easily.

Cases of old people leaving nursing homes and dying after going missing have prompted the Government to consider a tough approach to protect the old and frail. Under the plan, nursing homes would be legally bound to report any case of missing residents, particularly those with a diagnosis of dementia. The Government has already consulted civil libertarians over the plan.

Alzheimer's Australia national executive director Glenn Rees said electronic monitoring might be a necessary measure.

"Technology isn't a panacea but it is one of the options that must be looked at," Mr Rees said. "There are ethical issues that need to be explored in the use of tracking devices."

But NSW Council for Civil Liberties president Cameron Murphy said he had worries about the plan and would push to ensure people were not treated like prisoners.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23794689-23289,00.html

One really wonders sometimes about Civil Libertarians. This seems to be a clear use of technology to make some of the most vulnerable in our community a little safer in their last days. I want my civil liberties protected but not by people who are as confused as the NSW Council seems to be!

This article reports similar information.

Plan to electronic tag dementia patients

See here:

http://news.smh.com.au/national/plan-to-electronic-tag-dementia-patients-20080602-2kmg.html

And this one identifies a couple of really PC nitwits.

Specialist says govt proposal not good care

See here:

http://www.news.com.au/couriermail/story/0,23739,23805279-3102,00.html

Sixth we have:

Investigation into Queensland Health executive's expenses

Article from:

By Renee Viellaris

June 07, 2008 12:00am

QUEENSLAND Health is again fighting corruption claims over the expenses of one of its most senior executives, information chief Mr Paul Summergreene.

State corruption fighters are investigating the monthly corporate credit card invoices of Mr Summergreene, the chief information officer.

These have allegedly reached up to $25,000 - leaving the taxpayer to pick up the tab for limousine hire and expensive entertainment bills.

Queensland Health acting director-general Andrew Wilson, who was made aware of the allegations against Mr Summergreene, inferred The Courier-Mail could face legal action if it revealed the details.

The complaint was referred to the Crime and Misconduct Commission by Queensland Health, as required by law.

Some staff, who have transferred out of the department or quit, have also raised concerns about the amount of alcohol consumption on the premises.

It is alleged a private company contracted to Queensland Health is paying for some of the alcohol.

Continue reading here:

http://www.news.com.au/couriermail/story/0,23739,23822136-3102,00.html

This is a bit of a worry, given the problems that there have been in Health IT in Queensland Health (QH) over the last few years. I hope all the issues can be quickly and fairly sorted out – appropriate action taken if needed - and QH can then move on. It would be good for e-Health nationally if this were the to be the case.

Last we have:

Minnesota Governor Signs Law Requiring E-Prescribing by 2011

Minnesota Gov. Tim Pawlenty (R) signed into law a bill that requires electronic prescriptions and creates new quality reporting rules for physicians, Modern Healthcare reports (Evans, Modern Healthcare, 5/30).

Under the law, pharmacists, physicians and others who prescribe or dispense medication in the state will be required to use electronic systems by 2011.

More here:

http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080602/REG/625054228

This is an amazing step – it would be interesting to see how this sort of approach would work in Australia. The evidence that quality e-prescribing systems do improve the quality of prescribing is no longer contestable and so this initiative makes very good sense to me.

More next week.

David.

Web 2.0 and the Semantic Web – The Healthcare Viewpoint.

The following really interesting article came to my attention a few days ago.

Healthcare and Emerging Rich Web Technologies – The WEB 2.0/Semantic Web Challenge and Opportunity

Over the years, healthcare organizations have had to respond to many different changes – from advances in diagnostic and therapeutic procedures to the emergence of concepts such as managed care and telemedicine. Healthcare is fast becoming one of the most competitive and value added industries worldwide with many technology driven developments in diagnosis, treatment, care provision, patient monitoring and healthcare infrastructure.

One such technology is the Internet. The Internet has transformed various other industries by enabling the widespread sharing of information and allowing the creation of new business relationships. Public information increases on web sites, and consumers use the Internet to find information, communicate with friends and family, plan trips, and shop. It is expected that both the scope of applications and the number of Internet users will continue to grow as technologies improve and new online applications continue to emerge.

In healthcare, the Internet – with its powerful penetration and scalability – has the ability to empower patients, support information exchange, and consequently result in new operational strategies, business and care delivery models. To date, the use of the Internet in healthcare has been limited to e-commerce and e-mail communication between doctors. The Internet's potential, however, is increasingly being harnessed to transform healthcare delivery at the patient level. From growing email use by patients and consumer e-commerce in the drug market, to rising electronic procurement by hospitals, Internet diagnosis and eHealth, the use of the Internet in active healthcare delivery is rapidly gaining ground. Patients create online support communities, search for medical information, and share their experiences, while health care professionals get access to the latest information in their field, consult with their colleagues, and communicate with their patients. Indicative of the impact of Internet in healthcare is the fact that almost every healthcare business – from insurers to hospitals to pharmaceutical companies – has a dedicated Web site.

With the emergence of next generation rich web technologies, such as WEB 2.0 and Semantic web, the creation of a more dynamic and responsive online experience is within reach. This will, in turn, have an effect on how the web is used within the greater healthcare domain, presenting both new challenges and new opportunities.

……

Conclusion
Health-related activities can benefit enormously from the Internet. The large number of stakeholders in healthcare – general practitioners, specialists, nurses, patients, administrators, researchers, and others - can take advantage of the Internet and its capability to support communication, and improve access to health information, thus forging new relationships among those stakeholders. Although a number of technical, organizational, and policy issues need to be addressed, especially in areas such as security, reliability, and timely transmission of information, the Internet has the potential to improve the quality of care, expand access to it, and reduce its cost.

Next generation healthcare information systems will not only allow the exchange of data between heterogeneous systems, but will also enable the representation of complex medical contents. Intelligent search engines, virtual agents and very specific data analysis tools will process semi-structured data and will help make the latest, quality assured information available for health care professionals, executives and patients. Health information generators will search for individual person-centred information in the web, using person-specific information from the EHR and will design health promotion programmes based on the latest evidence-based, quality-assured knowledge.

However, Rich Web Technologies should be seen as a double-edged sword. The main opportunities lie in the fact that consumers will have even better possibilities to find, aggregate and appraise health information than today. On the other hand, one might fear that this may lead to a further over reliance on external information, a process of disintermediation between patients and healthcare professionals and erosion of the patient-physician relationship.

Such concerns will however not stop the development of these technologies, as health information is still some of the most sought after on the web. People will not stop short of using these technologies for health products and services, researching the attributes and reputation of health products and services with a far greater sophistication than on today's web. The World Wide Web as it exists today might be just at the beginning of a health informatics revolution.

The complete long and informative article is found here:

http://www.obbec.com/specialreports/86-healthcare-it/1828-healthcare-and-emerging-rich-web-technologies-the-web-20semantic-web-challenge-and-opportunity/

This is a good perspective on these technologies that recognises the human dimension that must be addressed as well as clearly understanding the complexity of health care and the difficulties associated with the successful use of technology within the sector.

A valuable briefing and update.

David.

The Healthcare Supply Chain – An Important Part of the E-Health Agenda

iHealthBeat published this interesting feature recently

Healthcare Supply Chain Coalition Hits Milestone

by George Lauer, iHealthBeat Features Editor

The word of the decade in health IT is interoperability. It conjures up images of nurses and doctors using compatible digital languages and technological syntax in diverse systems and organizations all over the country.

The image shouldn't stop there. It should include the people who manufacture and order the materials used in health care -- everything from bandages and bedpans to implants and X-ray machines. And it shouldn't stop at the border. Supply chain interoperability is an international effort.

While the quest for interoperability marches on in legislatures, board rooms, hospitals and doctors' offices, a parallel march is taking place in shipping and receiving.

Last week, the organization leading the campaign, the Healthcare Supply Chain Standards Coalition, announced it has reached a milestone. The Standards Coalition, a collaborative of 30 organizations, is combining its efforts with newly formed GS1 Healthcare US.

GS1 Healthcare is descended from the organization that developed the ubiquitous Universal Product Code, or UPC, used in retail, shipping and manufacturing. GS1, based in Brussels and New Jersey, launched its Healthcare US division earlier this year.

…..

Global Perspective

Although the legal requirement deals only with the U.S., the Standards Coalition is taking a global perspective.

"This is all happening in concert," Dudas said. "We have been in direct contact with other countries working on the same problems. For the most part, the global health care industry is moving forward in unison. GS1 is the global standard; that's another reason we're aligning ourselves with GS1 Healthcare," Dudas added.

France, Australia and Turkey are particularly active in the effort to establish international supply chain standards in health care, according to Dudas.

MORE ON THE WEB

• GS1 Healthcare
• Healthcare Supply Chain Standards Coalition
• National Alliance for Health IT

More here:

http://www.ihealthbeat.org/articles/2008/5/29/Healthcare-Supply-Chain-Coalition-Hits-Milestone.aspx?a=1

This is an important reminder that part of the E-Health Agenda has to include those basic areas that can contribute to the effectiveness and efficiency of the health system. Moreover I have at least one colleague who, rightly, believes that better logistics can also improve the quality and safety of the care the patient ultimately receives.

Those of us who are focussed more clinically tend to forget the importance of systems that support logistics, human resources, financial management and rostering (among others) in the overall picture.

NEHTA has been active in the supply chain area, however, sadly, their approach here has mirrored what we have seen elsewhere and progress has been slower than might have been desired. At least the GS1 approach is what NEHTA has adopted!

There is money to be saved with proper adoption of these system that can help support other activities and we should be making these savings sooner rather than later.

David.

Guest Commentary - Dr Sam Heard on “Why is it Taking So Long?”

I have been working in Health Informatics my entire career as a doctor and I plan to see interoperable health records somewhere in the world before I retire (don't worry I have more than 10 years to go). Where to concentrate my time? Australia? It may well take some time to recover from the past 5 years. The UK are trying much harder, but the environment is hostile and legalistic and only those companies with massive purses or undue cunning are surviving (actually these features are necessary but not sufficient). Denmark and Sweden are taking up the archetype approach of the new ISO standard much championed by my close colleague Dipak Kalra, who like me, has been very involved in developing the openEHR specifications. Other countries are, like Australia, betting on HL7 CDA and IHE for access. Actually, we need messages, stand-alone documents and service protocols. And, it is now being realised, standard expression of clinical content. This is something that openEHR is good at but it is not clear that it is necessary until people really start to share information. It is interesting that openEHR, with its development largely in Australia, began to be taken seriously in countries like the UK and the Netherlands who had already embraced HL7 version 3 and CDA.

There are two broad visions of the e-health future which people now embrace.

1. A world where every vendor goes out and builds a system just how they want and makes it do everything that their users want. "Nothing should get in the way of that". Other users and patients can then get access to this information and share it via messages. "Just tell us what you want and we will give it to you". Vendors and clinicians spend years configuring these systems: all unique and each working with a variety of messages that are sent in the local environment.

2. A world where there is a standard format for personal health information and a standard service interface for reading and writing that information. How personal health information is actually stored behind the service is up to the vendor of that EHR service. There will be bells and whistles to go with each flavour. Application vendors will write their applications based on the standard EHR and configuration will be done in a collaborative and cooperative space. Hospitals and even general practices (if they wish) will be able to have their records independent of any clinical application.

Patients will too! Clinicians take a key role in determining what content is required and how it may be structured effectively and efficiently to 'boost' their performance. At times data to be collected will be for the person's long term benefit, such as determination of risk of stroke or other preventable catastrophe. At other times it will be structured to ensure the best possible outcome for the patient, such as an emergency presentation of chest pain.

I have chosen to work on the second approach since 1986. Why am I working on this when the first is the massively dominant approach at the moment? The answer is: because I believe it will get their first. "How?" you might ask. Simply because the first approach cannot deliver. Imagine if we worked in a world with 1000s of word processor applications - actually 100,000s - which did whatever you needed to allow you to write things that were important to you in just the way you wanted. And then each vendor could get together and agree how to use XML or other standards to get the paragraphs about your family, those about your medication, or those with pictures so you could share them with colleagues doing the same sort of work. Each of these messages would be specific to that type of information and ideal for exchanging these. We could even have special messages for sending information about more complex grouping of these - which could be slightly different if required in different jurisdictions. Does it sound plausible? Well, if you consider the complexity of health information compared to word processing documents, then you begin to realise why it is not attractive to me.

So where to start? The first problem is to agree what is needed clinically, how to allow structure and narrative to coexist in a manner that helps clinicians find relevant information. To do this we must be sure that the critical things that computers need to provide the functionality we seek are done in the same manner throughout. The rest, in openEHR, is in the Archetypes: the clinical statements of what is to be recorded and how it may be structured. These statements are formal and can be used, in the first instance, to provide Vendors in our current setting with a very helpful indication of what is required and what will be shared. Ian McNicoll has discovered in his work with clinicians in the UK NHS that they are very good at saying what they don't want but find it much more difficult to say what they do want. The 'maximal dataset' archetypes provide the starting point. The sponsors for specifying content are jurisdictions and the international clinical community.

What is next? Well, hospitals and jurisdictions can now choose to hold their records in a standard format; not just an exchange but at the heart of their system. Their purchasing then requires applications to read and write to their records, just like a locum clinician will be expected to use the clinic record system. But now they can bring in an intensive care application that suits, the ophthalmologists can use their own application with all the features they require and the gastroenterological researcher can even collect their research data in the clinical environment (after all 95% of it is straightforward clinical data). So far this has only happened twice, but this year it looks like a more will take the step. After all, if we are to have any progress in any field we need early adopters. If the collective 'configuration' is available through shared sets of clinical archetypes then vendors can choose to build their product on a standardised EHR. The benefit is that all the transformations required can be cooperatively determined with shared tools and the evolution of the information is not their responsibility. There are now 3 clinical application vendors doing this in Australia and 2 in the Netherlands. These applications then become the choices for the hospitals and others with standardised health records.

It will take a while before the real benefits are obvious. It will, after all, be like having Microsoft Word files - even if you use Open Office or whatever. Australia was on the brink of taking this route - 'common sense' pulled us back. With Denmark and Sweden now joining the UK and pursuing this path and changes at the helm at many levels in Australia, it might be time to look over the precipice again. It feels safer when you jump with others.

Declared interest:

Director of the openEHR Foundation

CEO of Ocean Informatics who make a living supporting the uptake of openEHR.

----- End Commentary.

All I can say is Sam is a very patient man – as I must be - given I started at this in 1984. I see this as a bit of a ‘cri de coeur’ (sic).

Enjoy and please comment.

David.

A Blog Submission to the National Health and Hospitals Reform Commission

I e-mailed this submission today to the NHHRC.

----- Begin Submission

30 May, 2008

National Health and Hospitals Reform Commission

More and Associates Submission

More and Associates is a small consulting firm which consults in the e-Health domain.

More and Associates are convinced there is overwhelming evidence that appropriate deployment and use of information technology in the Health Sector (e-Health) can enable much enhanced sustainability, quality, safety, efficiency and effectiveness in the Health System.

The professional evidence supporting this contention is available at the following URL:

http://healthit.ahrq.gov/portal/server.pt?open=512&objID=650&PageID=0&parentname=ObjMgr&parentid=106&mode=2&dummy=t

The Health IT Bibliography is a unique and highly valuable resource which should be thoroughly considered by the Commission in its deliberations.

Detailed reviewed references cover the following areas of e-Health value, adoption and deployment.

Organizational Strategy

Adoption Strategies

Business Case

Technology

Clinical Decision Support Systems (CDSS)

Computerized Provider Order Entry (CPOE) Systems

Electronic Health Record (EHR) Systems

Electronic Prescribing (eRx)

Health Information Exchange (HIE)

Standards and Interoperability

Evaluation

Evaluation Studies in Health IT

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Additional evidence is also available from my blog on Health IT which has over 450 articles on the topic.

See this URL:

http://aushealthit.blogspot.com/

We believe an appropriate consideration of the place of e-Health in all the reform proposals developed by the Commission is vital. If this is not done a key enabler of reform may be ignored to the peril of the success of the whole reform enterprise.

Yours sincerely,

Signed

David G. More

Executive Director

----- End Submission

I hope they listen.

David.

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

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

These include first:

How important is Mirth?

Posted by Dana Blankenhorn @ 7:44 am

Fred Trotter recently decided to turn his regular talks on open source health computing into a series of blog posts. They are well worth looking at.

His review calls Mirth the most important interoperability project out there. This despite what he acknowledges are weaknesses in the underlying HL7 standard.

Mirth is a great effort. There are implementations for Windows, Linux, the Mac OS, even JBOSS middleware. The most recent version is 1.7.1, released on April 30, and dozens of bug reports and improvement suggestions have already been posted.

More here:

http://healthcare.zdnet.com/?p=994

The answer to the question I believe is very important. This software is a key enabler of interoperation between different systems and to have it open source and available freely is really a good thing.

The web site for the project is well worth a careful review.

Second we have:

GPs reject web-based ‘Healthbook’ record

Andrew Bracey - Friday, 30 May 2008

GPs have roundly dismissed proposals for a Facebook-like system of personal electronic health records, pointing to issues of reliability and patient privacy as major stumbling blocks.

A recent national survey of 151 GPs by Cegedim Strategic Data for Medical Observer revealed just 13% of GPs were convinced the concept would work.

The proposal – dubbed Health­book – emerged from the recent 2020 Summit and involves the establishment of individual health profiles controlled by each patient.

The Internet-based system would allow patients to store medical data and share it with health professionals.

GPs were cynical about the proposal. Just over 28% said they did not believe such a system would ever be realised.

Patient privacy, security and incomplete record-keeping were cited as key barriers to safe implementation.

More here (if access available):

http://www.medicalobserver.com.au/medical-observer/News/Article.aspx/GPs-reject-web-based-%E2%80%98Healthbook%E2%80%99-record

I find this level of negativity quite interesting – I wonder how well the proposal was explained to the respondents before their views were sought.

Third we have:

Vic IT projects in crisis: Auditor

Fran Foo | May 28, 2008

PEOPLE with tunnel vision are running some of Victoria's most complex ICT projects, and the ramifications are hurting the state's bottom line.

Victoria's Auditor-General Des Pearson today said such projects, often involving myriad government agencies, were increasingly late and over budget.

Mr Pearson made the comments as he released an audit report on Project Rosetta, saying the whole-of-government enterprise directory project was a prime example of the deepening malaise.

"The time and cost overruns experienced in Rosetta are becoming commonplace when reviewing multi-agency ICT implementations ," he said in a statement.

"While not at the same scale as those experienced in other projects recently audited, such as HealthSMART, these recurring features indicate that lessons need to be learned."

In April, Mr Pearson said the $320 million HealthSMART project is two years overdue.

Meanwhile, Rosetta incurred additional costs of more than $10 million, and was delivered seven months past its deadline. The directory was nearly four years in the making, with work commencing in August 2002.

More here:

http://www.australianit.news.com.au/story/0,24897,23773298-15306,00.html

It seems that major projects in the public sector are virtually always very problematic. This lesson should not be lost on those in NEHTA proposing a Shared EHR (or whatever it is called today). A decentralised locally driven process would seem to me to be much more sensible.

Fourthly we have:

Data breach reporting a scramble

Karen Dearne | May 27, 2008

BANKS say they are well placed to adopt new data breach notification rules, but other businesses may struggle to get protections and policies in place.

The Rudd Government is considering making reporting of data breaches mandatory as part of a review of the Privacy Act.

In the meantime, federal privacy commissioner Karen Curtis is seeking public comment on an interim voluntary scheme.

ANZ Bank privacy compliance manager David Templeton said it had had an incident reporting system in place for a number of years. "Any privacy incidents are recorded in a database, which reports issues in real time to a central compliance area for review," he said.

"We then consult with the relevant business area to decide what action is appropriate."

Symantec Pacific vice-president Craig Scroggie anticipates a windfall for security vendors arising from new legislation. His firm recently acquired Vontu, a leader in data loss prevention tools.

"Data loss is clearly a big issue because of the federal privacy commissioner's draft guidelines for voluntary notification, and the forthcoming Australian Law Reform Commission recommendations on a mandatary scheme," he said.

"Data loss is not just an IT issue, it's a significant business issue, as information is a prime company asset. Data loss and leakage are hot topics right now, but they're not new."

More here:

http://www.australianit.news.com.au/story/0,24897,23762990-5013040,00.html

What I am not clear on as yet is just what the implications of this are for the health sector. It would seem to me that everyone who holds computerised (or even paper based) health information needs to keep an eye as to what is going on here.

Fifth we have:

One-stop shop for Centrelink, Medicare

Patricia Karvelas, Political correspondent | May 28, 2008

SOME Centrelink and Medicare outlets will be combined into "one-stop government shops" under a Labor plan to improve access for customers.

The overhaul of Centrelink, to be unveiled today, will also involve the introduction of digital forms to reduce processing times and allow for quicker decisions.

While a national rollout of the one-stop shop concept remains a long-term plan, Human Services Minister Joe Ludwig said that in areas where the viability of the local Centrelink office might be in question, the all-in-one option would enable towns to keep their branch open. Uniting offices would be trialled in one-off locations under a $10million plan.

Senator Ludwig said some of the service improvements, to be announced today, were aimed at introducing new technology to Centrelink agencies, including digital scanning of documents.

Online "smart forms" would allow questions about customers' circumstances to be asked in one hit for a range of benefits.

"Similarly, better use of available technology could mean that, for students, requests for information from Centrelink can be sent via SMS," Senator Ludwig said.

More here:

http://www.theaustralian.news.com.au/story/0,25197,23769877-23289,00.html

While at first blush this may seem like a good idea I wonder just how people would feel talking to the same customer service officer about both their Centrelink payments and their health claims. The possibility for all sorts of privacy breeches and possibly some forms of abuse of privilege seem higher in this environment. The officers would potentially have access to a huge amount of private information on a client to be able to manage all these programs from a single visit – and that may not be uniformly a good thing.

This article may also be relevant.

Medicare IT outsourcing deal delayed

Karen Dearne | May 29, 2008

THE planned retendering of Medicare's key ICT outsourcing services contract has once again been postponed while the Human Services Department awaits direction from the Gershon Review of federal government agencies' use and management of IT systems.

Human Services Minister Joe Ludwig says the plan to take a "more universal" approach to ICT requirements will affect the timing of approaches to the market by agencies.

"We have a number of major contracts - including the Medicare Australia ICT services contract - which are due to expire over the next 12 to 24 months," Senator Ludwig said in a statement.

"A key element of the department's service delivery reform strategy involves strategic portfolio approach. Our agencies, including Centrelink, Medicare and Child Support, are collectively among the biggest users of ICT within Australia."

More here:
http://www.australianit.news.com.au/story/0,24897,23777892-15306,00.html

Sixth we have:

Rollout of NHS e-record software faces more delays

22 May 2008 09:15

Connecting for Health and CSC may be preparing a new contract extending the schedule for implementation of the Lorenzo software until 2016

Further delays have beset the implementation of a key feature of the NHS National Programme for IT.

According to a paper released online by the North West Strategic Health Authority, NHS Connecting for Health and local service provider CSC are preparing a new schedule, extending to 2016, for installation of the Lorenzo software within health service trusts. Lorenzo will provide the core clinical information system for hospitals in the north and east of England and the Midlands.

This is at odds with a National Audit Office report released on 16 May, which said the implementation of electronic care records, the core of the national programme, had been delayed to 2014-15, making it four years late.

Continue reading here:

http://news.zdnet.co.uk/itmanagement/0,1000000308,39422253,00.htm

This is a little worrying. One really hopes some of this ground can be made up over the next few years.

Last we have:

Call for e-health to ‘permeate’ rural Scotland

27 May 2008

E-health should permeate thinking about every aspect of remote and rural healthcare, according to a newly-published report on healthcare in remote areas of Scotland.

Scotland’s Remote and Rural Steering Group, 'Delivering for Remote and Rural Healthcare: what it means for you', sets out a framework to develop a sustainable care system in remote Scotland. Its findings have been accepted by the Scottish government.

The report calls for Scotland’s eHealth Strategy Board to ensure that the level and quality of connectivity is the same across Scotland and says that remote and rural communities should be supported by a “first class IT infrastructure”.

The steering group said that the principles underpinning a technological approach should be that specialist advice could be provided from a distance using videoconference, telephone or e-mail, that videoconferencing could avoid the need for traveling to a central point and that digital data such as blood tests and ECGs could be transferred from remote sites to other points, enhancing diagnosis.

More here:

http://www.ehiprimarycare.com/news/3784/call_for_e-health_to_%E2%80%98permeate%E2%80%99_rural_scotland

It seems that some of the ideas for remote Scotland might be worthwhile considering for remote Australia given our plans to improve the network connectivity all over Australia with the new Broadband investments.

More next week.

David.