Secrecy Gone Feral! – Why Can’t the Public Access the Information and Advice they have Paid For?

I must be from a very old school, or totally naive, but I really believe that when reports are commissioned by Governments on matters that don’t affect national security and such like matters the openness and transparency is a good thing and that Government secrecy is a really bad thing.

In the present context it is good to see the National Health and Hospitals Reform Commission actually releasing discussion papers and submissions. It is also amazing that some submissions should be confidential – surely anonymous as the author is good enough – but not so for reasons I can’t even begin to guess at.

As a result of the release of the most recent paper on e-Health the issue has again raised its ugly head.

This paper is found here:

E-Health - Enabler for Australia's Health Reform, Booz & Company, November 2008.pdf (PDF 1082 KB)

As I browsed I noticed the following reports – which to the best of my knowledge are not in the public domain.

1. Allen Consulting Group, “Economic impacts of a national Individual Electronic Health Records system”, July 2008.

2. NEHTA, “A National IEHR Service Business Case”, COAG 2008

3. KPMG, “Cost Benefit Analysis of Shared Electronic Health records”, NEHTA, September 2007

These need to be added to the following:

The matters discussed here:

http://aushealthit.blogspot.com/2008/09/nehta-and-openness-just-what-is-problem.html

and here:

http://aushealthit.blogspot.com/2008/06/just-why-are-nehtas-plans-for-shared.html

There are, of course, a legion of consulting reports and modelling developed for NEHTA which have never seen the light of day and probably never will – and I know because I wrote parts of some of them!

We are also yet to see the detailed of the evaluation of the Eastern Goldfields Reference Project which was submitted in June, 2006 to DoHA. Of course none of the earlier HealthConnect evaluations ever saw the full light of day as well – so no lessons have been learned except by the bureaucrats who received these reports and who for the most part have now moved on. It really is just hopeless.

Of course state Governments are as bad. Anyone seen this one?

NSW Department of Health, Healthelink EHR Evaluation (KPMG), May 2008.

Of course not.

Until this all changes – with the best will in the world – we will continue to stumble around repeating mistakes and making a general mess of things!

Access to the information in these reports is vital both to ensure investment proposals receive the appropriate amount of scrutiny at both a business and technical level and that mistakes made and ideas not included in analysis can be given due consideration.

DoHA and the new NEHTA CEO could make a difference by responding to these suggestions.

I really hope this may change – but I am not holding my breath!

David.

Useful and Interesting Health IT Links from the Last Week – 07/12/2008

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

These include first:

E-health privacy threat for small towns

Elizabeth McIntosh - Friday, 28 November 2008

THE federal government’s plans to roll out patient e-health records could cause serious problems for those in small communities if strict privacy protocols are not in place, the Consumers’ Health Forum has warned.

In a submission to the National E-Health Transition Authority (NEHTA), the forum raised questions around the levels of access health professionals would have to patient records.

In particular, it expressed concern that if health professionals were given unfettered access to health records containing highly sensitive information, patients in small towns with specific conditions may find themselves stigmatised.

“If more people know information, or people have access to irrelevant information, it could lead to leaks and in a small town, that leaked information could have an awful impact,” the submission stated.

More here:

http://www.medicalobserver.com.au/medical-observer/news/Article.aspx/E-health-privacy-threat-for-small-towns

I find this an interesting perspective that has not been widely aired. In small communities there is no doubt very great care will need to be taken with information relating to diseases that may stigmatise people.

Second we have:

Hospital data 'rorts' face audit

• Julia Medew
• December 4, 2008

CLAIMS of "virtual wards" and data manipulation in Victorian hospitals to meet Government targets for bonus payments are being investigated by the Auditor-General.

A spokeswoman for Des Pearson yesterday confirmed the audit of hospital performance data despite Health Minister Daniel Andrews' insistence that there is no evidence to warrant an inquiry.

The investigation comes six months after the Australasian College for Emergency Medicine said overcrowded hospitals were changing patient data, admitting patients to fictitious wards and inconsistently measuring waiting times to qualify for bonus payments.

A survey of 19 emergency department directors by the college found almost 40 per cent of their hospitals had "admitted" patients when they were still in waiting rooms, corridors or on trolleys.

The doctors said the "virtual wards" were used purely for "creative accounting" to receive funding and avoid "performance watch".

More here:

http://www.theage.com.au/national/hospital-data-rorts-face-audit-20081203-6qo0.html

First we have NSW bureaucrats faking ED information and now we find Victoria up to the same tricks. The auditors nationwide need to really now conduct a comprehensive review of Health System data quality and reliability – especially as the Health Minister is planning to make so much more use of performance data.

Third we have:

Sydney hospitals switch TVs for MFDs

Liam Tung, ZDNet.com.au

03 December 2008 09:32 AM

Days after NSW's Health's technology was slammed as archaic, the Sydney West Area Health Service has gone to market for over 2,000 high-capacity bedside touch-screen computers for patient entertainment and clinician access to core health systems.

The proposed bedside "multifunctional devices" which Sydney West Area Health Service (SWAHS) released request for tender documents yesterday, are planned to be powered by 40 gigabyte hard drives, with 1Ghz Intel CPUs, and garnished with a 17 inch touch-screen.

SWAHS has asked for the units to be supplied with infrared keyboards, a web camera for video conferencing, and a magnetic swipe card reader and biometric scanner for secure access.

.....

Auburn's 185 hospital beds are the first planned to be equipped with the devices, followed by 400 beds at Blacktown Hospital, 116 at Blue Mountains District Anzac Memorial Hospital, 40 at Lithgow, 180 at Mt Druitt, 480 at Nepean, 32 at Springwood and 900 Westmead — in total, 2333 devices.

Tender responses are due by Wednesday 17 December.

More here:

http://www.zdnet.com.au/news/hardware/soa/Sydney-hospitals-switch-TVs-for-MFDs/0,130061702,339293601,00.htm

This is an interesting tender and show some forward thinking about the need to provide a more interesting environment for patient’s stuck in bed as well as for clinicians to access core clinical systems.

I must say, however, that the devices seem rather underpowered, and I wonder why the tender was not State-wide to help reduce costs.

Fourth we have:

Microsoft change hits aged care

Karen Dearne | December 02, 2008

MICROSOFT Australia has accused aged-care services providers of illegitimately buying software through a discount licensing program.

Aged-care providers were shocked in October by the software giant's decision to revoke their not-for-profit status and charge full commercial rates for using Microsoft's Office, Sharepoint and SQL Server products.

The move will hike annual licensing fees by about 400 per cent. Despite representations from the Aged Care Industry IT Council, Microsoft has not changed its mind.

An independent review by Connecting Up Australia found that a number of customers across a range of industries had been illegitimately buying software through a discounted licence program, called Academic Open, for which they did not qualify, a Microsoft spokeswoman said.

Most customers were unaware they were buying an illegitimate licence, but a small number were deliberately abusing the system to access discounted software.

In the past, customers and partners had self-qualified their use of this licence, with no independent vetting.

Microsoft said lack of oversight had contributed to the issue of licence misuse and isolated cases of abuse.

The Aged Care IT Council estimated full licences for installed software would cost the industry $70 million over the next 18 months, swallowing half of the sector's annual technology budget at a time when it was being urged to improve uptake of technology systems.

.....

Federal Minister for Ageing Justine Elliot and federal Finance Minister Lindsay Tanner both said they were monitoring the issue.

Ms Elliot has launched a free, plain-English guide, called the Aged Care IT Implementation Kit, developed at a cost of $212,000 to promote the use of technology to reduce administrative burdens.

.....

More here:

http://www.australianit.news.com.au/story/0,24897,24734620-15306,00.html

Two points

First, aged care providers do have options (especially Open Source options) to reduce the cost of software.

Second the guide developed by the Department is quite a worthwhile document for all those starting up the technology curve. It can be found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/7C8F0E64280BF568CA2574AC00183992/$File/ITAC%20Guide.pdf

Fifth we have:

iSOFT signs $14 million pharmacy contract with WA Department of Health

02 Dec 2008

Sydney – 1 December 2008 – IBA Health Group Limited (ASX: IBA) – Australia's largest listed specialist health information technology company, today announced that its iSOFT Health division has signed a contract with the Western Australian Department of Health (WA Health) for a pharmacy management solution and support services in a deal worth up to $14 million.

In up to a ten year contract, which includes license revenue and support, the centrally-managed solution from iSOFT will streamline pharmacy services at 21 public hospitals across Western Australia. The iPharmacy solution will provide consistency in managing medications and offers clinical decision support to assist with the prevention of medication errors at the point of dispensing.

i.Pharmacy will assist WA Health in implementing a series of pharmaceutical reforms, including on-line PBS processing. i.Pharmacy is already installed at 250 sites throughout Australia making iSOFT the country’s market-leader in hospital pharmacy systems.

Gary Cohen, Executive Chairman & CEO of the IBA Health Group, said: “WA Health is one of iSOFT’s major customers in Australia. We are pleased WA Health has chosen our hospital pharmacy and medication management solution to improve pharmacy, clinician and medication management in the state’s hospitals. The selection of i.Pharmacy by WA Health follows on the heels of the recent wins in South Australia and Tasmania and demonstrates that iSOFT meets the needs of collaborating health professionals operating in an integrated healthcare environment across Australia.”

More here:

http://www.ibahealth.com/html/isoft_signs_14_million_pharmacy_contract_with_wa_department_of_health.cfm

This is good to see as it means there is a process of upgrading the clinical software infrastructure of WA public hospitals actually really underway. Not before time after various problems and changes of senior management. (Usual disclaimer that I have a few IBA shares)

Last we have the slightly more technical article for the week:

Would InternetWatch Actually WORK?

By Geordie Guy

Network engineer Geordie Guy explains the technical limitations of the Government's clean feed proposal

The Australian Government's plans to introduce mandatory ISP filtering have caused something of a media frenzy.

Most of the debate has been conducted on either side of an imaginary line between advocates of free speech and critics of censorship on the one side, and organisations which seek to protect children and adults from indecency and harm on the other. This debate has at times descended into a shouting match over statistics and objectives, confusing Australians who are unsure how they feel about the issue.

Supporters argue that the clean feed proposal would merely bring the internet into line with existing regulation on traditional media such as print publications, television and radio. Meanwhile, opposition to the plan is based on a number of concerns, and of these, possibly the most confusing for many people is the claim that the filter simply won't work.

So what are the technical problems that the opponents are claiming? Are they necessarily deal breakers which make the filtering plan unworkable, or are these arguments just what filter supporters claim they are: an excuse to try and maintain the free availability of pornography?

Nobody knows precisely what screening method would be used if the filter were to go ahead. The Government trials considered several commercial products, referred to by code names, and each of them could use any one of several methods, or a set of the available methods in combination.

Much more here:

http://newmatilda.com/2008/12/04/would-internetwatch-actually-work

I found this a clear, lucid, technical explanation of why Minister Conroy is dead wrong on this internet filtering nonsense. It would do more harm than it is worth. We would be better off insisting parents take an active interest in what their young ones are doing on the Internet (and elsewhere)!

More next week.

David.

Vital Links Regarding New E-Health Plans.

There are two vital links that follow from the Australian Story.

1. Communiqué from Health Ministers Meeting (December 5, 2008)

See:

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept051208.htm

2. Booze and Co E- Health Report.

See:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/discussion-papers

Direct link:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

Happy reading!

David.

Good News – Seems There Was Major Progress!

Sounds good at first blush – the devil will be in the detail!

Health ministers agree to share patient e-records

Siobhain Ryan | December 06, 2008

Article from: The Australian

HEALTH ministers have finally agreed on a national plan to share patients' electronic records, on the same day a new study slammed scattergun spending of almost $1.3 billion on state-based e-health schemes.

At a meeting in Brisbane yesterday, they gave the tick to the strategy commissioned in April amid controversy over delays, cost blowouts and resignations in e-health projects and bodies across the country.

Electronic records for patients are currently held separately, if at all, across GP surgeries, hospitals, government agencies and other health centres, allowing only patchy sharing of information.

The gaps have resulted in duplicate consultations, tests and treatments and prescribing mistakes, with past studies calculating the net benefits of better electronic record-keeping at up to $8.7 billion over the first 10 years.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24758462-23289,00.html

David.

Nope!

Well, I have just checked around and can find nothing about e-health out of the Health Ministers get together today.

All sorts of stuff about more operations (really good!) and so on but nothing else I can find. (10.30pm 5 December, 2008)

Please send a web link if you have, or know of, better news!

David.

Health and Hospitals Fund – Announcement Details.

As this is now important I thought what it known of its purpose, so far, would be useful.

Here is the announcement release:

Investing In A Health System For The Future

13 May 2008

The Australian Government will establish a $10 billion Health and Hospitals Fund to support strategic investments in health as part of the Government’s reform agenda to equip Australia’s health and hospital system for the future.

The Health and Hospitals Fund will be the single biggest investment in health infrastructure ever made by an Australian Government.

The Health and Hospitals Fund will support future health infrastructure priorities, including investments in:

• health and hospital facilities and equipment as part of the Government’s health reform agenda;
• medical technology and equipment;
• major medical research facilities and equipment, including projects and facilities which will support better links between hospital-based clinical research and high quality clinical practice.

The Government will invest $10 billion in the Health and Hospitals Fund, drawn from the 2007-08 and 2008-09 surpluses. A proportion of future surpluses may be allocated to the Fund as appropriate.

Expenditure from the Health and Hospitals Fund will be subject to consideration through the Budget process each year.

The establishment of the Health and Hospitals Fund means the Government will not proceed with the establishment of the previous Government’s Health and Medical Infrastructure Fund.

In addition to our other commitments to health and hospitals, including an additional $1 billion for hospitals this year; up to $600 million to clear elective surgery waiting lists; $780 million for dental health; and $275 million for GP Super Clinics, the establishment of the Health and Hospitals Fund demonstrates the Government’s commitment, in partnership with State and Territory Governments, to equipping Australia’s health and hospital system for the future.

The Health and Hospitals Fund will be established by 1 January 2009.

The announcement is found here

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr078.htm

Mr Bill Ferris AC has been appointed as Chair of the new Health and Hospitals Fund Advisory Board.

We will have to see if “medical technology and equipment” covers e-health!

David.

Last Chance Saloon for E-Health in Australia for 2008 Tomorrow!

The ABC News has just confirmed Australian Health Ministers are meeting tomorrow.

This means we will soon know if e-Health gets a serious boost in 2008 or we have to wait till who knows when to see some action.

It seems very unlikely, with the silly season upon us, we will see much happen after this meeting for the year.

As they say! – Stay Tuned!

David.

News Extras For the Week (04/12/2008).

Again there has been just a heap of stuff arrive this week.

First we have:

Md. health officials track flu with e-mail queries

By Frank D. Roylance

November 21, 2008

You're all achy, coughing and feverish. Work is out of the question, but you're not sick enough to see a doctor. How nice it would be if someone checked in to ask how you're feeling.

The Maryland Department of Health and Mental Hygiene won't send over a pot of chicken soup. But state epidemiologists have a first-in-the-nation, Web-based project to ask thousands of residents whether they've been laid low by flu symptoms.

The Maryland Resident Influenza Tracking Survey is designed to augment reports from the doctors, hospitals and medical laboratories traditionally used to gather data on the geography and intensity of the flu season. The health department sends a weekly e-mail to people who sign up, asking them such questions as whether they've had a fever or a sore throat.

"We're looking at ways to fill in the gaps of our existing surveillance system," said Rene Najera, an epidemiologist at the health department. "We're trying to get at people who don't go to the hospital or do not see physicians. When those people do not seek care, they don't get reported to us."

More here:

http://www.baltimoresun.com/technology/bal-te.md.flu21nov21,0,5604173,print.story

Also we have:

For World's Sick, Care Via E-Mail

By Kevin Sullivan

Washington Post Foreign Service

Monday, November 24, 2008; A08

WINGHAM, England -- Geese honked happily outside as Pat Swinfen sat in the study of her 16th-century farmhouse, cozy and warm amid thick Oriental carpets and a glowing wood fire.

Pure English countryside idyll -- except for the critically ill pregnant woman in Iraq desperately in need of a neurologist.

Swinfen, a retired nurse in her early 70s, sat at her computer and tapped out an e-mail, trying to connect doctors in Basra working on the woman, who had suffered a brain hemorrhage, with a renowned neurologist from Northern Ireland trekking in Nepal.

She soon had an e-mail response from the neurologist, who told Swinfen to forward details of the case.

The Swinfens run the Swinfen Charitable Trust, a telemedicine charity that uses e-mail to link sick people in poor, remote or dangerous parts of the world with hundreds of medical specialists in some of the world's finest hospitals.

Doctors in about 140 hospitals and clinics in 39 nations use the organization to seek help for patients requiring specialized care beyond their capabilities. Through the trust, they can be put in e-mail contact -- often within hours -- with one or more of the 400 specialists who work without pay as part of the trust's network.

More here

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/23/AR2008112302629.html

Seems there is a lot of news on how e-mail can make a difference! Good stuff.

Second we have:

Balancing Privacy with Progress
Health care IT continues with the struggle between access and security.

By David St.Clair

One of the primary roadblocks in the advancement of health information technology (IT) is the ongoing debate about the privacy and security of personal health information. Many maintain that the timely exchange of patient information among the various entities in the health care process - which is essentially the backbone of effective health care IT - increases the risk of that very personal data falling into the wrong hands. These claims have gained resonance in recent years with the all-too-frequent reports of cybercrimes and high-profile security breaches involving the medical records of various celebrities.

Privacy and security concerns are by all means legitimate. But are they significant enough to warrant slowing the vast improvements to health care quality, safety and affordability that technology can generate? Indeed, the greatest potential danger to the health care system may not be the misuse of personal health information, but the non use of it.

Right now, valuable clinical data sits idle in various places throughout the health care system when we could be deploying it through electronic health records (EHRs) to improve the system and perhaps even save lives. Delivering a greater breadth and depth of actionable information to the point of care furnishes clinicians with a much more thorough and complete picture of a patient and his or her medical history. The EHR fills in important blanks; it essentially makes known to a physician that which is otherwise unknown. As a result, doctors can make faster and more accurate decisions, which can snowball into a wealth of related benefits: better outcomes, increased operational efficiencies, less waste, lower costs and so on.

Given these almost certain benefits, one must consider whether we're approaching the point in the privacy debate where fear of the misuse of information needs to be overcome in order to prevent the nonuse of information, and whether the somewhat misdirected fear of potential security breaches is really worth stifling health IT progress and all it has to offer - especially at a time when the country is grappling in earnest for solutions to the high cost of quality health care.

Much more here:

http://health-care-it.advanceweb.com/Article/Balancing-Privacy-with-Progress.aspx

This is a very useful view and the full article is worth a read!

Third we have:

Germany’s GEK picks Atos for e-health card

20 Nov 2008

German health insurer, Gmünder ErsatzKasse (GEK), has signed a five-year deal with Atos World line, to implement and operate the new German electronic health card (EHC) on its behalf.

During 2009, GEK plans to issue 30,000 cards per day in order to provide its 1.7million members in Germany with the new e-health card.

Due to be rolled-out nationally in 2009, the electronic health card is one of Germany’s most important public sector IT projects. The card is designed to guarantee the secure exchange of data between insured parties, doctors, pharmacists and health insurance companies and will serve to validate patient’s identity, rather than hold their electronic medical record.

The introduction of the new electronic health card is intended to help connect citizens, pharmacists, doctors, hospitals as well as the private and statutory health insurance companies. Use of the card will help simplify and accelerate information exchanges, reducing and in some cases eliminating current paperwork.

Atos Worldline, a division of Atos Origin, has been selected by GEK to implement and operate the issuing and management of e-health cards. Services include the implementation of the health insurance data, the running of the card application and management system.

Atos will provide its card application management system for the electronic health card ‘Worldline eGK KAMS’.

Atos says its Public Key Infrastructure ensures that patient data is securely stored. The keys for the e-health card Atos Origin will supply are approved as trusted services by Gematik (Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH), the national body overseeing the German e-health card project.

More here:

http://www.ehealtheurope.net/news/4344/germany%E2%80%99s_gek_picks_atos_for_e-health_card

It is important to understand just how the Germans are proceeding on e-Health. Here is a useful article to get started.

Fourth we have:

DOD, Veterans Affairs will use SOA to increase EHR interoperability

By Peter Buxbaum
Published on November 24, 2008

The Defense and Veterans Affairs departments will migrate their respective electronic health record systems to a service-oriented architecture to enhance the interoperability of outpatient clinical data.

Stephen Jones, principal deputy assistant secretary of Defense for health affairs, made the announcement at a Pentagon press conference this morning.

SOA means that the systems will rely on Web services that connect loosely coupled, reusable components.

A study by Booz Allen Hamilton recommended the use of SOA, and officials accepted that recommendation, Jones said.

The decision came on the heels of speculation that DOD might ditch its EHR — AHLTA — in favor of VA’s Veterans Health Information Systems and Technology Architecture or another alternative.

“The Booz Allen study looked at three different options: building on the current approach, replacing AHLTA with VistA and replacing both with another commercial off-the-shelf solution,” Jones said.

Booz Allen recommended the first option, which would allow DOD and VA to “move forward with information sharing in a compatible way,” Jones said. He added that he could not provide cost or schedule information because the implementation effort is just beginning.

More here

http://www.govhealthit.com/online/news/350692-1.html

Interesting where these large organisations think SOA fits.

Last for this week we have:

Joint Commission outlines ‘hospital of the future’

Posted: November 20, 2008 - 3:30 pm EDT

The Joint Commission released a white paper urging the healthcare industry to consider specific actions within five core areas of hospital development.

In its paper, Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future, the commission maps out steps hospitals should take in the areas of economic vitality, technology adoption, patient-centered care, staffing and design to better meet the needs of patients. “The importance of hospital-based care will not diminish in the future, but hospitals will have to meet the high expectations of the public and all stakeholders in an increasingly challenging environment,” said Mark Chassin, a physician who is president of the commission, in a written statement. Aramark Healthcare supported the development of the white paper.

Full article here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20081120/REG/311209972/-1/TODAYSNEWS

This is a useful study – and shows where technology can help future hospital developments.

David.