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."

Sunday, August 17, 2008

Useful and Interesting Health IT Links from the Last Week – 17/08/2008

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

These include first:

NHS database awaits legal diagnosis

A recent EU court judgment could scupper the £6bn NHS patient database, says Jonn Elledge

Government IT projects have a pretty poor reputation. They turn up late, cost twice as much you expect, and don't work when they arrive. But the NHS looks set to go one better. Legal experts are warning that its £6bn database could actually breach your human rights.

The idea of the database sounds sensible enough. Each patient will have a single record, detailing their medical history, allergies and any medication they're on. Doctors should thus have all the information they need to treat them, whether they're in Plymouth or Penrith.

It's a nice theory, but critics are fretting about data security. Tens of thousands of NHS staff will have access to the database. It would only take a couple of them to create data losses of tabloid headline proportions. "The real test will be whether Leo Blair's vaccination records ever go on," says healthcare IT expert Richard Gunn. "Because 30 seconds later the papers will know whether he had the MMR."

Now campaigners say a judgment from the European Court threatens the entire project. The ruling concerned a Finnish nurse who lost her job after colleagues discovered she was HIV positive. The hospital argued that, by punishing those who'd misused her records, it had done all it could to protect her. Nonsense, the court replied. Instead it demanded measures which "exclude any possibility" of a breach occurring in the first place.

Much more here:

http://www.thefirstpost.co.uk/45094,opinion,recent-eu-court-judgment-could-scupper-the-6bn-nhs-patient-database

This is an interesting, if slightly alarmist analysis, on the possible fate of the UKs proposed Shared EHR. It is important proponents of similar systems watch all this carefully.

Second we have:

SNOMED CT Gets an Upgrade

HDM Breaking News, August 11, 2008

The International Health Terminology Standards Development Organization in Copenhagen, Denmark, has released its second enhancement this year of the SNOMED CT clinical terminology.

The system offers a comprehensive database of standard medical terms and concepts that can be embedded in electronic health records systems.

More here:

http://www.healthdatamanagement.com/news/terminology26766-1.html?ET=healthdatamanagement:e544:100325a:&st=email&channel=systems_integration

The full article offers a listing of the changes.

The full press release is found here:

http://www.ihtsdo.org/news/article/view/snomed-2008-international-release-of-snomed-ctR-now-available/

Third we have:

Even free software has copyrights: judge

August 15, 2008 - 11:14AM

In a crucial win for the free software movement, a US federal appeals court has ruled that even software developers who give away the programming code for their works can sue for copyright infringement if someone misappropriates that material.

The decision by the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., helps clarify a murky area of the law concerning how much control programmers can exert over their intellectual property once it's been released for free into the so-called "open source" software community.

People are free to use that material in their own products, but they must credit the original authors of the programming code and release their modifications into the wild as well, a cycle that's critical for free software to continue improving.

Because the code was given away for free, thorny questions emerge when a violation has been discovered and someone is found to have shoved the code into their own for-profit products without giving anything back, in the form of attribution and disclosure of the alterations they made.

More here:

http://www.theage.com.au/news/biztech/even-free-software-has-copyrights-judge/2008/08/15/1218307187197.html

This is a very good decision in my view as it makes sure that ‘open source’ software cannot be just appropriated without complying with the license under which it is made public. The open source movement is an important balancing force to the commercial software industry and helps keep those interests much more honest and indeed innovative.

Fourth we have:

People Turn to Internet for Health Info When Stakes High, Connection Fast

by Susannah Fox

The Internet is changing the way Americans engage with information, whether they are choosing a president or making health care decisions. Two major drivers for this change are broadband adoption and personal motivation.

First, an update: The Pew Internet Project estimates that between 75% and 80% of Internet users have looked online for health information. We get slightly different results for the size of the e-patient population depending on our survey strategy, but these results are close enough to make us confident we have the right contours of this group. Our estimate is also in line with Harris Interactive's latest data on health information seekers (81% of Internet users; 66% of all adults).

We got the 75% reading in our October-December 2007 national phone survey, which included 2,054 adults ages 18 and older, including 500 cell phone users. In this survey we asked: "Do you ever use the Internet to look for health or medical information?"

In surveys we conducted between 2003-2007 (and plan to repeat in coming months), respondents were prompted with questions about specific health topics, such as diet, drugs or alternative treatments, yielding a consistently higher estimate (80%) for the percentage of Internet users who seek health information online in 2003, 2004 and 2006.

More here:

http://www.ihealthbeat.org/articles/2008/8/12/People-Turn-to-Internet-for-Health-Info-When-Stakes-High-Connection-Fast.aspx?ps=1&authorid=1616

Interesting article showing the importance of broadband in making information – especially health information – available to the public.

Fifth we have:

Cervical cancer vaccine boost

  • Nick Miller
  • August 11, 2008

MELBOURNE is about to become the centre of efforts to vaccinate young Australian women against cervical cancer, with the opening today of the National Human Papillomavirus Register.

The register will record all HPV vaccinations from councils, schools, GPs and nurses around the country.

Since July last year the vaccine, which protects women against some strains of the virus responsible for most cervical cancer, has been fully subsidised by the Commonwealth for girls and young women.

The register will monitor the success of the vaccination program, and assess its impact on cancer rates. It will also issue reminders to women and girls who have missed part of their three-dose vaccination schedule.

The register shares its Carlton headquarters with the Victorian Cytology Service, which has analysed Pap test results since 1989.

The $23.5 million project has already started collecting data from GPs, and will now start uploading data from state school vaccination programs.

More here:

http://www.theage.com.au/national/cervical-cancer-vaccine-boost-20080810-3t2n.html

This is a good announcement, but one is really forced to wonder why this was not established as the program, rather than a year later?

Sixth we have:

Mainframe here to stay, survey says

IT's planned use for the mainframe as a computing platform continues to grow, BMC survey finds.

Denise Dubie (Network World) 14/08/2008 09:34:00

The future looks bright for the mainframe as a majority of IT managers report they will continue to use the systems for legacy applications and start moving new workloads that could benefit from the mainframe's availability and scalability onto the platform.

In its annual survey of 1,100 mainframe users, management software maker BMC discovered that IT's planned use for the mainframe as a computing platform continues to grow. For instance, 65 percent of respondents said the mainframe platform will continue to grow and attract new workloads in their environment, compared with 52 percent of respondents who said the same in the 2007 survey. Thirty percent said that the mainframe will continue as a viable long-term platform, but restricted to legacy workloads. And 4 percent indicated mainframe users should consider an exit strategy in the next five years. Fewer organizations surveyed this year also plan to eliminate their mainframe environment in the short term. According to BMC's findings, 59 percent of respondents said they would be ridding themselves of the mainframe in less than three years, compared with 74 percent in 2007. Thirty-six percent said they would work toward removing mainframes in three to six years and 6 percent expected to keep mainframes in house for more than six years.

More here:

http://www.computerworld.com.au/index.php?id=24684117&eid=-255

It is fascinating machines of this type continue to prosper 50 plus years after the first ones appeared. The first “real” one – the IBM Model 360 appeared as far back as 1964!

The history of all this is pointed to here:

http://www.beagle-ears.com/lars/engineer/comphist/ibm360.htm

and here:

http://www-03.ibm.com/ibm/history/exhibits/mainframe/mainframe_PR360.html

The original announcement with the pictures etc makes fun reading so far down the track.

Last we have our slightly technical note for the week:

Two different views on technical trends for the next few years.

Report: Cloud computing poised for enterprise adoption

Cloud computing, green IT and social-computing platforms will reach broad enterprise adoption in the next few years, Gartner says.

Elizabeth Montalbano (IDG News Service) 12/08/2008 08:32:25

Gartner has named cloud computing, green IT and social-computing platforms among technologies that are poised to reach broad enterprise adoption in the next two to five years.

The report "Hype Cycle for Emerging Technologies, 2008" by Gartner Vice President and Fellow Jackie Fenn and other analysts, also cited video telepresence, which utilizes high-end videoconferencing systems to provide remote conference participants with the feeling that they are in the same room, and microblogging popularized by the Internet application Twitter as being on the brink of widespread adoption among enterprises.

All of these technologies are at the peak of what the report calls their "hype cycle," a term Gartner began using in 1995 to describe the human response to technology -- from overenthusiasm at the beginning, through a period of disillusionment with the technology, to an eventual understanding of the technology's relevance and role in a market or domain.

Gartner uses the hype-cycle assessment to advise IT managers about when they should begin to adopt certain technologies that are getting a lot of attention but whose value to the enterprise is not yet known, according to the report. IT professionals generally have a better understanding of how to implement technologies at the peak of their hype cycle in a few years, once the initial excitement about them dies down.

The impact of technologies that are at the peak of their hype cycle in 2008 will differ depending on the technology, according to the report.

Cloud computing, defined by Gartner as "a style of computing where massively scalable IT-enabled capabilities are delivered 'as a service' to external customers using Internet technologies," in particular should have "transformational impact" on the enterprise, according to the report. This means the technology will change the way the IT industry "looks at user and vendor relationships," Fenn wrote.

More here:

http://www.computerworld.com.au/index.php?id=1561926085&eid=-180

and from Forrester

The future of IT: No big bangs, information everywhere

Posted by Mike Ricciuti

There's plenty of technological innovation headed to the enterprise in the coming years, but don't expect any new game changers on the order of Internet or ERP, according to a new report.

Instead, existing technologies like service-oriented architectures and mobile will combine with component business applications and social networking to form what Forrester Research analyst Bobby Cameron calls "IT everywhere."

Information technology is at the beginning of a "new 16-year cycle of innovation and growth that follows the previous cycle of networked computing for enterprise applications and the Internet," Cameron writes in the report, which debuted on Wednesday.

Cameron identifies several technologies that are already in place but will gather steam in the coming years, such as X Internet--the explosion in RFID and other devices--SOA, business-process management, and mobile.

There will be some new acronyms joining the technology mix: dynamic business applications (and architectures) (DBA) that build on SOA and are far more flexible and easier to adapt than older technologies; master data management (MDM), which seeks to improve the quality of data that businesses use; and information workplace (IW), the notion of delivering information through available technologies.

More here:

http://news.cnet.com/8301-1001_3-10017210-92.html?tag=nl.e433

It is re-assuring that broadly the pundits have similar views as to what will be important!

The impact of ‘cloud computing’ on privacy makes interesting reading.

Cloud computing may 'threaten' privacy

August 11, 2008 - 1:38PM

A US military computer science professor has warned that a trend to push software into the "clouds" exacerbates privacy risks as people trust information to the Internet.

Websites routinely capture data that can reveal pictures of users' lives, US military academy professor Greg Conti told an audience at the annual DefCon hackers gathering in Las Vegas.

The danger is being heightened by a growing Internet trend toward "cloud computing," software being offered online with applications hosted on outside computers instead of programs being installed on people's machines.

A common example of the practice is Web-based email services such as those offered by Google and Yahoo.

The world of cloud computing is expanding to include software for documents, accounting, spread sheets, photo editing and more.

"With cloud computer looming on the horizon it is important for us all to think of the privacy threats there as well," Conti said.

"The tool resides with someone else and the data is stored somewhere else. Generally, that is a bad idea."

More here:

http://www.smh.com.au/news/web/cloud-computing-may-threaten-privacy/2008/08/11/1218306734865.html

More next week.

David.

Thursday, August 14, 2008

Picture Archive Communications Systems – The Real No Brainer.

Two articles appeared in the last week showing just what a strong case there is for getting on with implementing Picture Archive Communication Systems (PACS) and the associated Radiology Information Systems (RIS).

First we have:

Canada Health Infoway finalizes preferred solution agreement with GE Healthcare for diagnostic imaging solutions

August 7, 2008 (Toronto) - Canada Health Infoway (Infoway) today announced it has negotiated preferential conditions and pricing with GE Healthcare Canada through a Preferred Solution Agreement for their Centricity Picture Archiving and Communications System (PACS) and Diagnostic Imaging Repository (DI-r).

Diagnostic imaging and PACS refers to systems that allow X-rays, MRIs, ultrasounds and CT scans to be captured, viewed and transmitted electronically from one site to another. These systems replace conventional X-ray film and greatly improve access to patient information. Diagnostic imaging repositories provide a secure environment for the storage and retrieval of diagnostic images and reports.

"The project investments made in diagnostic imaging are translating into real-time benefits and progress in diagnosis and treatment, providing clinicians and patients with more accurate results and reduced wait times," said Richard Alvarez, Infoway's president and CEO.

Through an Infoway project investment, British Columbia's Interior Health Authority demonstrated an overall average 41 per cent decrease in turnaround time for radiology results since the implementation of PACS. Similar technology provided by GE Healthcare at the province's Fraser Health Authority uncovered millions in annual cost savings by reducing film costs and storage space and increasing productivity. By 2010, Canadians will benefit from improved radiology services made possible by digital diagnostic imaging in all provinces and territories.

A key element of the Canada-wide agreement is preferential pricing for jurisdictions who implement a shared service where several hospitals agree to use a common PACS and DI-r infrastructure. GE Healthcare's commitment to adhere to pan-Canadian standards, and applicable privacy and security requirements, is covered in the agreement.

"This agreement will benefit our jurisdictional partners by reducing the cost and risk of implementing PACS and DI-r solutions," added Alvarez.

The Canada-wide agreement will help accelerate the implementation of electronic health records, making it simpler for provinces and territories to acquire a diagnostic imaging solution. GE Healthcare Canada joins Agfa Healthcare, Christie Group Ltd., McKesson Information Solutions, and Philips Healthcare as preferred solution providers for diagnostic imaging.

Infoway's Preferred Solution Agreements show that participating vendors like GE Healthcare have a deep understanding of the pan-Canadian EHR and the need to adopt established standards to ensure interoperability. While Infoway believes that these agreements offer significant value, the selection of specific vendors rests with the individual province or territory.

At the end of fiscal 2007/08, Infoway invested $316 million in 21 diagnostic imaging projects, currently completed or still in progress, across eight provinces and one territory. This is part of 254 electronic health record projects, representing $1.457 billion in investment since Infoway's inception.

Source:

http://www.infoway-inforoute.ca/en/News-Events/InTheNews_long.aspx?UID=323

Second we have

Carestream rolls out French 'pay-as-you-go' PACS

06 Aug 2008

Carestream Health, formerly Kodak Health, has announced that 37 privately owned French medical facilities are now using its Hosted Information Management (HIM) system, a pay-as-you-go system for remote archiving, storage and image sharing.

HIM is one of a number of eHealth Managed Services from Carestream Health designed to archive, share and distribute medical data more cost effectively and efficiently.

The company says that the contracts with the French customers will result in the annual storage of approximately 1 million imaging studies.

Customers range from individual imaging centres such as Centre Duroc in Paris to GCN St. Vincent, which has eight imaging centres and clinics around Rennes in the Ouest Region of France.

The HIM service from Carestream Health is aimed at hospitals and imaging centres choosing to manage the exponential growth of patient data by outsourcing for disaster recovery or multi site virtual archiving and workflow.

The services are based on a “pay as you go” model. According to Carestream this payment model is helping French healthcare providers overcome the need for high initial and ongoing costs of infrastructure, which it says represent the greatest barrier to healthcare IT adoption.

This led Carestream to develop the “Avenant 24” initiative, which offers financial incentives to private facilities in France implementing a digital archiving solution for radiology images.

……

The service is based on a GRID infrastructure that supports both local and remote storage and is powered by KODAK Versatile Intelligent Patient Archive (VIParchive) software, the leading radiology archiving platform that allows on site storage for quick access to data to be combined with off site storage at a data centre for protection, disaster recovery, data exchange and access.

Developed in Europe, the key advantages of Carestream Health’s remote archive services offer a flexible combination of on site and remote storage to meet existing workflows with on site storage ranging from a few days to several years. This model supports a virtual community with all sites connected, even where different PACS, modalities and workstations are operating

…..

More here:

http://ehealtheurope.net/news/4028/carestream_rolls_out_french_%27pay-as-you-go%27_pacs

And as close to home as NSW we find NSW Health out to tender for a State-Wide PACS Archive – which will have more than the odd terabyte of data storage – to integrate picture information flows State wide.

There is just no excuse on quality, safety or convenience grounds not to invest in these systems. It is just silly that South Australia, for example, seems to want to wait to start even planning PACS until 2013-14 according to their master plan of March 2008! That would seriously discourage every radiologist who works in the SA Public Health System pretty severely!

SA should borrow the money and start saving lives and money today!

David.

Wednesday, August 13, 2008

Recognition of the Need for More Health Information Professionals

In the last week we have had more cries regarding the critical shortage of Health Informatics professionals around the world and comments emphasising just how important such people will be to the hopefully expanding e-Health agenda around the world.

First we have:

AHIMA: Action Needed on HIM Ills

HDM Breaking News, August 4, 2008

A growing shortage of qualified health information management professionals imperils the benefits that electronic health records, health information exchanges and other technologies can bring to help improve the quality, safety and efficiency of care, according to the Chicago-based American Health Information Management Association. The member organization issued a detailed policy statement on the challenges facing medical records departments and the need for industry and government action. What follows is the complete policy statement:

AHIMA regards the adoption and maintenance of electronic health records (EHRs), personal health records (PHRs), and the formation and utilization of health information exchange (HIE) networks as imperative to lasting improvements in the overall standard of quality healthcare delivered in the United States.

But achieving an effective electronic information infrastructure for healthcare delivery is more than a matter of technology deployment and growing the technology work force. Our future information infrastructure will indeed require technology, as well as staff who focus on information technology.

But there is a distinct need for a qualified workforce focusing on the underlying information management issues that are critical to the effective application of technology to sound information management and documentation principles.

HIM professionals possess the knowledge and skill sets to facilitate effective integration of technology in a way that meets care delivery needs as well as compliance, legal, public health, research, administrative, and policy needs.

…..

Recommendations

AHIMA calls on decision makers in industry, government, and higher education to acknowledge the unique contribution of HIM professionals to EHR and HIE implementation and the need for an expanded HIM work force by:

* Funding the educational and academic needs of the profession that facilitate:

* recruitment, preparation, and retention of educators in the HIM field,

* ongoing evolution of curriculum, including continued changes in HIM and informatics,

* expansion of HIM programs for master’s and doctorate-level education, and

* provision of loans and scholarships to students who enter the HIM field and to current practitioners who want to further their education to advance the transformation of the profession.

*Providing support for the continued education of HIM practitioners engaged in managing the healthcare industry’s transition from a paper to electronic environment.

*Creating a specific occupational category for HIM professionals by the Bureau of Labor Statistics, to permit ongoing tracking of national progress in solving this workforce shortage.

*Funding research related to:

* best practices for HIM related to EHR implementation and management,

* information quality assurance methodologies for HIE, and

* the socioeconomic impact on providers, organizations, and consumers related to the use of health information through EHR technologies while identifying the issues that inhibit effective implementations.

The promise of EHRs, HIEs, quality, safety, and improved healthcare delivery, efficiency, and effectiveness will not be realized solely through purchasing hardware and software.

Such an assumption fails to recognize the detail involved in planning, implementing, and integrating HIT into existing healthcare systems and regulations. It also fails to recognize the importance of managing information in a new environment of dispersed records and the increased need for management of data integrity, completeness, uniformity, security, confidentiality and analysis within an array of technologies, terminologies, and classifications.

This is the role of today’s HIM professional. Without an adequate HIM workforce, HIT adoption, implementation, and use will not achieve the return on investment and goals envisioned for the 21st century.

Much more here:

Secondly we have had CSC release a short report on their concerns about being able to find enough Health IT professionals.

http://www.healthdatamanagement.com/news/workforce_management26733-1.html?ET=healthdatamanagement:e540:100325a:&st=email&channel=business_intelligence

Report Studies I.T. Work Force Issues

HDM Breaking News, August 4, 2008

A new report from Computer Sciences Corp. examines challenges that health care CIOs face with a multi-generational workforce.

The information technology department in a health care organization can have employees from four generations--born before 1946, between 1946-1964, between 1965-1980 and after 1980--each with different needs and expectations.

And some of those expectations are changing, according to the report from Falls Church, Va.-based CSC, an I.T. services and consulting firm serving multiple industries. For instance, working flexible hours or from home traditionally has appealed to younger workers, but now is becoming attractive to older ones who want to postpone full retirement.

The report highlights numerous programs to attract and retain I.T. talent. These include enabling employees to customize benefit packages based on age, family status, special needs and other factors; or offering hospital-arranged car pools or “gas cards” to reduce employee transportation costs, among other programs.

…..

For a copy of the report, “The Multi-Generational Healthcare I.T. Workforce,” click here.

More here:

http://www.healthdatamanagement.com/news/HIM26730-1.html?ET=healthdatamanagement:e539:100325a:&st=email&channel=document_management

There is no doubt that our capacity to implement e-Health approaches will be compromised just as badly in Australia as is expected in the US with our lack of courses as well as assured career paths once trained.

Time to act on this is now – to be ready to be moving a year or two hence!

David.

Tuesday, August 12, 2008

HISA Comments on the Law Reform Commission Report – Especially on Health Information Privacy.

The following was released today (12 August, 2008)

MEDIA PRESS RELEASE – For immediate release.

“Australia Health Informatics Society ready to tackle the New Privacy laws”

The Health Informatics Society of Australia (HISA) welcomes the release yesterday of the report that recommends review of our outdated Privacy laws.

The Australian Law Reform Commission has produced nearly 3000 page report over three volumes that address the need to update Australia’s complex Privacy laws originally drafted 20 years ago. Predating the modern Internet and having no concept of many of today’s technology such as the now widely used RFID wireless chips commonly found on consumer products; the existing laws allow for misinterpretation compounded by the fact that State and Federal plus the Public and Private sectors all differ.

“Now we are entering the age of the ubiquitous Electronic Health Records the need to address this is of paramount importance” said HISA’s President, Dr Michael Legg.

Dr Peter Croll, the chair of HISA Health Privacy forum said that “Many lives can be saved, for example, through the introduction of RFID chip on pharmaceutical products but we need the protection through legislation that embraces these new technologies.”

The proposed changes to the Privacy Law are intentionally generic. The president of the ALRC, Professor David Weisbrot, states that “Although the federal Privacy Act is only 20 years old, it was introduced before the advent of supercomputers, the Internet, mobile phones, digital cameras, e-commerce, sophisticated surveillance devices and social networking websites—all of which challenge our capacity to safeguard our sensitive personal information.”

Although digital cameras, mobile phones and social networking are examples of what the public relates to, this is not the key areas of concern for health related data.

“Health information requires special treatment” says Dr Croll “Unlike financial record you cannot undo the harm from inappropriately releasing sensitive information” this needs to be understood since “bank records can be put right and any inconveniences compensated for but you can’t unlearn something you find out about a person who has a mental history or a sexual infection”.

This is why HISA has advocated for health information to be given special treatment and welcomes the recent media statement: “The ALRC recommends the drafting of new Privacy (Health Information) Regulations to regulate this important field. Recommendations also are made to deal with electronic health records, and the greater facilitation of health and medical research.”

How these regulations will be drafted has yet to be agreed. HISA is concerned that without suitable input from the public and heathcare professionals we might end up going nowhere as with the Health and Social Services Access card that was scrapped by the previous government. Failure to address privacy concerns was a major contributing factor.

Dr Croll said that “It is imperative that we from a consensus on such sensitive issues and get the balance right between what will protect the individual and yet allow for advancement of medical knowledge for the public good through access to quality health data.”

HISA has taken a lead role in addressing this by launching the inaugural ‘Health Privacy Futures’ conference HPF’08, to be held in Brisbane 10-11 Nov. 2008. Dr Brendan Lovelock, CEO of HISA, said: “HPF will bring together key stakeholders in Health privacy which is considered a key foundation of Australia’s transition to a safer and more efficient health system. This conference looks to bring together healthcare providers, consumers and Australia’s leading privacy experts, to bring clarity and definition to this critical issue.”

For more information on HPF’08 and the role that professionals can provide for the advancement of health informatics, please visit www.hisa.org.au.

----- End Release.

It is good to see HISA is being pro-active in this complex and difficult area. We need much more thought given to all this – unmediated in my view – from the pressure applied by entities like NEHTA to have their views prevail. Real public consultation is what is needed here to have e-Health succeed.

David.

Monday, August 11, 2008

Great News for General Practice in Queensland!

The following press release arrived today

MEDIA RELEASE

11 August 2008

iHealth Care - a shot in the arm for better patient information transfer

General Practice Queensland is set to roll out a new medical contact directory and messaging service that will save practitioners time and money while ultimately improving patient care.

The iHealth Care Directory will provide registered participants with free access to a comprehensive listing of GPs, specialists, allied health professionals, pharmacies and aged care facilities.

Using the highly secure messaging service provided by Medical-Objects, iHealth Care will also allow users to share relevant patient information electronically.

According to General Practice Queensland Board Chair, Dr John Kastrissios, the two new services will eliminate the need for traditional mail and facsimiles, improving the timeliness and accuracy of communication between practitioners.

“iHealth Care will dramatically increase the speed of communication between practitioners, providing virtually instantaneous access to information such as test results and other patient-specific data. This, in turn, will significantly reduce the amount of admin time spent at surgeries,” Dr Kastrissios said.

“The Directory allows doctors to search for and refer patients to the most appropriate service providers, while the secure messaging system will facilitate better communication between Queensland’s public and private hospitals, doctors, pharmacists, allied health professionals and aged care facilities.

“This is good news for patients. A better, more secure information and communication service across the State’s health sector will deliver more seamless care, so patients won’t have to endure the frustration and expense of attending consultations when test results haven’t arrived or clinical information is out of date.”

General Practice Queensland has awarded a two-year license to Medical-Objects to provide a free secure messaging service to eligible medical practitioners.

Medical-Objects Chief Executive Officer, Glenn Stephens said, “iHealth Care is the perfect example of what can happen when an entire State’s health system is connected. In short, the new services will provide health professionals with a secure, fast, integrated, reliable and easy contact directory and communication system that will improve efficiency, reduce the risk of legal action and allow for re-allocation of human resources within medical organisations.

“Businesses use email as a standard part of daily communication with clients and colleagues, but it is an unsecured and risky way of transmitting highly confidential data. Now, doctors can use Medical-Objects’ secure medical messaging to send patient data over the Internet.

"It is not email-based, but rather a fit-for-purpose real time, secure clinical communication system. Every individual report can only be viewed by those who have been granted specific access," Mr Stephens said.

Similarly, access to the iHealth Care Directory is password protected and restricted to participating subscribers only, so the system cannot be misused.

“Together, these two iHealth Care services will connect Queensland, for better patient care. It is a great step forward for Queensland’s health industry,” Dr Kastrissios said.

ENDS

For further information:

Carla Morison

Redline Communication

Ph: 07 3369 9199

Web Sites

iHealthCare Project

http://www.ihcdirectory.com.au/

General Practice Queensland

http://www.gpqld.com.au/

Medical Objects

http://www.medical-objects.com.au

Comment.

This seems to me to be a great way to demonstrate how much difference standardized secure communications between all the actors in the health system can make. Great effort on the part of all those involved to get to this stage! I really look forward to seeing a better Qld Health System a year or two from now as this is fully rolled out.

David.

Australian Law Reform Commission Releases Major Privacy Report.

This important work was released today.

Australian Law Reform Commission

Monday 11 August

Media Release: 'Australia must rewrite privacy laws for the Information Age'

Detailed Privacy Briefing Notes on 10 key areas:

  1. Simplifying and harmonising privacy law and practice
  2. Technology-neutral privacy principles should govern rapidly developing ICT
  3. New cross-border privacy laws-greater certainty for all Australians
  4. Rationalisation and clarification of exemptions to the Privacy Act
  5. Improved complaint handling and enforcement
  6. Introducing a mandatory data breach notification scheme.
  7. Reform of the credit reporting system
  8. Protecting Health Information in the Digital Age
  9. Children, young people and privacy
  10. A statutory clause of action for serious invasions of privacy: getting the balance right

To view or download the ALRC's Privacy Report click here

To order a CD Rom or hardcopy of the ALRC's Privacy Report click here

For a summary of the ALRC's review of Australian Privacy Laws click here

Access all the reports here:

http://www.alrc.gov.au/media/2008/mr11108.html

Important reading!

David.

Sunday, August 10, 2008

Useful and Interesting Health IT Links from the Last Week – 10/08/2008

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

These include first:

Satirical Sites Take Aim at Health IT Industry

by George Lauer, iHealthBeat Features Editor

This story has a prerequisite: If you haven't already seen SEEDIE.org and Extormity.com, you might save yourself confusion and frustration by checking them out before reading further.

For those already familiar with the two satirical sites spoofing the health IT industry in general and electronic health records in particular, this story will shed a little light on the motivation behind them. Emphasis on "little." We won't tell you who's behind the sites. They're not ready to go public yet.

But they did agree to answer a few questions from iHealthBeat. Two "executives" -- Extormity CEO Brantley Whittington and SEEDIE Executive Director Sal Obfuscato -- take turns answering in character.

And then site creators do it for real ... sort of.

Much more here:

http://www.ihealthbeat.org/articles/2008/8/7/Satirical-Sites-Take-Aim-at-Health-IT-Industry.aspx?a=1

The sites referred to are found here:

The interview and the two sites are very amusing – and well worth a browse – in the spirit they are offered!

Second we have:

Expert discusses computing in medicine

PM - Thursday, 7 August , 2008 18:34:00

Reporter: Mark Colvin

MARK COLVIN: For a century or more, the main weapons of medicine have been the stethoscope, the syringe and the surgeon's saw.

But in modern medicine they're increasingly being supplemented by information technology.

Computers can help a great deal in diagnosis, record-keeping and analysis.

But in some areas Australia is lagging behind in the field of what's called health informatics.

And there's pressure for huge centralised computer systems which could prove extremely costly, especially if things go wrong.

Enrico Coiera is Professor of Health Informatics at the University of NSW.

He spoke at the Centre for Independent Studies Consilium, where I asked him about how Australia rated when it came to computing in medicine.

ENRICO COIERA: Our General Practitioners have about 90 per cent penetration of computers on their desktops which is fantastic by world standards.

But our hospitals certainly are laggards. We can turn out attention to what's happening say in England where the National Health System, the NHS has spent something like 12-15-billion pounds in the last three or four years to start to modernise the IT use underpinning their hospitals and that's certainly not yet happened in Australia.

More here:

http://www.abc.net.au/pm/content/2008/s2328090.htm

It is good to see some good publicity for e-Health on a major national news program. The full interview is available for download from the ABC site.

Third we have:

No blocking expert patient pop ups

5-Jun-2008

By Dr Tony Copperfield

DO you remember the Internet before pop-up blocking software became the norm? Every website you visited would be hidden by a snowstorm of unwanted invitations to meet hot girls from your area, and malicious Windows Messenger prompts: “Your computer may be infected with a virus. Click here to make certain.” And sure enough, if you did, it was.

Nowadays, there’s only one arena where the uninvited and annoying pop-up window still holds sway, and that’s my consulting room.

As Mrs Blob waddles in and I click the mouse to pull up her medical record, I’m already bracing myself for the avalanche of mindless cyber-guano that’s about to rain down.

“ALERT! QOF* data incomplete! Mrs LZ Blob does not have an HbA under 7% on file!” Followed by: “Mrs LZ Blob does not have a total cholesterol under 5.8mmol/l on file!” And: “Mrs LZ Blob does not have a BP reading under 140/85 on file!”

Well, she does now. Because I’ve just made one up. There, right there, on her ‘Current Values’ template, I’ve just typed 138/82 and quite shamelessly clicked on ‘Enter’. Sorted. Ker-ching. No sphygmomanometer, nothing up my sleeve, just Copperfield’s Clinical Acumen being exercised to the max.

Respect is due to Mrs B, for she is the NHS’s ideal punter an ‘Expert Patient’ [The Expert Patients Programme is a self-management program developed for people living with long-term conditions. The aim is to support people to increase their confidence, improve their quality of life and better manage their condition.].

More here (subscription required):

http://www.australiandoctor.com.au/articles/a9/0c0573a9.asp

The article then goes on to say that Mrs B essentially resists all his attempts to have her co-operate in her treatment for a range of serious chronic diseases and it is a problem as his remuneration is linked to compliance with the UK Quality and Outcomes Framework (QOF). Frankly his approach in just making information is essentially illegal and what “Dr” Copperfield should do is remove himself from the care of this patient as his clinical relationship with his patient is clearly over!

Really a sad approach and quite wrong to write such material – even if it tongue in cheek as I suspect (and hope) it is

Fourth we have:

Vic doctors beat bugs online

Grant McArthur | August 08, 2008

A MELBOURNE-developed computer program that could save thousands of lives has taken the fight against killer superbugs to cyberspace.

The web-based prescribing program, designed by Royal Melbourne Hospital doctors, raises alarms when inappropriate or excessive quantities of antibiotics are prescribed. Such prescriptions are a major factor in the development of drug-resistant superbugs in hospitals.

Potentially fatal bugs such as MRSA are contracted by about 200,000 people in Australian hospitals each year.

They are most dangerous to the frail and elderly.

Preventing the overuse of antibiotics would reduce the chances of bacteria developing into antibiotic-resistant superbugs, infections expert Karin Thursky said.

She said 40 per cent of hospital patients were given antibiotics, half of which were inappropriately prescribed.

She said the Guidance DS program would have a huge impact as it was rolled out to 14 hospitals in Victoria and Tasmania, as it had done at the Royal Melbourne.

More here:

http://www.australianit.news.com.au/story/0,24897,24147129-15306,00.html

Antibiotic prescribing in the seriously ill has always been a challenging problem and this work seems to have great promise in making it just that much easier and safer. Well done to all involved – I hope the system can be quickly spread nationwide to all those centres where it can make a difference – once proof of its value is confirmed – which sounds to be very near.

Fifth we have:

Electronic retinas a step closer

August 7, 2008 - 7:00AM

Inspired by the human anatomy, researchers in the United States have created the world's first curved electronic "eye" camera, according to a new study.

The size and shape of a human eye, the device weaves a network of silicon detectors into a flexible mesh, and could usher in a new generation of distortion-free digital and video cameras.

Experiments already under way are testing other potential applications, including a thin, pliable monitor to detect electrical signals travelling across the undulating surface of the human brain.

Its breakthrough design also points the way to the development of artificial electronic retinas that could one day help restore sight, says the study, published in the British journal Nature.

"This approach allows us to put electronics in places where we couldn't before," said John Rogers, an engineer at the University of Illinois, who led the research along with Yonggang Huang of Northwestern University.

"We can now, for the first time, move device design beyond the flatland constraint of conventional wafer-based systems."

A curved array of detectors is "much better suited for use as retinal implants," Rogers said in a statement.

Animal eyes are naturally curved for capturing images, but up to now artificial vision systems have been limited to flat image-recording surfaces.

More here:

http://news.smh.com.au/world/electronic-retinas-a-step-closer-20080807-3rbb.html

Another report with a useful picture is found here.

http://www.smh.com.au/news/technology/just-picture-it--bionic-terminator-eyes/2008/08/07/1217702198814.html

Just picture it - bionic 'Terminator' eyes

This is interesting as is the report there is progress on the Bionic Eye project from the 2020 Summit as reported here.

Bionic breakthrough in sight with an Australian first

Volunteer … Steve Horan will receive a bionic eye this year.
Photo: Jacky Ghossein

Louise Hall Health Reporter
August 10, 2008

AUSTRALIA'S first bionic eye will be implanted by two Sydney researchers.

Using the same cochlear technology that allows the deaf to hear, the device aims to restore basic vision in patients with degenerative eye diseases, allowing them to walk without a cane or guide dog and differentiate between night and day.

Minas Coroneo and Vivek Chowdhury, from Sydney's Prince of Wales Hospital, say the visual prosthesis could be the first - and cheapest - to hit the world market.

Rather than "reinventing the wheel", they have adjusted the cochlear implant to allow patients to perceive light, rather than sound.

"We're using a bionic ear to make a bionic eye," Professor Coroneo said.

It should not cost much more than a cochlear device - $20,000. Instead of a microphone, it will use a camera and more electrodes.

There are 23 groups around the world racing to invent the first functional bionic eye. The ultimate goal is a permanent implant with enough resolution to enable patients to recognise faces and read large print.

More here:

http://www.smh.com.au/news/science/bionic-breakthrough-in-sight-with-an-australian-first/2008/08/09/1218139162870.html

Good luck to those involved in this important work – but it does seem there is a bit of competition for the prize! The sooner a really useful technology emerges the better!

Sixth we have:

'Cyberchondria' gives GPs a webache

Mark Metherell

August 5, 2008

"CYBERCHONDRIA" - the imagined conditions afflicting patients who have turned to the internet for diagnosis - can be a bane for doctors convincing patients of their misdiagnosis, says an internet health expert, Jared Dart.

Dr Dart recalls an elderly patient's relative suggesting on the basis of internet research that the patient required a biopsy of skull tissue. Diagnosis by a doctor actually found "the poor old guy had been having headaches as a result of a muscular-skeletal problem in the neck".

"Many doctors have lamented the rise of the e-health information consumer, suggesting it has led to patient 'cyberchondria' and anecdotal reports of patients bringing health information to doctors abound," Dr Dart says.

His survey of 700 people has found that surfing the net for medical explanations is widespread, although many remained uncertain about the veracity of the information.

More here:

http://www.smh.com.au/news/web/cyberchondria-gives-gps-a-webache/2008/08/04/1217702000290.html

I think Dr Dart has raised an important issue but as we have found the jurors who research those they are judging these days you have to go with the flow and I think the best thing to do is, as a practitioner, have a list of sites that you know are trustworthy and accurate and say to patients if they want to read more – here is where you can go for an independent view. If given 4-5 full scope quality sites the patient will soon be able to be confident of the advice they are receiving.

Last we have our slightly technical note for the week:

Taking advantage of multicore PCs

What app developers need to know to make their software work on new-gen CPUs

Tom Kaneshige (InfoWorld) 05/08/2008 08:56:33

Call it the great multicore discord: a parade of major hardware and software vendors promising desktop applications powered by multicore chips yet all marching out of step, leaving confused software developers in the dust -- but times are changing.

Far out front, chipmakers Intel and AMD have delivered quad-core chips for desktop computers earlier this year. And computers with dual-core chips are now the norm. But only the savviest of developers can harness this massive processing power by weaving a mind-bending web of code that foundational software vendors should have provided. So much of the multicore chips' processing power is unharnessed.

Software vendors are finally closing the gap: Microsoft, Apple, third-party platform vendors, and software developer consortiums are tweaking everything from the operating system schedulers to APIs to languages and libraries to make them multicore-friendly. The goal, of course, is to make it easier for developers to join the multicore movement.

There's no question that the pace is quickening, the gap closing. Apple, for instance, claimed earlier this month that its upcoming Mac OS X Snow Leopard will boast a new technology, code-named Grand Central, that supports multicore chips, along with developer tools that let applications leverage up to eight cores of processing power.

To take advantage of multicore-enabling technologies such as Grand Central and whatever Microsoft may be working on for Windows 7 (the company declined to comment), developers must move up a steep learning curve in areas such as multithreading, parallel, and concurrent.

More here:

http://www.computerworld.com.au/index.php?id=1145268561&eid=-255

This is an interesting long article that essentially explains that most of the extra computing power in the modern multi-core processers is yet to be even partially exploited. It seems the software writers have a bit of work to do yet to catch up with the hardware colleagues!

More next week.

David.

Thursday, August 07, 2008

E-Health to be Developed in Africa

I found this to be a very hopeful report indeed!

Developing Countries Must Plan Road Map for eHealth

INTERVIEW
24 July 2008
Posted to the web 24 July 2008

By Boakai M. Fofana
Bellagio

Developing countries in the Global South, which have already introduced innovative technology such as mobile banking, need to drive the development of "eHealth" – the harnessing of Internet-enabled technologies to improve public healthcare, says Karl Brown, associate director of applied technology of the Rockefeller Foundation. He was interviewed by AllAfrica's Boakai Fofana, at a conference on the subject in Bellagio, Italy, which has been sponsored by the foundation.

What is the idea behind the eHealth initiative?

The idea is that technology is at a turning point. In the industrialized countries – i.e. the United States and Europe – there has been long experience with using communication technology in health care. There have been a lot of lessons learned, a lot of mistakes, but also a lot of successes. We feel that in the developing world there is now an opportunity to use information technology in a more integrated way in health-care systems.

The time is now, because we feel that health care systems are undergoing a process of enormous change. There's been a change in the burden of disease in many countries. There are increasing numbers of patients entering the health care system. There's more money being spent on health care in developing countries.

The other reason we think that now is the time for "eHealth" is that there are a thousand flowers blooming. There are a thousand different eHealth pilots around the world. But the space is still fragmented, and there has been a lot of reinvention of the wheel. Now, people are learning from the experience of countries which have moved further.

The other issue that I think is important is interoperability. You have a lot of countries where donors will come and build a database, for instance, to track the HIV program. And then another donor will come in and build a database to track the TB program. And then another donor builds a database to track the malaria program. And none of these databases can talk to one another.

Speaking of the African context, what are you hoping to achieve at the end of this conference?

One of those things we are hoping to achieve is a consensus amongst the participants on the value of eHealth and on the vision for eHealth for the world. Underneath that vision, we would like to work with the participants in achieving a road map for how to bring that about.

Since the focus of this conference is eHealth in the South [developing counties], we have brought a lot of participants from the South to this conference. At the Rockefeller Foundation, we believe the vision, the strategy and the road map should all be driven by the countries who are going to be impacted by this technology. It's not a northern [developed countries] initiative, where we will define the standards and the solutions and then give them to Africa.

Innovations are coming from different places in the world. If you look at innovations in mobile banking, what are the best mobile banking systems in the world? Kenya and South Africa. They are way more advanced than anything we have in the United States. I think innovation is coming from new quarters, so we need to find a way to engage the IT [information technology] sector in Africa and elsewhere in the world in support of better health.

Much more here:

http://allafrica.com/stories/200807240417.html

The two links at the end of the article also provide some useful background and insight.

Read more about Rockefeller's eHealth initiative

http://allafrica.com/healthafrica/health.pdf

The Rockefeller paper is well worth a read as it highlights just how much is possible with the simplest of technology. I was surprised just how much greater mobile phone penetration in Africa compared with the Internet is – as I guess I though both needed a lot of expensive infrastructure – but is seems that the desire to be in communication can overcome major barriers – even in the face of considerable difficulties.

Reading about the issues being faced and the priorities for services and applications is well worth while.

In the context of helping Africa – and in especially addressing issues associated with HIV and TB another major project worth being aware of is found here.

http://openmrs.org/wiki/OpenMRS

As they describe themselves

“OpenMRS® is a community-developed, open-source, enterprise electronic medical record system framework. We've come together to specifically respond to those actively building and managing health systems in the developing world, where AIDS, tuberculosis, and malaria afflict the lives of millions. Our mission is to foster self-sustaining health information technology implementations in these environments through peer mentorship, proactive collaboration, and a code base that equals or surpasses proprietary equivalents. You are welcome to come participate in our community, whether by implementing our software, or contributing your efforts to our mission!”

All in all – also an exciting initiative and well worth a browse – or more!

David.