Australia’s National E-Health Strategy – An Obvious and Disappointing Hoax.

OK, I have now had 24 hours to consider how to respond to the document released by the Australian Health Ministers Advisory Council (AHMAC).

The report is available for download here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

In a few words I am ‘shocked and amazed’ at what has just happened.

AHMAC, for reasons it chooses not to publicly explain, has released about 20 pages of the 120 page document which was developed by Deloittes. ( As expected the summary report was released Friday afternoon close to Christmas to minimise any negative reaction!)

There are some very good principles to be found among the pages we have been given but sadly, without significant funding, it can and will go absolutely nowhere and its development has been a total waste of time.

These good things include focus on applications and messaging, standards, conformance and certification, governance, and incremental staged approach and getting basic infrastructure in place.

Sadly all this will cost some money to plan and implement – and there is neither funding, organisational will or organisational responsibility for moving the strategy forward identified

Actually, what was released is a classic case of bureaucratic ‘box ticking’. A country has to have a published National E-Health Strategy – so now we have one. Sad it is a total unfunded fraud on all those who have been waiting for some sign of change over the last 4 years since the bureaucrats last decided they would not invest in Health IT (When HealthConnect morphed from a real project into a “change management strategy”). Frankly I don’t think the box has been ticked if you don’t ensure action after planning.

What is worse still it is the same DoHA leadership people who did the blocking of funding act last time.

See here for the time line of that seven or so year saga:

http://aushealthit.blogspot.com/2007/12/abject-failure-of-howard-government-in.html

It was July 2005 this happened and 3.5 years later we are very little further ahead.

I find it just astonishing that the Australian Health System cannot find the capability to invest 0.5% of its expenditure in technology that, in time, will allow it to become safer, more efficient and more sustainable. Sure I know times are tough – but they are going to become a great deal tougher and more difficult if this is not done – as every other advanced economy recognises.

While not perfect, the full Deloittes plan was a very good, sensibly costed roadmap of a pragmatic way forward which, if adopted, would have made a real difference. It would also have required some investment which it seems is simply not available for no sane reason.

This is so short-sighted it is just awful. As the title says it is a hoax on all those who actually care for our health system!

I wonder is there any chance there might be some funds in the up-coming Budget – due in May, 2009. We can only hope the $60M or so spent in “Program 10.2 e-Health Implementation” can be some core start-up funding to get something going. (That plus some of the apparent NEHTA underspend might make a vaguely useful, but very small, bucket!)

See here for 2008/09 budget details.

http://aushealthit.blogspot.com/2008/05/federal-budget-for-2008-9-e-health-cut.html

News tomorrow!

David.

Australian National E- Health Strategy Released.

The following has just appeared.

National Ehealth Strategy

In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. As part of this process, Deloitte conducted a series of national consultations which included Commonwealth, State and Territory Governments, general practitioners, medical specialists, nursing and allied health, pathology, radiology and pharmacy sectors, health information specialists, health service managers, researchers, academics and consumers.

The National E-Health Strategy developed by Deloitte, together with key stakeholders, provides a useful guide to the further development of E-Health in Australia. It adopts an incremental and staged approach to developing E-Health capabilities to:

• leverage what currently exists in the Australian E-Health landscape;
• manage the underlying variation in capacity across the health sector and States and Territories; and
• allow scope for change as lessons are learned and technology is developed further.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia. It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.

A Summary of National E-Health Strategy can be accessed by clicking here (PDF 246 KB).

The page is found here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

Commentary later.

Enjoy!

David.

I Have a Bad Feeling About This!

I have been thinking about the Australian Health Ministers’ Conference Joint Communiqué of the 5th December 2008.

The communiqué is found here:

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

The relevant part is the following:

“E-health

All Ministers endorsed the National E-Health Strategy developed by Deloitte in consultation with key stakeholders, as a guide to the further development of E-Health in Australia.

The Strategy provides a practical framework and set of priorities that will help to support health reform.

The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia.

It also provides sufficient flexibility for individual States and Territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies.”

Note that there is no mention of any funding for implementation of the agreed Strategy.

As a little background I have been told the version of the Strategy considered by Ministers was dated 7 October, 2008. This provides a decent window for all aspects of the plan, including funding of the recommendations, to have been properly considered I believe.

In the meantime we have seen announcements for spending of gazillions of dollars.

Examples include:

1. The almost $15 Billion of new money from the Council of Australian Government’s Meeting of 29 November, 2008 over the next 4 years. (including the Commonwealth’s $108M for NEHTA over the next 3 years – to be added to equally by the States – making the total $216M over 3 years).

See:

http://www.pm.gov.au/media/index.cfm?type=1

Entries for November 30.

2. The announcement today of $4.7B for road and rail infrastructure and the various small business tax breaks.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0687.cfm

3. The 14 October Announcement of the: Rudd Government's $10.4 billion Economic Security Strategy which contained five key measures:

• $4.8 billion for an immediate down payment on long term pension reform.
• $3.9 billion in support payments for low and middle income families.
• $1.5 billion investment to help first home buyers purchase a home.
• $187 million to create 56,000 new training places in 2008-09.
• Accelerate the implementation of the Government's three nation building funds and bring forward, the commencement of investment in nation building projects to 2009.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0550.cfm

4. The $6.4 billion green car plan announced on the 10^th November, 2008.

See:

http://www.pm.gov.au/media/Release/2008/media_release_0592.cfm

Now I understand some of this was probably in the works for a month or so before it was announced but in each case the funding was announced at decision time.

It is now a week since the AHMC meeting and acceptance of the Deloittes work. But we have no funding announcement, I hear of all sorts of discussions happening in NEHTA and DoHA, and we have yet to see the Strategy document publicly.

As all readers know I am often wrong but I wonder if what is going on is that NEHTA’s plans are being re-jigged and that at the end of the day to funding for both NEHTA and the implementation of the E-Health Strategy will have to come from the $216M over three years.

I hope I am wrong as that will simply not be enough to do what is needed!

I look forward to a clarifying release some time real soon.

David.

Obama and Change - Some Real Differences are Emerging like Using Health IT as an Economic Stimulus!

It looks like there are some really interesting things that are relevant to Australia happening during the Obama transition.

First – as we all know – there is a bit of a crisis of sustainability and quality in the US Healthcare System.

In was therefore good to see the following report a few days ago.

Obama Policymakers Turn to Campaign Tools
Network of Supporters Tapped on Health-Care Issues

By Ceci Connolly
Washington Post Staff Writer
Thursday, December 4, 2008; A01

Barack Obama's incoming administration has begun to draw on the high-tech organizational tools that helped get him elected to lay the groundwork for an attempt to restructure the U.S. health-care system.

Former senator Thomas A. Daschle, Obama's point person on health care, launched an effort to create political momentum yesterday in a conference call with 1,000 invited supporters culled from 10,000 who had expressed interest in health issues, promising it would be the first of many opportunities for Americans to weigh in.

The health-care mobilization taking shape before Obama even takes office will include online videos, blogs and e-mail alerts as well as traditional public forums. Already, several thousand people have posted comments on health on the Obama transition Web site.

"We'll have some exciting news about town halls, we'll have some outreach efforts in December," Daschle said during the call. And tomorrow, when he appears at a health-care summit with Sen. Ken Salazar (D-Colo.) in Denver, Daschle said, "we'll be making some announcements there."

It is the first attempt by the Obama team to harness its vast and sophisticated grass-roots network to shape public policy. Although the president-elect is a long way from crafting actual legislation, he promised during the campaign to make the twin challenge of controlling health-care costs and expanding coverage a top priority in his first term.

Daschle, who is expected to become the next secretary of health and human services, is waging the outreach campaign by marrying old-fashioned Washington-style lobbying and cutting-edge social-networking technologies. Although he has yet to be formally nominated, he has already met with more than 100 insiders, ranging from union leaders and the seniors group AARP to hospital executives and representatives of corporate America.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/03/AR2008120303829.html

It seems to me there is no reason why the National Healthcare and Hospitals Commission could not be being a little more innovative in gathering public views than simply asking for submissions and commissioning expert papers. Australians are pretty much as worried about their health system as Americans and would like an easy way to have a say!

Second we have the following rather great idea – Health IT to improve the economy.

Health IT weighed for economic stimulus package

By Paul McCloskey

Published on December 5, 2008

Senate health care leaders are discussing whether to add health information technology to the programs that would be funded under the economic stimulus package now being readied by aides to President-elect Barack Obama and congressional staff members, sources said.

House Speaker Nancy Pelosi has promised to have a broad economic stimulus plan ready for Obama to sign by the time he takes office Jan. 20, and it may be ready earlier. The package, which could inject as much as $500 billion into large public works programs, has led to a scramble to identify projects that would create jobs and spur economic growth.

Transportation infrastructure and green energy top the list of projects being considered. But using the bill to encourage adoption of health IT, the goal of several nearly successful attempts to pass health IT legislation this year, is also being weighed, health care officials said.

One strategy would be to attach the Wired for Health Care Quality Act to the stimulus legislation, congressional sources said. The Wired bill, which failed to pass the Senate this summer, created incentives for health IT adoption and addressed several security and privacy problems that had long delayed action on the bill.

At the annual conference of the e-Health Initiative in Washington this week, health policy leaders voiced caution about driving health IT adoption through a big financial stimulus program.

Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said health IT financing is most productive when tied to specific standards, or functional and performance requirements focused on health outcomes.

Although direct financing of health IT is one way to raise levels of health IT adoption, he said, “I’m not sure that, by itself, it would lead to better care,” McClellan said.

Howard Dean, chairman of the Democratic National Committee and a medical internist, warned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted before purchasing started.

“In theory it’s a great idea,” Dean said. “We would just have to make damn sure the system works before we do it.”

ore here:

http://www.govhealthit.com/online/news/350700-1.html

I just love the idea – certainly makes justifying the hoped for spend a bit easier!

Third we have this

Obama to broaden role of genetics in medical care

By RICARDO ALONSO-ZALDIVAR,

Associated Press Writer Fri Nov 28, 1:58 pm ET

WASHINGTON – For years, scientists have held out hope that the rapidly evolving field of genetics could transform medical diagnosis and treatment, moving beyond a trial-and-error approach as old as the Hippocratic Oath.

But the vision of individualized treatment based on a patient's genetic makeup and other biological markers has yet to materialize, even if better use of genetic information has led to advances in cancer care and other areas.

Now the pursuit of "personalized medicine" is expected to get a major push from the incoming administration of President-elect Barack Obama. As a senator, Obama introduced legislation to coordinate the sometimes conflicting policies of government agencies and provide more support for private research. He remains keen on the idea.

"The president-elect has indicated his support for both advancing personalized medicine and increasing (research) funding," said Rep. Patrick J. Kennedy, D-R.I., who has introduced legislation in the House that builds on Obama's.

Obama is also interested in the role that personalized medicine could play as an element of changes in the broader health care system.

"The issue of getting the right treatment to the right person goes with his whole emphasis on health reform," said Mark McClellan, a noted Republican health care expert who served President George W. Bush as Medicare director and head of the Food and Drug Administration. "If we're thinking about reforming the health care system, we should be thinking about what medicine will be like down the road when health care reform is fully implemented," McClellan said.

Much more detail here:

http://news.yahoo.com/s/ap/20081128/ap_ca/transition_genetic_medicine_2

This approach to medicine is clearly part of the future – and really relies on detailed electronic records to work as hoped for. More stimulus to invest.

One can really sense there is serious change around as major papers run articles such as this.

U.S. 'Not Getting What We Pay For'

Many Experts Say Health-Care System Inefficient, Wasteful

By Ceci Connolly

Washington Post Staff Writer

Sunday, November 30, 2008; A01

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley (Iowa), argues the government does not have.

Much more here:

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/29/AR2008112902182.html

We are certainly living in exciting times to see how all this energy plays out. Well I hope!

David.

News Extras For the Week (10/12/2008).

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

First we have:

EHRs may reduce physicians paid malpractice settlements

By Molly Merrill, Associate Editor 11/26/08

A new study finds that the use of electronic health records may reduce paid malpractice settlements for physicians.

The study, which appeared in the November 24 issue of Archives of Internal Medicine, shows a trend toward lower paid malpractice claims for physicians who are active users of EHR technology.

There is broad consensus that electronic health records are an essential foundation for the delivery of high quality care. As electronic health record adoption proceeds as a national health policy objective, some have wondered whether EHRs can help to prevent medical malpractice claims," said Harvard University Assistant Professor Steven Simon, senior author of the paper.

The study examined survey responses from 1,140 practicing physicians in Massachusetts during 2005, focusing on demographic characteristics and the length and extent of EHR use. The investigators compared the presence or absence of malpractice claims among physicians with and without EHRs, including only claims that had been settled and paid.

The study found that 6.1 percent of physicians with EHRs and 10.8 percent of physicians without them had paid malpractice settlements in the preceding 10 years. The investigators, after controlling for potential confounding variables, found a trend favoring EHR use, although the results weren't statistically significant.

More here:

http://www.healthcareitnews.com/story.cms?id=10456

Yet another reason to go electronic it seems!

Second we have:

http://www.tradearabia.com/news/HEAL_153220.html

Saudi readies largest e-health system Riyadh: Sun, 30 Nov 2008

The largest electronic health system in Saudi Arabia has gone fully operational following a series of successful tests, said the Arabian Company for Trade and Industrial System (Alcantara).

Alcantara is an exclusive agent for Nexus AG of Germany and the Swedish enterprise resource planning applications company IFS.

The Nexus system is applied in a number of other hospitals in Saudi Arabia and more than 600 hospitals in Europe, US and other parts of the world.

Automatically accessible to all Armed Forces hospitals, the system serves to eliminate duplication of patient records, besides streamlining procedures and allowing for speedy and efficient administration, said a top Alcantara official.

“The project is considered as the largest electronic health system ever in Saudi Arabia,” he said. “It aims to overcome the phenomenon of duplication and scattering of Armed Forces members’ medical files in their various locations.”

So far, the first phase of the unified information system has been successfully completed.

It covers data on patients’ admissions, discharge and transfer systems, management of outpatient clinics, and patients’ registration, pharmaceutical and laboratories systems.

Systems users – administrators, doctors and laboratory technicians, pharmacies – can now access all information on patients in a unified electronic file that can be accessed easily and automatically.

Much more here:

Sounds like EHRs are even starting to penetrate the Arab world – a good thing indeed! Bit of a pity it had to be a military deployment!

Third we have:

Consent to view to get first test

01 Dec 2008

Five GP practices in South West Essex are to become the first GPs in the country to implement the new ‘consent to view’ model for the Summary Care Record from this week.

The practices will also implement consent to view for access to patients’ Detailed Care Records using TPP’s SystmOne.

Just under 15,000 patients from the five practices will receive information today (1 December) explaining how the SCR works and the implications for them as part of the 16 week consultation period.

After the consultation records will be uploaded by implied consent if patients have not chosen to opt-out, but the SCR will only be available to view if the patients give consent at the time of each clinical encounter. The new ‘consent to view’ model was agreed by Connecting for Health in September.

South West Essex has also opted to implement ‘consent to view’ for its detailed care records,as revealed by EHI Primary Care in September.

More here:

Heavens sorting out the privacy model has been a challenge for the NHS. Don’t imagine it would be any easier if we were to go to a large scale IEHR implementation without some major and difficult work needing to be done.

Fourth we have:

Former UCLA hospital worker admits selling records

By: Associated Press

Posted: December 2, 2008 - 5:59 am EDT

A former employee of 595-bed Ronald Reagan UCLA Medical Center pleaded guilty to selling information from the medical records of celebrities and high-profile patients, including Britney Spears and Farrah Fawcett, to the National Enquirer.

Lawanda Jackson, 49, spoke quietly as she entered her plea to the felony charge of violating federal medical privacy law for commercial purposes in U.S. District Court.

More here

http://modernhealthcare.com/article/20081202/REG/312029995/1134/FREE

A sobering and salutatory tale for all I would suggest.

Fifth we have:

Radiology reporting takes on a sharing approach

By Bernie Monegain, Editor

12/03/08

Two standards groups are making progress toward interoperability in radiology.

Health Level Seven and The Health Story Project announced on Tuesday a new development in the standardization of information flow between radiologists and electronic health record systems.

The organizations made the announcement at the annual meeting of the Radiological Society of North America.

The Health Story Project was previously known as the CDA for Common Document Types project, or CDA4CDT.

Executives of M*Modal, one of the founders of Health Story, said the new implementation guide for diagnostic imaging reports would create a standard channel for sharing the clinical detail in narrative radiology reports. This, they said, would make it possible for radiologists to make the information readily accessible to computerized clinical information systems.

The new implementation guide for diagnostic imaging reports will help radiologists capture and share the whole report or patient story in an industry-accepted, human- and machine-readable format that includes both narrative and structured data, according to HL7. As a result, high-quality diagnostic decision-making reports will be more easily available to both referring clinicians and clinical systems.

More here:

http://www.healthcareitnews.com/story.cms?id=10470

This is important stuff indeed. We all need to follow where this goes!

Last for this week we have:

Few consult online health care ratings, studies say

9:28 PM PST on Sunday, November 30, 2008

By LORA HINES

The Press-Enterprise

When it comes to finding the best health care providers, people still rely more on opinions of friends and family than Internet research.

More and more sites that rate health care services are cropping up on the Web, but national and state studies show that fewer people consult such quality ratings for decisions on insurance plans, hospitals or doctors.

Still, hospitals believe the online ratings are important, because good ratings bring better insurance contracts and doctors and more patients and money.

"It's certainly a marketing tool we can use when we get recognized by an independent health care ratings company," said Tobey Robertson, spokeswoman at Community Hospital of San Bernardino. In June, HealthGrades, a publicly traded health care ratings organization, recognized Community Hospital for five-star clinical excellence in maternity care, one of the facility's core services.

"But we encourage everyone to talk to other people who have used the hospital," Robertson said.

HealthGrades and other ratings organizations typically analyze data that health care providers are required to submit to regulatory agencies, such as the Centers for Medicare & Medicaid Services, to formulate rankings.

More here:

http://www.pe.com/localnews/rivcounty/stories/PE_News_Local_S_ratings01.3ddc0f4.html

This is a very interesting outcome indeed. I am interested in knowing what readers think of this result.

David.

A Gap That Really Needs to be Filled (and Can Be Easily) here in Australia.

The following appeared a few days ago.

Drug safety watchdog to be replaced with new body

Julie-Anne Davies | December 06, 2008

Article from: The Australian

THE drug safety watchdog is to be abolished and a new committee with broader powers established in its place, under reforms planned by the Rudd Government.

The Weekend Australian has learned the Adverse Drug Reactions Advisory Committee will be replaced by a Medicines Safety Committee as part of an overhaul of the nation's drug safety system.

It is understood the Rudd Government will introduce a more vigilant drug safety regime that will include rigorous surveillance of prescription drugs after they have received approval to be sold in Australia.

A spokeswoman for the Therapeutic Goods Administration, which oversees drug safety in Australia, confirmed there were a "number of enhancements proposed to the pharmacovigilance framework for prescription medicines".

These will include the introduction of drug audits and the appointment of a drug monitor to oversee the safety of specific drugs.

The new drug safety committee will be given extra powers to oversee, assess and review risk-management plans of drug companies for approved medicines.

A more flexible protocol that will allow drugs to be suspended rather than withdrawn or recalled when safety issues arise is also expected to be in the legislative reform package slated to be introduced into federal parliament early next year.

The Weekend Australian earlier this year revealed chronic under-reporting by doctors and hospitals of serious adverse reactions to drugs could be creating a false picture of which medications pose a health threat.

Of the estimated 500,000 cases a year nationally of people becoming sick because of a drug they are taking, GPs report less than 2 per cent to the TGA.

More here:

http://www.theaustralian.news.com.au/story/0,25197,24758470-23289,00.html

All I can say is amen to that and to point out that if ever there was an area where e-Health and Data Mining can help this is it.

Medicare has access to huge amounts of medicines and clinical outcome information that could be mined – with the right controls – to make a huge difference. I hope discussion of doing something like this is on the top of the agenda of the new National E-Health Management body.

David.

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.