Report Watch – Week of 12 April, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Effective Healthcare Identity Management: A Necessary First Step for Improving U.S. Healthcare Information Systems

Publication Date: March 2009

• Click here to download the brief.

Government policy makers are looking carefully at the best ways to improve the efficiency of information systems in the healthcare industry. Much emphasis has been placed on the need for electronic health records for every American, and at ways to exchange those records at the regional, state and national levels.

But this is putting the cart before the horse. Such an effort must start with the accurate identification of each person receiving healthcare services or participating in healthcare benefit programs. Next, there must be a way to uniquely and securely authenticate that person across the healthcare system, including over the Internet, in a secure and privacy sensitive way.

This brief introduces the current problems with healthcare identity management, security and privacy, and proposes leveraging existing federal standards and technologies already used in other government identity programs. The Healthcare and Identity Councils of the Smart Card Alliance, a non-profit public/private partnership organization whose members include healthcare providers, government users and technology providers, prepared the brief.

More here:

http://www.smartcardalliance.org/pages/publications-effective-healthcare-identity-management/

One possible approach to identity management from a group with a vested interest! Useful analysis of the issues however. The link to a .pdf is in the citation.

Second we have:

Industry Players Align to Support Microsoft's E-Health Strategy

Perot Systems and Philips Healthcare support Microsoft's efforts to build interoperable e-health solutions.

CHICAGO, April 6 /PRNewswire-FirstCall/ -- Today at the Healthcare Information and Management Systems Society (HIMSS) 2009 Annual Conference & Exhibition, Microsoft Corp. released an updated version of the Connected Health Framework (CHF) Architecture and Design Blueprint and additional solution accelerators in the Connected Health Platform (CHP) to help customers and partners deliver interoperable next-generation e-health solutions. In addition, leading healthcare solution providers Perot Systems and Philips Healthcare are supporting Microsoft's commitment to deliver to customers e-health solutions built on the CHF and CHP strategy.

"In today's IT environments, heterogeneity is a reality, and we recognize that collaboration is critical to building and managing technologies that will work well for customers in these environments," said Tim Smokoff, general manager of the Worldwide Public Sector Healthcare division at Microsoft. "CHF and CHP were born out of feedback and best practices from customers, partners and services providers such as Perot Systems and Philips Healthcare, and now as they enrich their offerings, we can further refine our tools to better respond to healthcare industry needs."

Collaboration Provides Healthcare Solutions Now

Information technology is a key asset for governments and healthcare organizations around the world facing an uncertain economic climate and needing to implement cost-effective solutions. Microsoft's CHF and CHP are free resources that healthcare organizations and partners are using to maximize the benefits and reduce the cost to design, build, deploy and operate solutions supporting the needs of patients, families, care professionals and healthcare providers.

Perot Systems is one of the largest providers of consulting, business process and technology-based solutions for global clients, including five of the top 25 U.S. health systems, more than 1,000 hospitals and 70 health insurance organizations, plus leading healthcare supply chain and retail pharmacy companies.

"Our healthcare clients expect the solutions we deliver to align with their cost and quality improvement requirements. This requires solutions that are adaptable, scalable and interoperable," said Chuck Lyles, president of Perot Systems' Healthcare Group. "We focus on developing e-health applications that adhere to these principles, and we were pleased that through the creation of CHF and CHP, Microsoft is offering the industry a means to collaborate on these best practices. As CHF and CHP continue to grow in content and adoption, the time to develop and the quality of e-health solutions that provide tangible business value should improve."

"We believe that this is an essential approach, because most healthcare systems use hardware and software platforms acquired from multiple vendors over a long period of time," Smokoff said. "By focusing on interoperability, our goal is to bring value to past and future IT investments by developing solutions that can work well in heterogeneous environments, evolve over time and serve the needs of healthcare organizations to improve patient care."

Philips Healthcare recently introduced the IntelliVue Clinical Information Portfolio (ICIP) Critical Care solution. The solution streamlines clinical workflow, helps improve financial outcomes, and ultimately helps improve and save lives through facilitating compliance to evidence-based medicine guidelines for critical care. ICIP Critical Care is built on Microsoft technology and supports the guidelines outlined in the CHF Architecture and Design Blueprint guidance and the CHP manifestation.

"Providing clinicians with timely and relevant clinical decision support solutions that analyze and interpret patient data -- when, where and how clinicians need that care-specific information -- is key to improving clinical and fiscal outcomes," said David Russell, vice president of marketing and chief marketing officer, Healthcare Informatics for Philips Healthcare. "Microsoft is making it easier for Philips to accelerate interoperability and ease of use by making available valuable guidance and tools as part of the Connected Health Platform that we can use and innovate upon to build solutions for our customers. With everyone on the same page, the opportunity to develop truly collaborative and innovative solutions exponentially increases."

Updated CHF Provides More Comprehensive View of Industry, Additional Tools

The CHF provides solution architects both a business pattern and a reference architecture to design and build healthcare and associated systems in a platform-agnostic way. Since published in 2006, the Microsoft Connected Health Framework Architecture and Design Blueprint and the associated Connected Health Platform have been downloaded more than 20,000 times and are widely used by healthcare providers and independent software vendors in more than 30 countries.

Version 2 of CHF targets lifelong well-being and covers the full continuum of care -- from the individual to health professionals, health institutions and payers. Because health is not about just hospitals, this version of CHF has been updated to do the following:

• Support both social care and lifelong well-being scenarios.
• Focus on the needs of families, care professionals, care providers and the funders of care services.
• Include the use of federation methods for identity management, authentication, authorization and data integration.
• Enable legacy applications to participate in the service-oriented architecture of the CHF.
• Provide more use case examples and step-by-step design guidance.

Coupled with the revised guidelines of CHF, the Connected Health Platform helps health organizations maximize the benefits and reduce the cost of designing, building, deploying and operating the Microsoft platform and its infrastructure capabilities in their solutions or environment. CHP contains more than 55 architecture, design and deployment guides, tools and solution accelerators such as the Integrating the Healthcare Enterprise Cross Enterprise Document Sharing reference implementation and the Common User Interface component.

More information and downloads of the Connected Health Framework Architecture and Design Blueprint and the Connected Health Platform guidance, tools and solution accelerators are available at http://www.microsoft.com/HealthIT.

Founded in 1975, Microsoft (NASDAQ: MSFT) is the worldwide leader in software, services and solutions that help people and businesses realize their full potential.

Website: http://www.microsoft.com/

The full release is here:

http://sev.prnewswire.com/computer-electronics/20090406/SF9464506042009-1.html

Microsoft is moving quite quickly in the healthcare space. These documents are worth reviewing indeed. The links are in the release.

Third we have:

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

James C. Robinson, Ph.D., et al., in Medical Care

April 2009

Physician use of clinical information technology, such as electronic medical records, can positively impact the management of chronic illnesses. Yet clinical IT adoption by physician practices has lagged behind other market sectors. A study published in the April 2009 issue of Medical Care and co-funded by the California HealthCare Foundation investigated the roles of direct and indirect incentives in accelerating clinical IT adoption among independent practice associations (IPAs) and large medical groups.

Document Downloads

Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology (121K)

More here:

http://www.chcf.org/topics/view.cfm?itemID=133912

The link is in the citation.

Fourth we have:

HHS Clarifies Genetic Info Protection Law

April 8, 2009

The Department of Health and Human Services has issued guidance on the Genetic Information Nondiscrimination Act that covers implications for investigators and institutional review boards.

.....

For a copy, click here.

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/GINA-28032-1.html?ET=healthdatamanagement:e828:100325a:&st=email&channel=data_security

Important stuff for those interested in this evolving and important area.

Fifth we have:

New Interview on E-Health Records with Dr. Ashish K. Jha of the Harvard School of Public Health on Talking Technology

Leroy Jones, Jr. has posted a new podcast interview with Dr. Ashish K. Jha of the Harvard School of Public Health on electronic health records and health information technology.

Washington, DC (PRWEB) April 10, 2009 -- Leroy Jones, Jr., a political commentator and government affairs consultant based in Washington, D.C., has recorded another episode of his podcast series, "Talking Technology with Leroy Jones, Jr."

The latest installment features an interview with Dr. Ashish K. Jha of the Harvard School of Public Health. Dr. Jha, who is an associate professor on Health Policy and Management and also a practicing physician at Brigham & Women's Hospital in Boston, recently co-authored "Use of Electronic Health Records in U.S. Hospitals," which was published in The New England Medical Journal.

Among other topics, a primarily focus of Dr. Jha's medical research is "Information technology among other tools as potential solutions for reducing medical errors and disparities while improving over-all quality." Dr. Jha addresses electronic medical records and other health information technology, especially as it related to improving the overall standard of American healthcare. The full interview is available as a podcast here: http://www.technicaljones.com/2009/04/ehealth-records-new-show-1.

Dr. Jha also addresses:

• Issues around electronic medical records and security
• Penetration of effective medical record systems
• Improving medical efficiency and reducing medical errors
• Roadblocks to healthcare reform
• The economic stimulus plan as it relates to healthcare
• Effects of the new administration on healthcare reform

More here:

http://www.prweb.com/releases/electronic-medical/42009/prweb2315494.htm

This is important material and is worth a listen.

Last we have:

Deloitte Survey Finds Healthy Consumer Demand For Electronic Health Records, Online Tools and Services

Privacy and Security of Personal Health Information Still Major Concern

CHICAGO, April 6 /PRNewswire/ -- As health care providers determine how they will take advantage of the $19 billion allocated in the stimulus package to help jumpstart advances in health information technology (HIT), consumer appetite for electronic health records (EHRs), online tools and services is also growing, according to the results of the 2009 Deloitte Survey of Health Care Consumers (www.deloitte.com/us/2009consumersurvey).

While only 9 percent of consumers surveyed have an electronic personal health record (PHR), 42 percent are interested in establishing PHRs connected online to their physicians. Fifty-five percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions. Fifty-seven percent reported they'd be interested in scheduling appointments, buying prescriptions and completing other transactions online if their information is protected. Technologies that can facilitate consumer transactions with providers and health plans, like integrated billing systems that make bill payment faster and more convenient, are also appealing to nearly half (47 percent) of consumers surveyed.

More here:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/04-06-2009/0005001525&EDATE=

There are all sorts of reports and resources available from the site referred to in this text.

So much to read – so little time – have fun!

David.

International News Extras For the Week (12/04/2009).

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

First we have:

Monday, April 06, 2009

HIMSS '09: Meaningful Use of Stimulus Money Is Key Theme

by George Lauer, iHealthBeat Features Editor

From a scary story of newborn twins struggling for their lives to a cinematic allusion of driving a car over a cliff, the central theme of the Healthcare Information and Management Systems Society's 2009 Annual Conference and Exhibition -- meaningful use of stimulus money to bring about change -- emerged loud and clear at the start of health IT's annual showcase.

"The stakes are extraordinarily high," said HIMSS Board Chair Charles Christian welcoming 25,050 participants to Chicago Sunday on the first official day of the four-day conference. Calling this a "momentous time," Christian pointed to Congress' passage of the American Recovery and Reinvestment Act as a major milestone for the health IT industry. The $19.1 billion in health IT spending in the bill represents "a huge opportunity and a significant challenge," Christian said.

Actor Dennis Quaid delivered the first keynote address Sunday, telling the saga of how his newborn twins almost died from medical errors at Cedars-Sinai Medical Center in California. The infants -- a boy and a girl -- survived two accidental overdoses of the blood anti-coagulant heparin, but others have died from similar mistakes. Quaid and his wife Kimberly established the Quaid Foundation to combat medical errors.

Lots more (with links) here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Meaningful-Use-of-Stimulus-Money-Central-Theme.aspx

The HIMSS Conference barely noticed the recession. Doubtless this was due to all the stimulus money being made available over the next few years. The US Health IT scene is going to be quite something to watch over the next decade.

More reporting on the HIMSS meeting is here:

http://www.ihealthbeat.org/Features/2009/HIMSS-09-Kolodner-Sent-Off-With-Standing-Ovation.aspx

HIMSS '09: Kolodner Sent Off With Standing Ovation

by George Lauer, iHealthBeat Features Editor

Robert Kolodner, soon-to-be-former national coordinator for health IT, got a standing ovation and then did some fancy dancing -- as promised -- at a town hall meeting Monday at the Healthcare Information and Management Systems Society conference in Chicago.

Kolodner's successor, David Blumenthal, whom President Obama named to head the Office of the National Coordinator for Health IT last month, takes over from Kolodner later this month. Blumenthal was conspicuously absent at the ONC's town hall meeting Monday.

Dave Roberts, HIMSS vice president for government relations, paid homage to Kolodner's work over the past two years after replacing David Brailer, the first coordinator of efforts to move the country's health system into the digital age.

Second we have:

CCHIT considers usability rating system, Leavitt says

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Business is booming at the Certification Commission for Healthcare Information Technology.

The not-for-profit commission is, so far, the only game in town when it comes to testing and certifying electronic health-record systems.

And in February, President Barack Obama signed the federal stimulus legislation with tens of billions of dollars for provider subsidies to buy EHR systems—provided they are certified and afford providers "meaningful use."

.....

A recent Health IT Strategist reader poll had 79% of respondents saying CCHIT should add system usability to its testing criteria.

Apparently, CCHIT has been hearing similar requests.

“We’re thinking of adding a rating system and give the data to the users,” Leavitt said. Its ratings could include evaluation by users regarding vendor support, implementation methodology, training capabilities, customer satisfaction as well as usability, which, Leavitt said, is difficult, but not impossible to do

More here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069981

The usability issue is clearly an important one. NEHTA certainly needs to keep it in mind if it ever gets its certification act together.

Third we have:

Open-source EHR developers, CCHIT leaders to meet

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 8:00 am EDT

Members of the small but passionate community of healthcare open-source software developers and users are meeting with the leaders of the Certification Commission for Healthcare Information Technology at the 2009 Healthcare Information and Management Systems Society's conference in Chicago and will attempt to find rapprochement with the federally supported not-for-profit organization that could play an increasingly important role in the government’s IT booster initiative.

Under the American Recovery and Reinvestment Act of 2009, providers can receive subsidies as part of the stimulus initiative to purchase and use an electronic health-record system, but there are strings attached. One of them is that providers must use a certified EHR system to qualify for the federal subsidy. So far, CCHIT is the only game in town for EHR certification.

“There are a number of people in the open-source community—some are folks that make software, some are just people involved in open source—(who) have taken a position that the CCHIT process, how can I put this in a diplomatic way, presents some obstacles for open source that it doesn’t for others,” said Joseph Dal Molin, a vice president of WorldVistA, a not-for-profit organization promoting an open-source version of the Veterans Affairs Department’s Veterans Health Information Systems and Technology Architecture EHR system.

WorldVistA, which helped develop a version of VistA for use in physician offices under contract with the CMS, has the only truly open-source software system to receive CCHIT certification.

Reporting continues here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069976/

This is becoming an issue that will need to be addressed. It is not easy as so few of the available products are open source at present and few will follow if certification becomes crucial and the costs are not managed.

Fourth we have:

April 6, 2009

Owners of LOINC, NPU, and SNOMED CT Begin Trial of Cooperative Terminology Development

On April 6, 2009, the owners of three standards that contain laboratory test terminology – the Logical Observation Identifiers, Names, Codes (LOINC), Nomenclature, Properties and Units (NPU), and the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) – began an operational Trial of prospective divisions of labor in the generation of laboratory test terminology content. This Trial will provide practical experience and important information on opportunities to decrease duplication of effort in the development of laboratory test terminology and to ensure that SNOMED CT works effectively in combination with either LOINC or NPU.

During the Trial:

• New laboratory test terminology content will be created by the Regenstrief Institute (RI) and the LOINC Committee, which own LOINC, OR by the International Federation of Clinical Chemistry (IFCC) and the International Union of Pure and Applied Chemistry (IUPAC), which own NPU, but not by the International Health Terminology Standards Development Organisation (IHTSDO), which owns SNOMED CT;
• SNOMED CT modeling of such content will be done as a by-product of creating new content for LOINC or NPU and then incorporated into SNOMED CT; and
• SNOMED CT codes will be used to represent appropriate parts of LOINC and NPU entities.

Designed to last 6 months or less, the Trial will also provide an opportunity to assess the robustness of the new SNOMED CT Observables Model as a structure for representing LOINC and NPU laboratory test terminology content; to gain a clearer picture of the differences between LOINC and NPU as background for future discussions about the feasibility of a more unified effort between them to further reduce duplication of effort; and to identify any country-specific aspects of laboratory test terminology that may not be suitable for inclusion in the International Release of SNOMED CT. During this period, users can continue to submit requests for laboratory test terminology to any of the three organizations involved in the Trial.

More here:

http://www.nlm.nih.gov/research/umls/Snomed/press_release.html

This work is important and has implications for the longer term approaches to laboratory test terminology used in Australia.

Fifth we have:

New Children's is a pioneer in paperless

(Pittsburgh Tribune-Review (PA) Via Acquire Media NewsEdge) Apr. 5--Wall-mounted flat-screen monitors glow in intensive care units, graphically representing each patient's blood pressure, medications, breathing, pulse and other vitals.

Nurses control computers on wheeled carts, recording patients' symptoms in a database. With a bar-code scanner, similar to a grocery store clerk's, they match a code on each patient's wristband to their medication.

Doctors type up prescriptions on laptops and electronically send requests to the pharmacy, through a system that cross-checks for allergies and correct dosages.

This is the paperless Children's Hospital of Pittsburgh.

"We built the hospital architecturally without any chart racks or spaces for charts to be," said Children's Chief Information Officer Jacqueline Dailey. "And we built a very small medical records department because we do not intend to move any paper records to the new campus. It's a completely digital hospital." A review commissioned by the U.S. Department of Health and Human Services found that adopting information technology improved the likelihood that doctors would remember to vaccinate at-risk patients by as much as 33 percent, cut problems associated with medications by at least half and reduced by 65 percent the time it takes to identify a hospital-acquired infection. Wait times for everything from getting X-rays to medication pickup fell by 24 to 73 percent.

"Do I think (health information technology) is the right thing to do? Absolutely, no question about it," said Nir Menachemi, an associate professor in the Department of Health Care Organization and Policy at the University of Alabama at Birmingham.

More here:

http://www.tmcnet.com/usubmit/2009/04/05/4106655.htm

A great read to see where the real leaders are going. Sounds like they are pretty close to getting there!

Sixth we have:

Trend shows more spending: health IT survey

By Joseph Conn / HITS staff writer

Posted: April 5, 2009 - 4:00 pm EDT

The dam has broken.

By Congressional Budget Office estimates, the federal government is poised to pour as much as $38.3 billion into healthcare information technology support through 2015 under the American Recovery and Reinvestment Act of 2009. The following trends, based on data from the 19th annual Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues, reflect the impact the legislation might have on the industry.

Former President George W. Bush raised the profile of health IT to a national priority in 2004 when he created the federal Office of the National Coordinator and tasked the office and the healthcare industry with providing an electronic health record to most Americans by 2014. Bush, however, staked out the ideological position that the nation’s IT goals should be achieved largely through free-market activity and specifically ordered the ONC to “not assume or rely upon additional federal resources or spending” to accomplish adoption of interoperable health information technology.

According to survey results, an overwhelming majority of respondents aligned more with recent congressional intent and favored the government changing the game plan by providing direct financial support for a federal IT development program.

Asked if they thought the government should subsidize the cost of providing electronic health record systems to physicians, 80.6% of respondents said yes. Asked if the government should subsidize IT systems for hospitals and other healthcare organizations in rural and medically underserved areas, 89.7% of respondents said yes. And even when it came to subsidizing IT programs at community hospitals and other healthcare organizations, 74.2% said yes.

Lots more here (registration required):

http://www.modernhealthcare.com/article/20090405/REG/304059995

This provides a useful review of present spending plans in the US. Clearly on the rise!

Seventh we have:

New online master's degree at DSU

MELANIE BRANDERT mbrander@argusleader.com

Dakota State University will start offering an online master’s degree in health informatics this fall.

The state Board of Regents approved this week the new degree program, which relates to the science of information, practice of information processing and engineering of information systems.

The new degree will help individuals for health care careers in occupations such as chief information officer, corporate health information manager or data analytics.

President Doug Knowlton said the program will support critical health-care related decision making in the state.

DSU will offer the new program without requesting new state funds or increased student fees by redirecting some existing resources, he said.

More here:

http://www.argusleader.com/article/20090404/UPDATES/90404010/-1/none

Altogether a good thing – the more courses that are available the better!

Eighth we have:

GE Threatens Philips With Push Into Home Health Care

By Marcel van de Hoef and Rachel Layne

April 3 (Bloomberg) -- General Electric Co.’s push into home health care threatens Royal Philips Electronics NV’s market leadership, as growth slows in the U.S. imaging equipment businesses that sell to hospitals.

GE, the world’s largest maker of medical-imaging equipment, and Santa Clara, California-based Intel Corp. said yesterday they will jointly spend $250 million over five years to develop home health-care products. Researcher Datamonitor Group predicts the market will more than double to $7.7 billion by 2012.

“GE is very strong in health care and has a lot of knowledge and technology in-house that they can leverage,” said Peter Olofsen, an analyst at Kepler Capital Markets in Amsterdam who has a “reduce” rating on Philips shares. “Philips will be facing the established names here as well.”

The home health-care market is forecast to outpace growth in the hospital business, making it a priority for Philips and GE. Aging populations will boost medical costs and force governments to move more care into homes. Sales to hospitals have been hurt since 2007 by the U.S. Budget Deficit Reduction Act, which has reduced reimbursement for imaging procedures and demand for such systems.

GE Healthcare, also the world’s biggest provider of digital health-record systems, will sell and market the Intel Health Guide, which the U.S. Food and Drug Administration approved last year. The machine collects vital signs and information, sends data to doctors and acts as a videoconferencing and e-mail link.

Full article here:

http://www.bloomberg.com/apps/news?pid=20601103&sid=aCbAm07nbwHs&refer=us

You can be sure this is only the beginning of major technology companies piling into this space!

Ninth we have:

E-health records hit Sam’s Clubs in three states

By Mass High Tech staff

E-health systems developed by medical software maker eClinicalWorks LLC and Dell Inc. are now available in Sam’s Club stores in Virginia, Illinois and Georgia. The companies said the e-health records could be available in Sam’s Club nationally later this year.

Electronic medical records have hit obstacles in the form of costs, according to a statement by Sam’s Club senior vice president Charles Redfield. Now, users can access the records through the Internet, using a software as a service (SaaS) model.

More here:

http://www.masshightech.com/stories/2009/04/06/daily10-E-health-records-hit-Sams-Clubs-in-three-states.html

The roll out of the Wal-Mart clinical record system begins.

Tenth we have:

Building Health 2.0 Into The Delivery System

April 6th, 2009

by John Halamka

View Author Bio

Over the past few months, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.

Beth Israel Deaconess Medical Center has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it’s important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it’s an extensive amount of work. We use First DataBank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.

Many hospitals and academic institutions do not have the resources to create and maintain their own best practice protocols, guidelines, and order sets. The amount of new evidence produced every year exceeds the capacity of any single committee or physician to review it. The only way to keep knowledge up to date is to divide the maintenance cost and effort among many institutions.

More here:

http://healthaffairs.org/blog/2009/04/06/building-health-20-into-the-delivery-system/

Amen to this plea. I hope it can be quickly and sensibly progressed.

This paragraph requires special attention.

“Based on my review of the literature, I believe decision support liability is a new area without significant case law. The good news is that there are no substantive judgments against clinicians for failing to adhere to a clinical decision support alert. As a licensed professional, the treating clinician is ultimately responsible for the final decision, regardless of the recommendations of a textbook, journal, or Decision Support Service Provider. However, as Clinical Decision Support matures and becomes more powerful and relevant, I believe that there could be greater liability for not using such tools to prevent harm.”

Eleventh for the week we have:

Health IT is set to grow - and consolidate

Mon Apr 6, 2009 4:21pm BST

By Debra Sherman - Analysis

CHICAGO (Reuters) - As interest in the health information technology sector swells ahead of government funding to modernize the U.S. healthcare industry's record-keeping system, consolidation cannot be far behind.

The U.S. stimulus package includes $20 billion to create computerized systems that can easily communicate with one another, replacing reams of disparate, paper records.

Both large and small companies are likely to join forces to increase the scope of their offerings, while others are looking to enter this potentially lucrative business.

Some 225 companies are exhibiting for the first time at the annual Health Information Management Systems Society meeting this week, which has drawn more than 23,000 health IT professionals.

"You can't dangle billions of dollars in front of an industry and not expect more people to try and get involved," HIMSS Chief Executive Stephen Lieber told Reuters.

More here (registration required):

http://uk.reuters.com/article/innovationNewsIndustryMaterialsAndUtilities/idUKTRE5353ZJ20090406

That last paragraph has the ring of truth – we will need to be careful and watch out for charlatans!

Twelfth we have:

Computerized Physician Order Entry May Be a Key Indicator in the 'Meaningful Use' of Electronic Medical Records

New KLAS report on CPOE looks at which EMR solutions are achieving the most adoption among physicians.

CHICAGO, IL, April 06, 2009 /24-7PressRelease/ -- As healthcare providers throughout the nation evaluate the impact of the 2009 American Recovery and Reinvestment Act, provisions in the package that call for the "meaningful use" of electronic medical records (EMRs) are driving much of the debate. In light of these challenging questions, a new report from healthcare research firm KLAS may offer a useful resource in determining just what constitutes meaningful use.

"Though EMR technology has yet to be deployed at many community hospitals and most physician practices, the vast majority of hospitals with more than 200 beds have already chosen a strategy and a solution for electronic medical records," said Jason Hess, general manager of clinical research for KLAS and author of the new CPOE study. "For those larger facilities, the goal now becomes one of proving that their EMR solutions will actually be used by physicians, replacing paper-based orders and instructions with computerized physician order entry."

More here:

http://www.24-7pressrelease.com/press-release/computerized-physician-order-entry-may-be-a-key-indicator-in-the-meaningful-use-of-electronic-medical-records-95146.php

Certainly a suggestion worth considering. Of course DoHA and NEHTA in Australia have totally missed the point and got it wrong in my view with our PIP program!

This other release is also worth a quick browse.

http://www.24-7pressrelease.com/press-release/ambulatory-emr-market-poised-for-significant-growth-95144.php

Ambulatory EMR Market Poised for Significant Growth

Legislative changes, new hosted solutions and a proliferation of vendors accelerating buying decisions.

Thirteenth we have:

Feds release open-source NHIN gateway software

By Joseph Conn / HITS staff writer

Posted: April 7, 2009 - 9:00 am EDT

The open-source movement in healthcare was afforded significant federal affirmation this week as the software code to create a gateway between multiple federal organizations and the proposed national health information network has been made available for downloading and public use, according to an HHS announcement made at the 2009 Healthcare Information and Management Systems Society meeting in Chicago.

More here (subscription required):

http://www.modernhealthcare.com/article/20090407/REG/304079996/

It is worthwhile being aware such software has become available via the US Government.

Third last we have:

Exclusive: Billing glitch led to mental health closures

BY ALEX PARKER / Staff Writer

April 07, 2009 | 7:00 AM

The Chicago Department of Public Health lost more than $1 million in state funding by failing to fix computer problems with its billing system, public records show, sparking a funding crisis and the scheduled closure of four South Side mental health centers today.

City officials have previously blamed the closures in large part on state budget cutbacks.

But a trail of official paperwork, obtained by the Daily News through the Freedom of Information Act, shows that the department’s new computerized billing system was so flawed that patient bills weren’t submitted to the state for six months in 2008.

Billing the state was crucial to getting funds because of the way the state allocates dollars for mental health services.

The city's current-year state payments are based on monthly reimbursements for service. When the state received no bills from the city for the last four months of the previous fiscal year, it amended the contract it had with the city to reflect the city's apparent lesser need for funds.

The city's public health chief, Terry Mason, declined to answer questions for this article. Carlo Govia, CDPH’s chief financial officer did not respond to a request to be interviewed. Nor did Cerner Corp., the Kansas City, Mo.-based company that developed the city's software.

Much more here:

http://www.chitowndailynews.org/Chicago_news/Exclusive_Billing_glitch_led_to_mental_health_closures,24833

Sounds like a bit of a mess! – Seems a few too many people have not tried hard enough to co-operate and get things fixed!

Second last for the week we have:

EHTEL helps Swedish government review e-health

07 Apr 2009

The Swedish government and healthcare authorities have called upon the European Health Telematics Association to discuss their national e-health strategy.

The discussion took place in a two-day meeting in Stockholm last week and was the first time that e-health industry body EHTEL had been asked to advise a national government.

EHTEL president, Martin Denz, told E-Health Europe: “They asked us to review their strategy as we could provide a full staff of e-health specialists and any stakeholder they needed, from IT professionals to software architects.

“The whole process meant that they were not being scrutinised but instead receiving structured criticism.”

EHTEL received extensive information on Sweden’s e-health strategy before the meeting so that they could prepare for discussions on how it could be to improved.

More here:

http://ehealtheurope.net/news/4730/ehtel_helps_swedish_government_review_e-health

Where do we sign up!

Last for this week we have:

eHealth agency 'out of control'

Antonella Artuso

Sun Media Queen's Park Bureau

April 7, 2009

TORONTO -- A provincial health-care agency that tallied up well over $200,000 in meal and travel expenses during a few months deserves much greater scrutiny, Tory MPP Elizabeth Witmer says.

Staff members and consultants with eHealth Ontario, which is developing the province's electronic health records, spent $39,235 on meals, $108,489 on travel and $18,327 on accommodation between October 2008 and January 2009.

Another $48,257 was spent catering "off-site" meetings.

"These people are out of control and nobody is providing any oversight," Witmer said yesterday. "And how the minister can accept this extravagant spending is beyond I think most of the people in this province . . . it's a flagrant abuse of hard-earned taxpayers' money."

More here:

http://lfpress.ca/perl-bin/publish.cgi?x=articles&p=262140&s=politics

Sounds like a bit of profligacy here! I hope they are doing good work if they are eating so well!

There is an amazing amount happening. Enjoy!

David.

The Mess That is the US Health System.

Dr. George Halvorson is chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. His health system provides health services to well over 10 million people and is the most advanced user of Health IT in the world.

He is also a very unhappy man as far as the performance of the overall US Health System.

Kaiser's Halvorson gives sobering speech at HIMSS

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 5:59 am EDT

George Halvorson hardly smiled even when he told jokes during his keynote speech to several thousand attendees at the 2009 Healthcare Information and Management System Society convention in Chicago and his several thousand listeners rarely laughed during what amounted to be a sobering, Dutch uncle lecture on the state of healthcare in America.

Halvorson, the chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, revealed little new, but added another powerful voice from the healthcare industry to what has been an old chorus describing the ills of the industry.

Halvorson’s bullet points were familiar to anyone who has followed the news in the past decade; only the numbers were freshly updated for Monday’s audience. The U.S. spends some $2.5 trillion per year on healthcare.

The nation is on path toward spending 20% of its gross domestic product on healthcare.

One of the “great tragedies” of spending so much on our “nonsystem” of care is the nation is still leaving 50 million of its people uninsured and 20 million underinsured, Halvorson said.

For those who have insurance that does cover the cost of their care, providers are paid through “a piecework, very primitive” system in which providers charge for individual units of care “and not the entire package,” Halvorson said. “We have 18,000 billing codes for procedures, and there is not one billing code for a cure,” he said. “Not one code for health.”

Citing studies from three separate sources—the Commonwealth Fund, Milliman and Dartmouth Atlas researcher John Wennberg, each showing extreme variability the quality, appropriateness and cost of care—Halvorson said, “each of those studies concluded if we got healthcare right, we could save half a trillion dollars a year,” enough to pay for universal coverage.

More here (registration required)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069929

He has been making it clear at the HIMSS conference, which happened last week, that he sees Health IT as basic to achieving health reform and making the system even survivable!

He also does not like paper records much.

Paper records are 'incomplete, inaccurate and inaccessible'

April 07, 2009 | Richard Pizzi, Contributing Editor

CHICAGO – There is a great deal of resistance to healthcare reform because industry players make so much money from the current system, said George Halvorson, chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.

Speaking Monday at HIMSS09, Halvorson said the current fee-for-service payment model generates $2.5 trillion worth of revenue, but merely sells "pieces of care" to consumers because the system is not efficient.

Healthcare is the fastest growing segment of the U.S. economy, moving toward 20 percent of the Gross Domestic Product, but Halvorson said the United States is on a dangerous path and must lower the costs of the system and improve outcomes.

"We need to fix the delivery of healthcare and move to full (health insurance) coverage," he said.

Halvorson affirmed that only a "systematic" approach to changing U.S. healthcare would succeed. He called for an emphasis on best practices, an increase in coordination between caregivers and a more consistent follow-through on patients.

Halvorson said there is tremendous inconsistency in the quality of healthcare in the United States, citing a study by Dartmouth professor Jack Wennberg that revealed a 40 percent variation by region in cardiac care.

"We need computers to get (systematic reform) done," Halvorson said. "Physicians don't have enough information to do their jobs right. Paper records are incomplete, inaccurate and inaccessible."

Kaiser is a completely electronic healthcare system, Halvorson said. The California-based system has electronic health records for more than 10 million patients.

More here:

http://www.healthcareitnews.com/news/paper-records-are-incomplete-inaccurate-and-inaccessible

The comments are also reported here:

http://www.fiercehealthit.com/story/halvorson-we-need-truly-reform-healthcare/2009-04-06

Halvorson: 'We need to truly reform healthcare'

April 6, 2009 — 12:59pm ET | By Dan Bowman

Dr Halvorson’s and Kaiser’s efforts in Health IT have been reviewed in the last week in Business Week.

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

By Rachael King

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July.

Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

E-Health Records Can Lead to Better Care

As Wiesenthal's lakeside workouts can attest, getting there hasn't been easy. Among those responsible for Kaiser's efforts are CEO George Halvorson, CIO Phil Fasano, and Louise Liang, senior vice-president for quality and clinical systems support. But Wiesenthal has been working on this project longer than just about anyone. A trained pediatrician specializing in infectious diseases, Wiesenthal is associate executive director at the Permanente Federation, an umbrella organization that oversees Kaiser's doctors.

Early efforts began more than 40 years ago and the path to electronic medical records has involved numerous detours, including a $400 million-plus project Kaiser developed with IBM (IBM) that was scrapped in 2003. Along the way, Kaiser has spent $4 billion and encountered disgruntled doctors, system outages, and a temporary decrease in productivity as physicians get accustomed to the new system.

Kaiser officials and patients say the overhaul was worth the headaches and costs, and industry experts say the upgrade has resulted in a higher quality of care in some cases. A 2002 report from a nonprofit organization called the National Committee for Quality Assurance indicated that in Northern California, Kaiser Permanente had reduced death from heart disease so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population. The report gave partial credit to Kaiser's databases, reports, and tracking and reminder systems.

In 2008, health-care spending in the U.S. reached $2.4 trillion. As much as 30% of that spending goes to ineffective or redundant care, according to studies published between 2002 and 2004 by doctors Elliott Fisher and John E. Wennberg at Dartmouth. Digital health records can improve care by reducing the incidence of medical errors and eliminating duplicative procedures. For instance, electronically stored results of such tests as an MRI or CT scan can be more readily accessible to a wider range of care providers—say, a doctor in an emergency room in a city far from a patient's regular physician—reducing the need for a repeated procedure. As records are integrated with a pharmacy, a doctor or nurse can tell whether a patient hasn't filled a prescription.

Much more here:

http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm

Kaiser has also been in the news for managing patient privacy very sensibly.

Octomom Records Breach a Lesson in Patient Privacy

John Commins, for HealthLeaders Media, April 6, 2009

Kaiser Permanente should be commended for quickly firing or disciplining 23 employees for unauthorized viewing of the personal medical files of Nadya Suleman, aka, Octomom.

The privacy breach at Kaiser Permanente Bellflower Medical Center in Los Angeles County—where the eight children were born on Jan. 27—occurred in mid-March. Suleman was immediately notified. Kaiser confirmed the breach to the public after several media outlets raised the issue. The case is now under investigation by the California Department of Public Health for possible HIPAA violations.

Kaiser's quick, unequivocal response and willingness to take responsibility for its employees' lapses in judgment will serve the health system well in the long run. Kaiser has sent a message to its employees, patients, and the public that spying on the health records of patients will not be tolerated.

So far, nothing more sinister than simply curiosity appears to have motivated the breach, Kaiser spokesman Jim Anderson says. There is no indication that any information in the files was sold to the media, or used for other nefarious purposes like identity theft.

Kaiser uses an electronic record system that allows the health system to track access to medical files. That's how the snoopers were caught. Anderson says Kaiser already had a training program in place at Bellflower well before Suleman's admission that stresses to the hospital's 5,000 employees the importance of patient confidentiality and the consequences for those who violate that trust.

More here:

http://www.healthleadersmedia.com/content/230986/topic/WS_HLM2_HR/Octomom-Records-Breach-a-Lesson-in-Patient-Privacy.html

What we have here is a health system that cares for the equivalent of ½ of the Australian population showing – through a major investment in Health IT and very considerable leadership at a clinical level both improved economic efficiency and much improved clinical outcomes.

Kaiser (and Dr Halvorson) has demonstrated Health IT really works and more has shown where Health IT can contribute to major Health System Reform.

I wonder when we will bother to take any notice of the obvious success.

David.

Australia’s Broadband Leap of Faith – Is it Justified?

This is definitely the news of the week! The impact on e-Health could be very significant.

Here is a basic news report.

NBN plan scrapped; govt seeks new partners

Mitchell Bingemann | April 07, 2009

THE federal Government has terminated the tender process for its national broadband network project and will instead look to partners to build a $43 billion fibre to the home network.

A new company, National Broadband Network Corporation, will be created to build the new network. It will be jointly owned by the Government and the private sector, Prime Minister Kevin Rudd said.

Mr Rudd said not one of the private bidders for the NBN's request for proposals met the government's requirements.

"None of the bids offered value for money," Mr Rudd said.

"The panel noted the rapid deterioration of the global economy had a significant impact on the process."

Prior to today, the Acacia consortium, comprising wealthy businessmen and telco veterans, had been regarded as frontrunner for the project ahead of Singapore-owned Optus and Canadian telco Axia NetMedia.

Telstra, Australia's largest telco, was expelled from the tender process after it failed to meet government guidelines in December last year.

Communications Minister Stephen Conroy said the Tasmanian government's state-based bid for the NBN was still being considered and that negotiations would commence over the next 24 hours to decide a construction timeline. He said it would be likely that the Tasmanian build would commence in July.

More here:

http://www.australianit.news.com.au/story/0,24897,25301755-15306,00.html

There has been a huge amount of commentary on this decision. I think it would be fair to say the experts are genuinely split on the soundness of this proposal.

Some typical commentary has been as follows:

http://www.theaustralian.news.com.au/story/0,25197,25314433-23289,00.html

Broadband opens door to specialist care

Adam Cresswell, Health editor | April 11, 2009

Article from: The Australian

FAST broadband links should allow a host of new health services to be delivered to people in rural and remote areas, and potentially right into aged-care or domestic homes.

And:

http://www.news.com.au/technology/story/0,28348,25319395-5014239,00.html

Consumer experts say Federal Government's high-speed broadband could cost $200 a month

By Alison Rehn

The Daily Telegraph

April 11, 2009 12:01am

• Government will build $43bn network
• Analysts, Opposition say it won't be cheap
• Prices could be $200 a month

CONSUMERS have been warned they will have to pay at least $200 a month to use the Federal Government's high-speed broadband network - or pay less for slower speeds.

And:

http://www.theage.com.au/opinion/other-projects-will-pay-for-harebrained-scheme-20090408-a0y4.html

Other projects will pay for hare-brained scheme

• Kenneth Davidson
• April 9, 2009

National broadband can be rolled out more cheaply using the existing network.

KEVIN Rudd is a political genius, but can the nation afford him as Prime Minister? Instead of announcing that Senator Stephen Conroy and whoever advises him on communications policy are duds who should be sacked, he has set off a $43 billion hare designed to last long enough to carry his Government through the next election.

And:

http://www.smh.com.au/national/cable-eye-to-the-future-20090409-a27m.html?page=-1

Cable eye to the future

• April 10, 2009

The national broadband network is touted by the Government as the key to the universe, but there are doubters, reports Phillip Hudson.

Super high-speed broadband can save lives and save the planet. The Minister for Broadband and Communications, Stephen Conroy, envisages a Sydney specialist examining in real time a three-dimensional MRI for a patient in far-off Broken Hill and giving a diagnosis.

And second last:

http://newmatilda.com/2009/04/07/australia-lead-world-something-good

Australia To Lead The World At Something Good

By Paul Budde

Kevin Rudd surprised a lot of people this morning with the news that instead of contracting someone to build its National Broadband Network (NBN), the Government would take the lead itself.

And last:

http://www.computerworld.com.au/article/298454/analysts_nbn_questions_need_answering?eid=-255

Analysts: NBN questions need answering

ICT analysts welcome the Federal Government's NBN decision but also raise concerns

Matthew Sainsbury (ARN) 07 April, 2009 16:08

ICT analysts have welcomed the Federal Government’s flip flop on the NBN but raised concerns its plan lacks detail.

----- End Links

So we definitely have this as the biggest news of the week. The implications of improved broadband for e-Health are obvious.

The plan provokes a number of questions in my view.

The first issue in my mind is if it really needs so much money and so much time to make the difference we need.

To get this in perspective this is $2047 per person for every one of the 21 million persons in the country.

If you consider the following page you will see there are about 8 million internet connections in Australia.

http://www.abs.gov.au/ausstats/abs@.nsf/mf/8153.0/

Break these down and guess what:

“HIGHLIGHTS

• Mobile wireless access connections were 1.30 million subscribers, or almost 20% of all non dial-up access connections. The number of connections using this technology continued to grow at a significant rate, as more ISPs offered this service, networks increased in coverage and prices fell.
• Digital Subscriber Line (DSL) continued to be the dominant access technology used for non dial-up subscribers, increasing to 4.21 million, or almost 63% of all non dial-up connections.
• Cable, satellite and fixed wireless connections are now available separately for the first time.
• Access to higher download speeds have increased since June 2008, with approximately 50% of all subscribers using a download speed of 1.5Mbps or greater.
• Those subscribers accessing the internet with download speeds of 1.5Mbps to less than 8Mbps represented the greatest number of users (25%). Over 41% of business and government subscribers were using this speed, compared to 22% of household subscribers. This and 8Mbps to less than 24Mbps were the most frequently used download speed for household subscribers.”

Australia had almost eight million active internet subscribers at December 2008; with just under 84% being broadband connections.

Given there are only about 9 million households in Australia and maybe 1.5 million businesses we are talking about a maximum of 10.5 million connections for the network at 100% adoption. This means each connection will cost $4000 or so to establish.

At $50 per month this means the payback will take 80 months excluding the cost of capital etc for the initial investment. That is almost 7 years and you need to add operational, maintenance and staff costs to those costs as well.

I may have this wrong but I can’t see how each connection is going to be put in place and serviced for under $100 - $150 per month. I am not sure there is going to be huge demand at that price – when ADSL2+ and Cable can deliver ¼ of the speed at a known cost of about $60 per month.

We shall see but at first cut it looks pretty expensive! There also have to be real issues about how many people will want to switch from their current provider to pay more.

The second issue is the one of technology choice. I have no problem with the choice of fibre as a transmission medium, but if we are talking about an eight year build I believe we should be going gigabit connectivity at a minimum. (Heaven’s above I swapped my home network to a gigabit switch over 12 months ago and every PC I have bought over the last 3 years has had gigabit Ethernet as standard.) The major capital costs of this network seems to me to come from 2 areas. First the actual work laying out all the fibre and then the cost of all the driving electronics. The first is hard to avoid (wireless maybe?) but the second you want as future proof as possible – so why buy technology that is essentially obsolete before you start?

The third issue has to be questioning if we need to spend as much as $43B to provide all those who need high speed connectivity with it. I am a little concerned that the zeal to snub Telstra – while it may make a great deal more sense to have a phased plan to have Telstra build the new network and merge its national assets into the new entity open access network for a reasonable return and have no risk of legal and other complications. Going that way certainly solves the next issue and would have to be able to happen more quickly. Even using Telstra ducts etc – for a fee – could save squillions according to the Financial Review.

The fourth issue is certainly the fact that there is substantial political opposition to the project as currently framed. This must increase the risk dramatically.

See here:

http://www.theaustralian.news.com.au/story/0,25197,25329883-7583,00.html

Ruddnet is too good to be true

Malcolm Turnbull | April 14, 2009

Article from: The Australian

KEVIN Rudd promised a broadband revolution if he became prime minister. A state-of-the-art, fibre-to-the-node broadband would reach 98 per cent of the population. It would be built by the private sector with a $4.7 billion investment from the Government.

The fifth is the issue of just where network costs flow from. See this:

http://www.australianit.news.com.au/story/0,24897,25329613-5013040,00.html

Global costs are choke point for broadband plan

Andrew Colley | April 14, 2009

THE federal Government will closely monitor Australia's international internet transmission capacity as its plans for building a $43 billion national broadband network move closer to fruition.

The last issue that worries me is just where we are going to find the large number of skilled network engineering staff to operate a network of this scale and complexity. I am not sure these people are sitting around in the numbers required waiting to be recruited into the effort!

All in all I don’t think the options and possibilities have been as fully explored as I would like and certainly I need a great deal more information before I will be convinced this ‘back of the envelope’ plan is indeed the right one for Australia.

I know I shouldn’t raise the issue in this context but we should all remember the Minister responsible for delivering all this is the one who wants to censor our internet feed! Ironic indeed to want to both speed up and slow our internet access.

The business case and implementation plan will be vital in helping us all decide if all this makes sense. It had better be a decently open and transparent process. Before anyone asks I am quite convinced of the importance to our future of ubiquitous broadband – it’s how we get there I am worrying about here! It seems to me that before you spend that much money, you really need to provide the public with a serious strategic option analysis covering network capabilities and requirements, costs and risks, commercial viability and at least some discussion of technology futures that may impact over the next decade.

David.

(Disclosure note: I have a few telco shares – both Singtel and Telstra)