What a Very Good Idea!

An old but very important idea seems to have obtained a new lease on life!

Patient data could show medicines danger

Mark Metherell
January 3, 2009

THE national health safety agency is pressing the Federal Government to cross-check the huge bank of information held in the Medicare and pharmaceutical records of patients to curb thousands of avoidable illnesses and deaths caused every year by medication problems.

Harmful new drugs and lethal side effects would come to light much more quickly if Australia used "two of the richest health information stores in the world" - the Pharmaceutical Benefits Scheme and Medicare, according to the Australian Commission on Safety and Quality in Health Care.

The commission cites the rapid growth in use of new anti-inflammatory drugs in 2000 which were later found to be associated with a higher risk of death and side effects in diabetes and heart patients. One of the drugs, Vioxx, was linked with more than 1000 adverse events, about 30 per cent of which ended in deaths.

"Earlier recognition of this pattern of medicine use may have prevented adverse events in these high-risk groups," says the commission in a new report.

By linking patient details (from which personal information has been removed) from PBS and Medicare computers with death and disease records, "we would be able to identify problems with medications more quickly, identify previously unrecognised side effects, identify the risk of side effects in groups not included in the clinical trials [for new drugs], and assess the appropriateness of medication use in practice".

The commission calls for "national leadership" to support the development of a more integrated approach to exploit the information available.

The call comes in the commission's annual report Windows Into Safety And Quality In Health Care 2008, in which it makes the case for a more open and accountable approach to combat mistakes in surgery, medication and infection control.

More here:

http://www.smh.com.au/news/national/patient-data-could-show-medicines-danger/2009/01/02/1230681748884.html

The full report is found here:

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/content/windows-into-safety-and-quality-in-health-care-2008/$File/ACSQHC_National%20Report.pdf

Not much of this is new as can be seen from my blog of last month.

Tuesday, December 09, 2008

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.

End Blog.

What is a little sad is just how little apparent effort the Australian Commission on Safety and Quality in Health Care seems to be investing in causing these obviously useful outcomes to come about. As readers of this blog will know only too well quality and safety of care are both a key stimulus to broader use of Health IT and one of the few evidence based ways to actually achieve major improvements.

It is well past time the Australian Commission on Safety and Quality in Health Care pushed a good deal harder on this button in my view.

David.

Medical Objects Comments on Deloittes National E-Health Strategy.

I received the following press release today. I thought the views were worth passing on.

5th January 2009

E-health strategy should be national priority in 2009, says leading software vendor

Medical Objects, a major Queensland-based software provider, believes Australia cannot afford to let another year slip by without significant progress on a national e-health strategy.

A report by Deloitte, commissioned by the Australian Health Ministers' Conference and released in December 2008, noted that only "marginal progress" had been made on e-health over the last decade even though Australian Governments had spent in excess of 5 billion dollars during that time on e-health projects (report summary, page 4).

"We believe it would be a tragedy if this excellent report, which sets out a sensible pathway for national co-ordination, was allowed to gather dust on a Canberra shelf", Medical-Objects CEO Mr Stephens said.

"With President-elect Obama planning to spending $US10 billion a year for each of the next five years on health IT including electronic records, Australia risks being left behind if our governments don't act quickly", Mr Stephens said.

The Deloitte report accurately points to the very real dangers of duplication and the growth of a multitude of incompatible systems and projects which would deny Australia the very real cost and patient health benefits on offer through the use of sophisticated internet-based software to manage patient information flows between health professionals.

Medical Objects which provides software to a number of Australian health organisations has long been an advocate of a standards based approach for messaging and decision support software through its participation in national and international standards bodies, and by building agreed standards into its products.

Mr Stephens said his company was already implementing most of the aspects that Deloitte identified as desirable in a truly national approach to e-health. For instance, Medical Objects already supports many of the priority solutions listed in the report such as Referrals, Discharge summaries, specialists' reports and notifications, decision support for medication management and test ordering, and health information knowledge bases.

Mr Stephens cited the free secure messaging service Medical Objects is providing to eligible medical practitioners under a two-year contract with General Practice Queensland as a great example of what can be done when e-health is approached on a system-wide basis. The new services 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.

"The only major barrier to a faster adoption of e-health in Australia has been the lack of co-ordination between various governments and the Deloitte report is a rare opportunity to overcome the drawbacks of Australian federalism in this exciting new area", Mr Stephens said.

Glenn Stephens can be contacted on 0432 933 972

The release can be viewed on line here:

http://www.medical-objects.com.au/EHealthStrategy/tabid/449/Default.aspx

Good to see industry supporting the approach suggested by Deloittes.

David.

The Australian Medical Journal Slips Into the Past and Irrelevance.

Today we have this announcement from the eMJA.

Access to eMJA: 2009

Martin B Van Der Weyden

MJA 2009; 190 (1): 5

The Medical Journal of Australia (MJA) is published by the Australasian Medical Publishing Company (AMPCo), a wholly owned subsidiary of the Australian Medical Association (AMA). The Journal is available on subscription and is included as part of the membership package of the AMA. Since 2001, AMPCo has published an Internet version of the MJA (eMJA) to which readers have enjoyed free open access since its inception.

The eMJA now contains 6350 pages of valuable information, which, while formidable, unfortunately comes with increasing production and maintenance costs. Because of these essential costs, the Board of AMPCo has decided that, commencing with the first MJA issue in 2009, access to certain content in the eMJA will require a subscription. In this move, the MJA will follow the steps taken by other prestigious medical journals, including the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine (the journal of the American College of Physicians), the BMJ and The Lancet.

Much information, including all previously published articles, current editions of In This Issue, plus guidelines, position statements and supplements, will remain on open access. Research articles will be freely accessible online for 2 weeks following publication, after which a subscription will be required. Twelve months after publication, all articles will revert to open access. This policy will be continually reviewed. Naturally, open access will be provided for any articles we consider to be of urgent public health importance.

Importantly, all current AMA members will continue to enjoy free access to all content of the eMJA. Information about how to access the eMJA is available at

http://www.mja.com.au/access_policy.html.

The Medical Journal of Australia

Martin B Van Der Weyden, Editor.

----- End Announcement

A few points.

First if the MJA thinks it is of similar prestige to the Annals, JAMA, the BMJ or Lancet it is smoking a very strong brew of something which I suspect is not legal.

Second we now find Australia lacks an open professional platform for discussion of Health Policy – with the possible exception of the site run by John Menadue’s Centre for Policy Development (CPD).

This is the URL for this Centre.

http://cpd.org.au/

The ACHSE’s Journal has been member only for ages.

Third closing a professional health publications is a retrograde step in an era when we are working to improve information flows in health.

Last we will now find the Journal will become a journal for members, by members and its quality and relevance will inevitably decline I believe.

Given how rich and well funded the AMA is – a bit sad really.

I hope there will be an open professional journal emerge to fill the gap for Australia. In the mean time Health Affairs in the US - sadly by subscription - will be the most useful health policy journal.

It is ironic that in the first locked 'non-open' copy there is an article on the value of Telemedicine which looks quite interesting and would warrant wider dissemination.

See here:

http://www.mja.com.au/public/issues/190_01_050109/smi11086_fm.html

David.

Useful and Interesting Health IT Links from the Last Week – 04/01/2009.

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

First – welcome back and Happy New Year!

These include first:

Why is Health IT so hard?

Every now and again someone decides that health IT is obviously doing something wrong and they are going to fix it. This is a familiar call, often made by well meaning bureaucracy and its part of the problem and not part of the solution.

Health IT is hard and its become much harder with the involvement of well meaning bureaucracy. They often regard (and even refer to!) health it people as a bunch of “nerds”. If only there were more nerds and less bureaucracy we may be further ahead. Yes it is possible for the banks to have ATM machines working in a global sense and interoperating but they are only adding and subtracting figures from a balance and tolerate a fair bit of fraud as part of the cost. I am sure it all we wanted to do was maintain long term records of patients blood pressure and have this interoperate, with low levels of security it could be done quite easily. If we did this for the same transaction fees as the banks charge for ATM transfers there would also be a funding model!

The full blog article is here:

http://blog.medical-objects.com.au/?p=37

This is well worth a read from a real expert and a clinician. He explains clearly just why even the basics are hard and why NEHTA has a way to go to achieve mastery of its domain.

Second we have:

UK doctors could be reviewed on the Net

December 31, 2008 - 2:06PM

British patients could soon rate their doctors by posting reviews on an official health service website, Health Minister Ben Bradshaw says.

By being able to read feedback from other patients, people would be better able to decide which doctor they wanted to consult, the junior minister told The Guardian newspaper.

The scheme would take its cue from the way people leave comments and ratings about books and music on internet retail sites, Bradshaw said.

Posters would be able to leave positive and negative feedback, though the site would be moderated.

However, doctors' representatives voiced concern that it would descend into a meaningless popularity contest rather than providing accurate information about medical skills.

Officials have been told to get the necessary software ready in 2009, The Guardian said.

More here:

http://news.smh.com.au/world/uk-doctors-could-be-reviewed-on-the-net-20081231-77ql.html

This is not a trend I think we should follow – but it will be interesting to see how a trial goes and if such feedback can make a difference.

Third we have:

Blog Stats for End 2008

I thought it was worth posting these for the end of December

VISITS

Total - 68,796

Average Per Day - 123

Average Visit Length - 2:49

PAGE VIEWS

Total - 110,406

Average Per Day - 212

Average Per Visit - 1.7

In December, 2008 there were 3,798 Site Visits with 6,561 Page Views

Despite the holidays, this was the busiest month ever with over 140 reader comments posted!

Fourth we have:

Snooping public servants sacked

By Fiona Hudson

Herald Sun

December 22, 2008 12:01am

HUNDREDS of federal public servants were sacked, demoted or fined in the past year for serious misconduct.

Investigations into more than 1000 bureaucrats uncovered bad behaviour such as theft, identity fraud, prying into private files, leaking secrets and being rude to clients in Victoria.

The most common breach was improper use of taxpayer-funded internet and email.

But investigators uncovered a wide array of offences, including two officials on overseas duty sanctioned for not behaving in a way that would uphold the good reputation of Australia.

Almost 80 public servants were sacked in 2007-08 for breaching their code of conduct, while 162 resigned while under investigation.

Fines were handed to 218 public servants, 111 were counselled, 93 took a pay cut, and 26 were shifted sideways.

About 50 were found to have made improper use of inside information or their power and authority for the benefit of themselves, family or friends.

Some of the offences were committed at social functions outside working hours.

More here:

http://www.news.com.au/story/0,27574,24832419-1243,00.html

Oh dear! Here we have the human nature of some being shown at its worst. Just how we can make people behave properly when handling easily accessible electronic health information remains a live issue. Certainly education, reminders, well managed surveillance and audit trails and appropriate sanctions will all play a part.

Fifth we have:

Fatal flaws in website censorship plan, says report

Asher Moses

December 23, 200

TRIALS of mandatory internet censorship will begin within days despite a secret high-level report to the Rudd Government that found the technology simply does not work, will significantly slow internet speeds and will block access to legitimate websites.

The report, commissioned by the Howard government and prepared by the Internet Industry Association, concluded that schemes to block inappropriate content such as child pornography are fundamentally flawed.

If the trials are deemed a success, the Government has earmarked $44 million to impose a compulsory "clean feed" on all internet subscribers in Australia as soon as late next year.

But the report says the filters would slow the internet - as much as 87 per cent by some measures - be easily bypassed and would not come close to capturing all of the nasty content available online. They would also struggle to distinguish between wanted and unwanted content, leading to legitimate sites being blocked. Entire user-generated content sites, such as YouTube and Wikipedia, could be censored over a single suspect posting.

This raises serious freedom of speech questions, such as who will be held accountable for blocked sites and whether the Government will be pressured to expand the blacklist to cover lawful content including pornography, gambling sites and euthanasia material.

The report, based on comprehensive interviews with many parties with a stake in the internet, was written by several independent technical experts including a University of Sydney associate professor, Bjorn Landfeldt. It was handed to the Government in February but has been kept secret.

More here:

http://www.smh.com.au/news/technology/web/fatal-flaws-in-web-censorship-plan/2008/12/22/1229794328860.html

More government secrecy because the government didn’t get the answer it wanted – and the report released just before Christmas – sound familiar?

Sixth we have

Windows 7: The Linux killer

Now Microsoft may fear Linux on the desktop as much as it does the Mac.

Preston Gralla (Computerworld (US)) 23/12/2008 08:46:00

Microsoft has long been worried about Linux competition in the server market. When it came to ordinary PCs and laptops, however, it knew it had little to fear.

But that was then. Now Microsoft may fear Linux on the desktop as much as it does the Mac. It's finally taking Linux seriously as a desktop operating system, and it has designed Windows 7 to kill it.

Let me explain.

The threat to Windows comes entirely from "netbooks" -- lightweight, inexpensive laptops that typically use Intel's low-powered Atom processor and don't come with substantial amounts of RAM or powerful graphics processors. They're designed mainly for browsing the Web, handling e-mail, writing memos, and taking care of simple word-processing or spreadsheet chores.

Netbooks will account for about a third of all PC growth this year, according to Citigroup. Shipments will rise at an annual average rate of 60% to reach 29 million netbooks in 2010, compared with 18% growth for standard notebooks, says a September BNP Paribas report.

Clearly, the future is in netbooks. And that has Microsoft worried. Netbooks can't handle Vista's hardware demands, so XP is the only Microsoft operating system that runs on them. But Linux is ideally suited for lower-powered netbooks.

More here:

http://www.computerworld.com.au/article/271645/windows_7_linux_killer?eid=-255

I found the idea Preston puts and the forecast penetration of Netbooks fascinating. Being old fashioned I still like having my data on my computer – but it seems times are changing!

Last we have the slightly more technical note.

15 events that changed technology history

The key milestones that shaped the industry

Neil McAllister (InfoWorld) 24/12/2008 09:00:00

There are certain key points that have shaped the way technology is today. We've rounded up the 15 most important milestones and explained why they changed the course of the industry.

Technology has become what it is today thanks to key milestones that changed the direction of the industry. For example it was only during a tour of Xerox PARC that Steve Jobs was struck with the idea of Macintosh after seeing the PARC's GUI in action, but would Apple be as popular today if he hadn’t made that pilgrimage?

We've charted the 15 most important points in tech history that have already influenced the direction the industry has taken and will continue to shape its future.

Much much more here:

http://www.computerworld.com.au/article/270452/15_events_changed_technology_history?eid=-255

This is a fun summary of some major turning points. I wonder do people agree with the choices made as to the key points?

More next week.

David.

Totally Unrelated Extra!

Rovin', rovin', rovin' - Mars explorers don't want to stop

Richard Macey

January 3, 2009

IT IS a common complaint these days: things are just not made to last any more.

But it is one gripe that does not hold water on the red planet. The warranty on NASA's two, six-wheeled Martian rovers - Spirit and Opportunity - guaranteed their survival for only 90 days on the planet's dusty surface, and promised that they would drive a mere 600 metres.

But this weekend Spirit celebrates its fifth birthday on Mars. Its identical twin, Opportunity, reaches the same milestone on January 24.

Since its landing Spirit has motored more than 7.5 kilometres, while Opportunity has clocked more than 13.6 kilometres. Together the rovers, which set down on opposite sides of Mars, have snapped about 250,000 pictures.

When Spirit opened its robotic eyes on January 4, 2004, after bouncing to a halt, it spotted a series of hills about one kilometre away. Engineers wondered whether the mechanical explorer, no bigger than a small ride-on mower, could be coaxed to reach them.

Spirit not only reached the hills, but climbed 110 metres to the summit of the highest peak, and then trundled down the other side.

The rovers have found Mars was awash with salty water 4 billion years ago but was drained bone dry by some environmental catastrophe. They have sent back movies of willy willies dancing across the Martian plains and pictures of eerie sunsets.

More here – with lots of pictures:

http://www.smh.com.au/news/world/rovin-rovin-rovin--mars-explorers-dont-want-to-stop/2009/01/02/1230681745988.html

I just think this is amazing and is a nice uplifting story to start 2009!

D.

News Flash – NEHTA Updates Web Site.

An informant has just let me know the NEHTA web site has had a major facelift.

Go to www.nehta.gov.au to experience the new site.

We also seem to have another new Director – here is what the site tells us.

Dr Peter Flett

Dr Peter Flett graduated in medicine in Adelaide, South Australia. After four years in the Royal Australian Air Force he undertook specialist chemical pathology training in Melbourne. He moved to Perth where he worked for 20 years in the private sector of pathology with a consultancy to the King Edward Memorial Hospital for Women. His current roles are Chief Executive of PathWest (the public pathology arm of the Department of Health of WA) and Area Chief Executive of the South Metropolitan Area Health Service, which oversees two major tertiary hospitals and several secondary hospitals.

Welcome and good luck Peter!

This means we now have 2 of 10 directors with a clinical background. My view is that that is still at least 2-3 too few!

The other distinct lack is that there is not a single Health IT expert on the Board – just how can that be justified?

Happy New Year to all!

David.

Happy Christmas - And Now Go Back to What You Were Doing to Celebrate Surviving 2008!

A partner in a major consulting firm recently described me as “sad” because of my enthusiasm for the e-Health cause...he was right – sadly!

So – have a great one – I plan to..and in case you need a tiny fix..here it is.

Hospital safety reports withheld

Sean Parnell, FOI editor | December 23, 2008

Article from: The Australian

REPORTS detailing the extent and economic impact of dangerous and sometimes fatal errors in hospitals are being withheld from the public.

The Rudd Government's hospital safety regulator, the Australian Commission on Safety and Quality in Health Care, earlier this year commissioned a series of reports from associate professor Terri Jackson.

But The Australian's bid to gain access to the reports using Freedom of Information laws has been blocked by the commission because it would damage relations between governments and potentially hinder reform efforts.

The commission's deputy chief executive Bill Lawrence yesterday said Professor Jackson obtained information from a state government "under the requirement that it would remain confidential unless and until the state approved its release".

While Professor Jackson -- who works at the Australian Centre for Economic Research on Health at the University of Queensland -- has used West Australian data in the past, it is understood for this project she is relying on Queensland and Victorian data.

The Australian understands Professor Jackson has found that, on average, about 12per cent of hospital procedures in those states encounter problems, the most costly being post-procedural and general maternity complications.

Mr Lawrence said while he considered the public interest in making the reports known to the broader community, he also needed to consider the need to preserve the efficient and proper function of government, its relationships and "the interest in promoting further research into the causes of patient safety risks and the economic effects of patient safety interventions".

"In my view, in relation to these documents, the factors against disclosure outweigh the factors in favour of disclosure, as the risk of damage to relations in regard to the safety and quality of healthcare is very high," Mr Lawrence said.

Full story here:

http://www.theaustralian.news.com.au/story/0,25197,24835779-23289,00.html

The arrogance of government and associated ratbags is just spectacular. The reason they can get away with not investing in Health IT is that they suppress and hide the information that shows just how bad the system is and how Health IT could actually help.

Just no excuse for this at all! Dissembling creeps the lot of them!

Back to Christmas Dinner. You too!

David.

And They Are Optimistic in the USA Too!

Sorry, I spotted this today and just could not resist spreading the joy!

It could be springtime for health IT

December 22, 2008 — 12:59pm ET | By Anne Zieger

Editor’s Corner

Don't say it too loudly or someone might take it back, but (shhhh) things may be turning around for the health IT business as a whole. While hospitals and clinics may be cutting back hard on building projects, or slowing down the IT projects they do have in force, it seems likely that the Obama administration will be inclined to give IT a boost.

Just look at the Congressional Budget Office report appearing in today's FierceHealthIT newsletter. As you'll see, the CBO has concluded that the only healthcare reform plans that are capable of offering reasonable savings relative to their cost are the health IT plans. The CBO came to that conclusion after examining 115 healthcare reform proposals, so that's not a "shoot from the hip" conclusion, either.

Of course, there's no question that a gusher of money will have to flow out of federal coffers to bring the whole healthcare industry up to the level that will meet the health IT standards assumed by the CBO's report. According to HIMSS, we're talking at least $25 billion just to kick up EMR adoption a notch. And that doesn't even cover a national health network, e-prescribing and other important efforts.

.....

Am I being too optimistic? Is there anything that can stop the changes that seem to be underway? Or is it springtime for health IT, for once? - Anne

Full article here:

http://www.fiercehealthit.com/story/it-could-be-springtime-health-it/2008-12-22?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

Enjoy the optimism and the Christmas Spirit.

Have a great one!

David.

Welcome to 2009 – It May Be Very Much Better!

Well it has really be quite a year for e-Health in Australia in 2008.

In thinking about what has happened since Santa’s last visit (thanks to a reader for the term!) we have – ranked in importance in my mental map – the following:

1. Development of a National E-Health Strategy by Deloittes

2. Development of a Health IT Roadmap and Discussion paper for the NHHRC by Booz and Co.

3. A period of major change and transition and change at NEHTA (New CEO x 2 and major executive changes at least – but still a work in progress).

4. A COAG decision to continue NEHTA funding for another 3 years.

5. The emergence of IBA Health as a substantial (and Australian based) force in Health IT globally. (Usual share holding disclaimer applies)

6. Substantial change in the e-Health Leadership at DoHA very late in the day with continued silence from Ms Roxon on her position with respect to e-Health implementation.

7. Some really interesting scalable private initiatives in the e-Health domain with a few others I am very much less convinced about.

Despite some good things, however, we still have a long way to go. Hopefully 2009 can be the year of getting significant funding, improved governance and standards development and more implementation, better support of GPs, specialists and hospitals and a new era of improving message use and diversity.

There are some straws in the wind in the last week or two that lead me to see out 2008 with some hope and optimism.

First it is increasingly clear that the new NEHTA CEO (Peter Fleming) now has a clear view of much of what has gone wrong in the last 2-3 years and plans to set about fixing it. The loss of some senior management to date (CFO, CTO) may not be last as Mr Fleming reshapes the organisation to better deliver on its goals – with strong support from the Board. I am sure the NEHTA we have at the end of 2009 will be a much better one than we had in early 2008

Second there appears still to be a real chance of some funding to implement the Deloittes strategy coming either from the Health and Hospitals Fund or the May Budget.

See here for fund details.

http://aushealthit.blogspot.com/2008/12/health-and-hospitals-fund-announcement.html

As best I can tell the Act of Parliament – the Nation-building Funds Bill (2008) – which included the set up of the Health and Hospitals Fund - passed on the last day of Senate sitting (4 December, 2008) (amid some considerable chaos as I recall).

There also seems to be considerable recognition within government that the governance changes suggested by Deloittes are very important for future success.

Third there does seem to be an increasing political recognition that the performance of some bureaucrats in implementation of Health IT Policy and Plans may not have been as good as could have been expected.

Fourth there is a considerable change in the e-Health Branch at DoHA with Rob Cameron replacing Lisa McGlynn in the very recent past. The track record of this branch can only improve one might hope with less waste on silly one-off projects and more openness as to project outcomes.

Fifth I really think the NHHRC is recognising the need to make sure e-Health is a key ingredient of the reform agenda when it reports later in 2009.

Sixth I think the evidence of value in Health IT now found on the blog, the emergence of the Coalition for E-Health, the continuing growth of the Health Informatics Society of Australia (HISA) and the Health IT plans of President-elect Obama will contribute to significant forward momentum.

All in all I plan to go into 2009 on a positive and hopeful note.

Season’s compliments to all those who have put up with my rantings this year. (I am not promising any improvement – be warned ) .

To all those pollies and bureaucrats offended by what I write – remember you are free to comment - and that we will all be better off if truth and openness prevail.

The blog will be back – baring amazing vital news - in the week beginning January 5, 2009

Safe and Happy Holidays!

David.