Only NSW Health Could Mess Up Like This!

I know it seems to be a little unfair to make critical comments two days in a row but this really is a ripper.

Power failure lasting 36 hours cripples hospital care

• Kate Benson Medical Reporter
• May 6, 2009

DOCTORS at more than 100 hospitals in the state could not access patient records or vital test results for up to 36 hours last weekend after a power failure crippled NSW Health's computerised database.

Some records were lost, X-ray and pathology results could not be accessed and staff were forced to use whiteboards to keep track of emergency patients after the main server shut down at 9am on Saturday because of a faulty circuit-breaker.

Back-up power from the Cumberland Data Centre, which provides computer access to the Greater Western, Greater Southern and Sydney West area health services also failed, plunging some of the busiest hospitals in the state into chaos.

Thousands of patients were affected, with doctors and nurses forced to take notes on paper and go to other parts of the hospital to collect hard copies of results, extending treatment times and adding to the confusion.

Some staff, who did not want to be named, said the weekend was chaotic and a shambles. One surgeon said it was fortunate no lives were lost.

.....

A spokesman for Mr Della Bosca said workers doing routine maintenance at the data centre had triggered the outage. No patients had reported problems connected to the blackout but a full investigation would be launched. "If necessary changes will be implemented to prevent a recurrence," he said.

with Louise Hall

BLACKED OUT

Hospitals at Westmead, Auburn, Blacktown, Nepean, Lithgow, Mount Druitt, Cumberland, Blue Mountains, Dubbo, Bathurst, Orange, Mudgee, Parkes, Bourke, Albury, Queanbeyan and Goulburn were affected.

Full article here:

http://www.smh.com.au/national/power-failure-lasting-36-hours-cripples-hospital-care-20090505-au1s.html

Further coverage is here:

Patients weren't at risk during hospital power failure: Della Bosca

LiveNews | Francis Keany and Richard Maxton

“There are no reports of adverse patient outcomes related to the temporary power outage.”

NSW Health Minister John Della Bosca

The health system is in damage control again after revelations wide-sweeping blackouts meant doctors at more than 100 hospitals couldn't access patients records or test results for 36 hours.

The power failure last weekend crippled the health database impacting on more than 100 hospitals.

Some records were lost and doctors were unable to access x-ray and pathology results.

.....

However surgeons and the NSW Opposition claim the power loss indicated a serious failure.

NSW Shadow Health Minister Jillian Skinner has told 2GB's Alan Jones the failure of the back up system is extremely concerning.

"The Minister's response is almost, 'Oh well, don't worry about it, no one's lives were at risk'. The same with the Health administrators that spoke out yesterday.

"I joined doctors in saying this is a real worry. We've got to get guarantees this will never happen."

More here:

http://www.livenews.com.au/news/patients-werent-at-risk-during-hospital-power-failure-della-bosca/2009/5/6/205376

There are a few things to be said here:

First the Health Minister would not have a clue and has no way of knowing if any patient was harmed or put at risk. The oppositions comments are more than reasonable I believe.

Second the fact that problems lasted for more than an hour or two suggests total incompetence at both a planning and operational level. Everyone recognises that there can be single point failures that can take a little while to sort out – but 36 hours! Just who was the clueless person who designed the fail safe systems that it took this long to become operational again. Management of the shared services environment should be held accountable and it would be more than reasonable to conduct a short formal PUBLIC enquiry to properly apportion blame and put appropriate remedies in place. I bet that does not happen!

Third, this enquiry should also examine how the manual back-up system worked so the whole Health Sector can learn any lessons that may be available. From the reported comments of staff it does not seem the manual systems coped all that well.

Fourth, I wonder why, if this happened at the weekend, why it has taken until Wednesday for the issue to be reported? Could it be that staff are a bit nervous about speaking out – Mr Garlig SC did suggest there was a little problem with bullying etc in NSW Health?

Fifth incidents like this need to be seen to be effectively handled so we don’t create undue anxiety regarding EHR initiatives. Just hiding the issue under the carpet does not help!

On a positive note this incident should prompt a risk review of all contingency and continuity plans state wide – and testing of them fully to ensure they actually work as intended. 36 hours is just way to long as further automation occurs. I bet that if done, the resulting document would never make it into the public domain as it should!

David.

NSW Health IT – Has Much Changed over the Years?

The following press release appeared over the weekend (always a suspicious time!).

02 May 2009

Patient care and safety enters the digital age

NSW Minister for Health, John Della Bosca, announced today that the State Government had started rolling out new electronic medical records (eMR)s technology into public hospitals across the State to help improve patient care and safety.

The Minister said the new technology would also make it easier for doctors and nurses to track the condition of patients through the health system as hospital information would be linked between facilities via eMRs.

“The $100 million project will be rolled out to 188 hospitals across the State by the end of 2010,” Mr Della Bosca said.

“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital.

“A major benefit of the eMR program is the completeness of patient data and information on medical orders.

“Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.

“This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork which will further improve patient safety,” he said.

The benefits for patients include:

• Decreased delays in retrieving clinical information;
• Timely availability of integrated patient information, including results of tests and patient scheduling;
• Reduced duplication of orders for diagnostic tests; and
• A reduction in the potential for errors.

The benefits for doctors, nurses and allied health professionals is that eMR will allow them to:

• Record patient care where and when it is delivered
• Review progress and order treatment or diagnostic tests from any workstation within the health facility
• Be prompted with alerts and allergies at the time of ordering
• Continually review results and outcomes as well as alter care as required.

“In his Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals, Peter Garling SC recommended the implementation of the eMR into NSW hospitals as a way of improving the sharing of information and communication among medical teams,” Mr Della Bosca said.

“Results from the initial trials and roll-out reveal a positive take up of the new technology by clinicians, demonstrated by the use of electronic medical orders to request blood tests and x-rays.

“The eMR is one of the cornerstone projects of NSW Health’s Information and Communication Technology Strategy, which is modernising the way health services are supported in NSW.

“Delivering a statewide eMR will help provide consistent delivery of quality healthcare for patients in both rural and metropolitan hospitals across the State,” he added.

For a range of health information, go online to www.health.nsw.gov.au

The release is found here:

http://www.health.nsw.gov.au/news/2009/20090502_01.html

The SMH followed up thus

Paper patients' notes out, digital records in

• Louise Hall Health Reporter
• May 2, 2009

BY THE end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced.

The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors.

Mr Della Bosca said doctors, nurses, allied health and social workers will be able to access a centralised repository of a patient's medical chart, laboratory results, prescriptions and referrals, no matter where the patient enters the health system.

Peter Garling, SC, recommended an urgent roll-out of electronic medical records (eMR) in his special commission of inquiry into acute care services, which found NSW's record-keeping system is "a relic of the pre-computer age" that puts patient safety at risk.

.....

The next step will link hospital-based records to primary care providers, such as GPs, by way of an electronic discharge summary.

.....

NSW Health has admitted that two previous attempts to implement electronic medical records in 1991 and 1999 had failed, at a cost of $12 million and $30 million respectively.

The National Health and Hospitals Reform Commission has recommended an individual patient-controlled electronic health record owned by the patient who decides which health care providers can access it.

Full article here:

http://www.smh.com.au/national/paper-patients-notes-out-digital-records-in-20090501-aq6k.html

The NSW AMA reaction is here:

AMA casts doubt on hospital paper scrap plan

Posted 1 hour 14 minutes ago

The Australian Medical Association (AMA) has cast doubt on plans for all of New South Wales' public hospitals to scrap paper records by the end of the year.

The association's state president, Dr Brian Morton, has welcomed the State Government's $100 million project to move to electronic medical records.

.....

"I think there must be extreme cynicism as to the ability of NSW Health and the State Government to actually respond in implementing change and to actually allow independent audit of the process, so that we can see as a community that change has occurred and that quality of care really is improving," he said.

Full report here:

http://www.abc.net.au/news/stories/2009/05/03/2559261.htm

Quite telling is this report from Computerworld.

http://www.computerworld.com.au/article/301824/nsw_health_spend_100m_electronic_medical_records?eid=-6787

NSW Health to spend $100m on electronic medical records

Patient information to be shared between health facilities

Rodney Gedda 04 May, 2009 14:32

After many promises and trials, NSW Health has committed $100 million over the next two years to replace existing paper-based health records in public hospitals with a state-wide electronic system aimed at improving patient care.

NSW Health anticipates the new electronic medical record (eMR) technology will make it easier for doctors and nurses to track the condition of patients through the health system as hospital information will be linked between facilities electronically.

Minister for Health, John Della Bosca, said the $100 million project will be rolled out to 188 hospitals across the state by the end of 2010.

“The new eMR replaces many existing paper records and makes secure patient information available to authorised clinicians from computer workstations across the hospital,” Della Bosca said.

“A major benefit of the eMR program is the completeness of patient data and information on medical orders.”

A similar system is the NSW Healthelink project, which began about five years ago and was well received by clinicians.

Healthelink now claims 70,000 subscribers.

Della Bosca said prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records.

More here:

http://www.computerworld.com.au/article/301824/nsw_health_spend_100m_electronic_medical_records?eid=-6787

The scepticism that anything has changed is pretty obvious.

The recent release should maybe compared to this one:

30 May 2005

Patients to benefit from online access to medical records

Public hospital patients across NSW will have access to state of the art Electronic Medical Record (EMR) technology after the NSW Government today announced a call for tenders to expand the roll out of the EMR system, Health Minister Morris Iemma said today.

"The Electronic Medical Record is a foundation stone of our vision for how we will harness technology to improve patient care," Mr Iemma said.

"The Electronic Medical Record system will give clinicians online access to diagnostic tests for their patient carried out in hospital, regardless of whether as inpatient, outpatient or in emergency.

"From this base we aim to build a network that will ultimately allow consolidated test results to be accessed online from any authorised PC location across the state.

"So if a patient is admitted to Prince of Wales Hospital Emergency Department, their clinician will be able to access diagnostic test results done previously at Nepean Hospital or even Wagga Base Hospital.

"Improved access to clinical information can help reduce delays and give medical professionals the information they need to deliver the best possible care to patients," Mr Iemma said.

"This will be a significant boost for frontline health services delivering better access to a patient's clinical information wherever they are in the health system," Mr Iemma said.

"The system will also allow electronic charting making it easier for treating clinicians to detect trends in diagnostic results."

"NSW Health is looking to secure state-wide EMR coverage, and to do this it is seeking a second provider for point-of-care clinical system to those Areas that currently have not had a provider appointed," Mr Iemma said.

Mr Iemma said that online results reporting is already being used by Sydney West, Sydney South West, the Children's Hospital at Westmead and Central Coast and would be extended to Northern Sydney and Greater Western Area Health Services by early 2006.

This second call for tenders will see this technology rolled out to the remaining Area Health Services.

The Minister said that privacy and security will be assured as each clinician is given a unique identification and password to access the system.

Preserving system integrity and patient privacy are critically important aspects of the project and NSW Health will take all necessary steps to ensure patient confidentiality is maintained.

Roll out of the software will be managed through HealthTechnology, the new shared IT services agency established as part of the restructure of the state health information management and technology function.

For a range of health information, go online to www.health.nsw.gov.au

The release is found here:

http://www.health.nsw.gov.au/news/2005/20050530_04.html

Of course that didn’t quite go as planned!

09 February 2006

Electronic Medical Record Tender Closes with no vendor meeting all requirements

NSW Health today announced that it would review its options for its second Electronic Medical Record (EMR) solution after concluding that no single product presented in the tender could meet the defined requirements to a satisfactory level.

NSW Health's Chief Information Officer, Michael Rillstone, said that while he was sympathetic to vendors, who had put in a significant effort, it was important that NSW Health move forward with its EMR program with confidence that the needs of Area Health Services would be met with minimal disruption to front line health services.

"A number of the clinical information systems presented were currently under development and while these may yet meet NSW Health's requirements in the future, at present they represented too high a risk on a number of fronts.

"We only have one chance to get this right. Health is a complex environment, and that does not mix well with high-risk software implementations, as we have seen in the past.

"Nine responses were received. A comprehensive evaluation found that no single product could meet to tender requirements to a satisfactory level," said Mr Rillstone.

The EMR is aimed at providing an information system that will enhance the health care of people attending NSW public hospitals. It will allow statewide coverage of clinical information systems with the goal of making comprehensive information available to treating clinicians, no matter where a patient enters our health system.

Mr Rillstone said that key modules of the EMR strategy have already been rolled out over the past three years into two Area Health Services and the Children's Hospital at Westmead.

The selection of a second vendor was preferred because it provided a more competitive environment with alternate product options. However, this approach represents no advantage if it comes with significantly higher implementation risks.

"Sound health care and clinical decision-making is enhanced by timely access to quality information.

"For example, having the test results of a patient in hospital quickly integrated into their treatment notes so that treating clinicians can consider the results in the context of the patient's overall condition and current therapies to make timely decisions," Mr Rillstone said.

The Chief Information Officer said it was important to understand that NSW Health remained committed to delivering an EMR and that improving the quality and timeliness of patient care and providing support to busy clinicians as they care for their patients was a priority.

While the current second EMR tender outcome is a setback, work has begun immediately on reviewing the options for moving forward aimed at minimising any delay.

The release is here:

http://www.health.nsw.gov.au/news/2006/20060209_02.html

The bottom line is that unless something has changed dramatically, this is just a joke. I wonder will we get a new announcement of essentially the same thing a further four years (an one or two ministers) hence.

The AMA and Computerworld are perfectly justified in being sceptical! A review of the news releases from NSW Health since 1999 shows at least 2 other seeming starts down the e-Health path that don’t seem to have gone far.

This one, from February, 2001, is my favourite:

Electronic Health Records - Better Care, Your Choice

A SYSTEM of linked electronic health records (EHRs) will significantly improve patient care in NSW hospital patients within two years, the Minister for Health, Craig Knowles, said today.

The full release is here:

http://www.health.nsw.gov.au/archive/news/2001/February/02-02-01.html

Just how focussed efforts are on this newly announced initiative becomes a little clearer when one goes here:

http://www.emr.health.nsw.gov.au/

The information on the eMR page says it was last updated 26th Sep 2008! Only eight months ago!

Funny how EHR has become EMR and then become eMR – I wonder what all that means?

Time will tell I guess if this is serious or not. I, for one, will not be holding my breath.

David.

The NHHRC Gets E-Health Very Badly Wrong at the First Go!

The following is going to form the basis of my submission regarding the e-Health plan proposed by the National Health and Hospital Reform Commission (NHHRC).

First some press reaction to last week’s announcement.

Quickly of the mark we have the Australian IT Section.

Patients may have to foot e-health bill

Karen Dearne | April 30, 2009

PATIENTS may have to pay for their own electronic health records, with the key healthcare reform body urging the federal Government to mandate "person-controlled" systems commercially available from providers like Microsoft and Google.

"We believe that the rapid development of new IT applications required across the health sector to give people the opportunity to have an electronic health record is best undertaken by commercial IT developers in an open competitive market," the National Health and Hospitals Reform Commission (NHHRC) said in a supplementary paper released today.

While tech-savvy patients are increasingly keen to manage their own medical records, public agencies worldwide have opted to maintain control over health information-sharing systems to ensure confidentiality, technical security and data quality.

But in an unexpected turnaround, the NHHRC said "every Australian should be able to choose where and how their personal e-health record will be stored, backed-up and retrieved", and that the record should be "at all times owned and controlled by that person".

Instead of providing a national health IT infrastructure, the Government's role should be "to regulate privacy and technical standards", and allow the market to come up with products that suit both consumers and healthcare providers

"By 2012, every Australian should be able to have a personal e-health record," said NHHRC chair Christine Bennett. "The Government must legislate to ensure the privacy of a person's e-health data, while enabling secure access to the data by the person's authorised health providers."

To thwart likely objections from doctors over sharing information contained in their patients' records, the NHHRC wants the payment of public and private benefits to health and aged care services "to be dependent upon the provision of data to patients, their authorised carers and other health providers, in a format that can be integrated into a personal e-health record".

Microsoft has previously told the NHHRC it was feasible to establish an affordable, consumer-controlled e-health record nationwide within one year. Its HealthVault web-based platform has been designed to allow people to collect, store and share their own medical information with doctors and family members.

The commission's interim blueprint, released late last year, has been criticised for its failure to put information technologies at the heart of planned health sector reform.

While today's paper said the nationwide adoption of individual e-health records would return between $7-$9 billion in economic benefits from increased productivity and reduced adverse events over 10 years, the federal and state governments have baulked at providing the necessary funding.

More here:

http://www.australianit.news.com.au/story/0,25197,25409711-15306,00.html

Second we have the professional press

GPs face MBS restrictions under proposed e-health agenda

Friday, 1 May 2009

GPs who do not sign up to the Government’s e-health agenda could find their access to the MBS restricted, under radical new proposals touted by the National Health and Hospitals Reform Commission.

The new proposals – released yesterday – recommend public and private benefits for health and aged care services be tied to the provision of personal electronic health records to all patients. GPs would have until January 2013 to comply.

However, AMA e-health committee chair Dr Peter Garcia-Webb criticised the proposal, claiming it could greatly disadvantage patients.

http://www.medicalobserver.com.au/News/0%2C1734%2C4453%2C01200905.aspx

And here:

Push for e-health records by 2012

1-May-2009

Doctors should lose funding if they fail to integrate referrals, discharge and patient information into a national system of e-health records, the Federal Governments main advisory group has said.

Yesterday the National Health and Hospital Reform Commission released a series of recommendations designed to kick start the development of national e-health records.

Its key message is that Federal Government should guarantee every Australian can “own and control” their own e-health record by 2012.

But as part of that process it also said the government should make funding to health providers dependent on their ability to send and receive information in a way that is compliant with the e-health record system.

That includes GPs, medical and non medical specialists, pharmacists and health and aged care providers being able to transmit key health data – including referrals, discharge information, prescriptions and synopses of diagnosis and treatments - in a format that can be “integrated into a personal electronic health record” by January 2013.

The commission said hospitals would also face loss of funding unless they were able to provide referral and discharge information under a national e-health system by 1 July 2012. And the same deadline has been suggested for pathology and diagnostic imaging providers.

More here (if access available):

http://www.australiandoctor.com.au/articles/ec/0c0607ec.asp

And finally the mainstream press health section

Push for electronic health records

Adam Cresswell, Health editor | May 01, 2009

Article from: The Australian

THE federal Government's main health reform advisory body has set a target date of 2012 by which it says every Australian should be able to have their own electronic health record.

In one of its most definitive statements, the National Health and Hospitals Reform Commission said yesterday that any electronic health record should be under the control of individual patients, instead of doctors.

It also called on the federal Government to take steps to enable health records to be introduced. These steps include introducing unique personal health identifiers - code numbers for each individual - by July next year. Medicare numbers are not suitable for this purpose because entire families can be included on one Medicare card.

More here:

http://www.theaustralian.news.com.au/story/0,25197,25411894-23289,00.html

Interestingly, in parallel we have this paper appear.

Acceptability of a Personally Controlled Health Record in a Community-Based Setting: Implications for Policy and Design

Elissa R Weitzman^1,2,4, ScD, MSc; Liljana Kaci¹, BA; Kenneth D Mandl^1,3,4, MD, MPH

¹Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Children’s Hospital Boston, Boston, MA, USA

²Division of Adolescent Medicine, Children’s Hospital Boston, Boston, MA, USA

³Division of Emergency Medicine, Children’s Hospital Boston, Boston, MA, USA

⁴Department of Pediatrics, Harvard Medical School, Boston, MA, USA

Corresponding Author:

Elissa R Weitzman, ScD, MSc

Children’s Hospital Informatics Program

One Autumn Street, Room 541

Boston, MA 02215

USA

Phone: +1 617 355 3538

Fax: +1 617 730 0267

Email: elissa.weitzman [at] childrens.harvard.edu

ABSTRACT

Background: Consumer-centered health information systems that address problems related to fragmented health records and disengaged and disempowered patients are needed, as are information systems that support public health monitoring and research. Personally controlled health records (PCHRs) represent one response to these needs. PCHRs are a special class of personal health records (PHRs) distinguished by the extent to which users control record access and contents. Recently launched PCHR platforms include Google Health, Microsoft’s HealthVault, and the Dossia platform, based on Indivo.

Objective: To understand the acceptability, early impacts, policy, and design requirements of PCHRs in a community-based setting.

Methods: Observational and narrative data relating to acceptability, adoption, and use of a personally controlled health record were collected and analyzed within a formative evaluation of a PCHR demonstration. Subjects were affiliates of a managed care organization run by an urban university in the northeastern United States. Data were collected using focus groups, semi-structured individual interviews, and content review of email communications. Subjects included: n = 20 administrators, clinicians, and institutional stakeholders who participated in pre-deployment group or individual interviews; n = 52 community members who participated in usability testing and/or pre-deployment piloting; and n = 250 subjects who participated in the full demonstration of which n = 81 initiated email communications to troubleshoot problems or provide feedback. All data were formatted as narrative text and coded thematically by two independent analysts using a shared rubric of a priori defined major codes. Sub-themes were identified by analysts using an iterative inductive process. Themes were reviewed within and across research activities (ie, focus group, usability testing, email content review) and triangulated to identify patterns.

Results: Low levels of familiarity with PCHRs were found as were high expectations for capabilities of nascent systems. Perceived value for PCHRs was highest around abilities to co-locate, view, update, and share health information with providers. Expectations were lowest for opportunities to participate in research. Early adopters perceived that PCHR benefits outweighed perceived risks, including those related to inadvertent or intentional information disclosure. Barriers and facilitators at institutional, interpersonal, and individual levels were identified. Endorsement of a dynamic platform model PCHR was evidenced by preferences for embedded searching, linking, and messaging capabilities in PCHRs; by high expectations for within-system tailored communications; and by expectation of linkages between self-report and clinical data.

Conclusions: Low levels of awareness/preparedness and high expectations for PCHRs exist as a potentially problematic pairing. Educational and technical assistance for lay users and providers are critical to meet challenges related to: access to PCHRs, especially among older cohorts; workflow demands and resistance to change among providers; inadequate health and technology literacy; clarification of boundaries and responsibility for ensuring accuracy and integrity of health information across distributed data systems; and understanding confidentiality and privacy risks. Continued demonstration and evaluation of PCHRs is essential to advancing their use.

(J Med Internet Res 2009;11(2):e14)
doi:10.2196/jmir.1187

KEYWORDS

Medical records; medical records systems, computerized; personally controlled health records (PCHR); personal health records; electronic health record; human factors; research design; user-centered design; public health informatics

Full paper is here:

http://www.jmir.org/2009/2/e14/

My initial response (associated with the announcement of the plan) is found here:

http://aushealthit.blogspot.com/2009/04/important-e-health-release-from.html

With the advantage of a few days of thinking and reading around this topic I can only say that, while I am entirely happy with what I said last week I now believe I was not sufficiently condemnatory of the vast number of weaknesses contained in this proposal.

My purpose here is not to say we should in any way slow or constrain the overall development of e-Health in Australia but that we should be doing it is a balanced, co-ordinated, consultative way.

It is simply absurd to propose a national deployment of Personal Health Records without addressing a range of other critical issues.

These critical issues in the e-Health domain include governance, funding, leadership, communication, professional and provider education and consumer involvement. I believe the necessary balance was properly and consultatively achieved in the National E-Health Strategy which was developed last year and which I am deeply concerned may not receive the attention and funding it is due because of the release of this new document.

The NHHRC needs to absorb two key pieces of information is seems to be ignoring.

First it needs to recognise there is no established benefits case for PHRs (they are essentially too new for the work to have been done) so investment in this area is speculative and not evidence based at preset. (see paper cited above)

Second it must be clear that when it has been talking of EHRs it has been – to date – talking of provider maintained and used EHRs – for which there is a much longer history of use and an overwhelming benefits case – including work done by organisations as diverse as the RAND Corporation and NEHTA.

No-one, just no one, has asked to public if they want their own personal health record to which their health professionals will be financially compelled to contribute. This is a nonsense of a just staggering magnitude.

The new NHHRC document is essentially a semantic and definitional con job as it takes evidence of value and success from ‘real’ electronic health records and just assumes the same can be said about PHRs. This is just not true!

Balance and leadership is critical here and what I am seeing are a range of vested interests subverting what should be a quite simple staged strategic implementation.

The drivers are the Commonwealth wanting to minimise expenditure on e-Health but needing to be seen to doing something, NEHTA recognising the real Shared EHRs are complex and slow to implement and fundamentally require quality provider systems in which they have essentially no expertise and various health software providers seeing PHRs as something they have already done and can easily bring to our market at a very good profit. The NHHRC also does not seem to have the depth of understanding in e-Health that can really help it optimise overall health sector outcomes through the use of e-Health. If it had this expertise e-Health would not have been left to being an afterthought.

It is also important to recognise that with Internet access being nowhere near universal there is significant policy discrimination against the poor, the older and the IT illiterate who will miss out on access to PHRs.

Overall the NHHRC has two reasonable ways forward.

The first is to make it clear that the present paper is adjunctive to the already developed National E-Health Strategy and formally recommend that this strategy be funded and implemented.

The second is to develop a new balanced National E-Health Strategy and insist it be funded and implemented.

Given the NHHRC does not have the time to do the latter the first is the only way forward. I see any other outcome as deeply flawed.

In passing the NHHRC has to recognise that he medical profession is presently being battered by all sorts of regulatory changes, PIP vagueness and uncertainty, probity reviews, challenges to professional autonomy and a threat to its vital role in the health system.

This shift seems to many of them to be part of a pattern. As a result many are finding the professional practice of medicine dramatically less attractive and fulfilling.

Love or hate them the medical profession is key to any success in e-Health and alienating them will sink any progress before it even starts. This sort of jackboot compulsion to supply information for patient systems at their cost will spark a backlash the like of which I can only imagine - once they realise what is going on.

Lots of issues also remain in this NHHRC proposal such as the data quality and reliability of PHRs. Care should never be based on untrustworthy information and this proposal encourages that deeply flawed approach.

David.

Useful and Interesting Health IT News from the Last Week – 03/05/2009.

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

First we have:

E-health data collection key to tracking Swine Flu spread

As health agencies rush to analyze data, some companies prep for a pandemic

Lucas Mearian 30 April, 2009 08:10

As the prospect of a flu pandemic grew more likely Wednesday -- the World Health Organization raised its threat alert to level 5 -- data is pouring into federal health care agencies using systems that a decade ago did not even exist.

As of Wednesday afternoon, the U.S. Centers for Disease Control & Prevention had reported 91 cases of Swine Flu in 10 states. One death in Texas -- a 23-month-old child from Mexico -- has been attributed to the flu, and health officials expect more deaths to follow.

The swiftness with which the Swine Flu has spread -- and the speed with which new electronic health surveillance systems have tracked its emergence -- is prompting companies to quickly dust off business continuity plans and warn workers to guard their health.

"Businesses need to take this serious and put plans in place for personnel," said Michael Croy, director of business continuity solutions at Forsythe Solutions Group Inc., an IT consulting firm in Skokie, Ill. "They need to make sure employees can work from home. They need to tell them about how to take care of their health and be overly cautious by telling workers to stay home if they feel sick. But they also need to do it in way so as not to create panic."

The best antidote for panic is information, and disease surveillance systems rolled out in recent years are allowing health agencies to track, report and confirm Swine Flu cases faster than ever. But gaps in the system remain, health care experts said.

Much more here:

http://www.computerworld.com.au/article/301391/e-health_data_collection_key_tracking_swine_flu_spread?eid=-255

Certainly the big news of the week – with lots of Health IT trying to help!

See also here:

http://www.australianit.news.com.au/story/0,24897,25407965-15306,00.html

Google tracks swine flu in Mexico

Glenn Chapman in San Francisco | April 30, 2009

GOOGLE.ORG has begun using flu-related internet search traffic in Mexico to create an online map that might provide clues to how influenza is spreading in that country.

Second we have:

Confusion over PIP leaves docs in dark

Shannon McKenzie - Friday, 1 May 2009

A LACK of detail on the new requirements for the e-health Practice Incentive Payment (PIP) has left many GPs in the dark as to whether they qualify for annual payments of up to $50,000, experts claim.

According to the Federal Health Department, for PIP eligibility practices must ensure GPs can access three different types of “key electronic clinical resources” from their computers. Practices were given one example of each resource, leading to widespread concern that these examples were the only acceptable resources.

No further examples are expected to be forthcoming, and no assessment of which resources meet the requirements has been carried out.

However, the department told MO that the onus was on individual practices to determine whether or not their resources met the eligibility requirements.

More here (subscription required):

http://www.medicalobserver.com.au/News/0,1734,4413,01200905.aspx

Looks like this policy fiasco is just going from worse to worser!

Third we have:

Privacy Commissioner rejects Betfair's bid for Medicare records

Friday, 1 May 2009

REQUESTS from gambling agency Betfair for access to patients' Medicare records for the purposes of verifying the identity of its customers have been rejected by the federal Privacy Commissioner.

In a submission to a Productivity Commission inquiry into gambling, Betfair requested access to the records, arguing it would increase the accuracy of identification processes and reduce cases of identity theft.

More here (subscription required):

http://www.medicalobserver.com.au/News/0%2C1734%2C4452%2C01200905.aspx

I guess that bit of silliness has gone away now!

Further comment here:

http://www.medicalobserver.com.au/News/0%2C1734%2C4417%2C27200904.aspx

Gambling agency bids for access to Medicare records

Monday, 27 April 2009

REQUESTS from gambling agency Betfair to gain access to Medicare records to verify customer identities have been slammed by the AMA.

Fourth we have:

IBA in rude health after near-death experience

Teresan Ooi | April 18, 2009

Article from: The Australian

FOR four years after the tech wreck, which slashed the share price of medical software company IBA Health, chairman Gary Cohen was a finance sector pariah.

"My reputation was at stake," Cohen says. "I felt responsible for 5000 shareholders who had put their trust in me."

IBA Health had raised $68 million in one of the biggest tech floats in March 2000. But by June the share price had tanked from $2 to 70c, then over the next 12 months fell to 9c. Market capitalisation skidded from $300 million to $30 million.

"I had angry shareholders who had dropped a bundle and wanted their money back," says Cohen.

For four long years, he felt in the wilderness -- shunned by the financial community.

"Those were very difficult days," Cohen says. "There was enormous pressure on the board to make changes or sell the company. My reputation was severely dented. It took us years to rebuild our credibility."

As it turned out, the core board members at the outset are still on IBA's board today and, according to Cohen, have come out stronger, bigger and wiser.

Much more here:

http://www.theaustralian.news.com.au/business/story/0,28124,25348805-36418,00.html

This is an interesting perspective on IBA’s almost failure and process of getting towards success. Analysts are still a little divided on how close they really are. (Usual disclaimer about having a few shares in what will soon be iSoft – I hope the optimism is well founded!)

Fifth we have:

Spammers seize on swine flu to pitch bogus meds

'Just another day at the office' for spammers, says one researcher

Gregg Keizer 28 April, 2009 07:51

Tags: symantec, swine flu, sophos, mexico, mcafee, malware

Spammers have seized on the growing interest in news of a possible swine flu epidemic to hawk fake pharmaceuticals, security experts warned Monday.

The number of spam messages with subject headings such as "First US swine flu victims!" and "Madonna caught swine flu!" has spiked today, said Dave Marcus, director of security researcher at McAfee Inc. And no one should be surprised.

"This is the same pattern that we've seen for the last year, year-and-a-half," said Marcus, noting that domain registrations that include "swine" in their URLs are up 30-fold, and search strings that contain the words "swine" and "flu" are also on a major uptick.

"I checked earlier today, and 'swine flu' spam was a little over 2% of all spam," said Marcus. "Compare that to yesterday, when you wouldn't have seen any."

More here:

http://www.computerworld.com.au/article/300924/spammers_seize_swine_flu_pitch_bogus_meds?eid=-255

Some things never change – like opportunism and greed! Sad.

Sixth we have:

Veterans data riddled with errors, says

Andew Colley | April 28, 2009

THE national auditor has questioned the integrity of Department of Veteran's Affairs income support payments as a result of its record management system modification stalling.

The Australian National Audit Office in a report last week recommended major improvements to the department's IT governance practices after identifying thousands of incomplete or inaccurate client records on its systems.

The report finds also that the agency's IT modernisation program, which involved moving its records from legacy mainframes to newer systems and software, had stalled, with no changeover date in sight.

The department distributed about $45 million in pension income-support payments to veterans and their surviving dependents last financial year.

It has about 1.5 million clients on its books, of which only about 317,000 are active.

A spokesman for Veteran's Affairs Minister Alan Griffin said the office had found no evidence that veterans or their dependants had been paid incorrectly or denied payments. The department was, however, unable to provide a spokesperson prepared to make more detailed official comments about the ANAO report.

The report questions the department's ability to make reliable decisions.

It also discovered what it describes as "data anomalies".

An example is 438 clients older than 130 on the department's books, with no recorded date of death.

Among other problems with client records, the ANAO found 24,820 clients had been assigned multiple identification numbers.

More here:

http://www.australianit.news.com.au/story/0,24897,25395062-15306,00.html

The issues raised here are quite large. One to contemplate is just how good the NEHTA IHI can be when based on data (held by Medicare) which can hardly be expected to be of more reliability that what is illustrated here. There is a lesson here and it could be along the lines of ‘you only get reliable information when those responsible for it have a substantial stake in its accuracy’.

Seventh we have:

Centrelink goes open on in-house smartcard protocol

Mitchell Bingemann | April 27, 2009

CENTRELINK has released a smartcard authentication protocol developed in-house in the hope of attracting a manufacturer to use the standard in a commercial off-the-shelf product.

The standard was developed for use as Centrelink's authentication protocol when the agency migrates its 27,000 employees to a contactless identification smartcard system later this year.

The smartcard system will eventually replace the random number generator security tags used by Centrelink staff to access the agency's secure databases and network.

The system will also control access to the agency's premises.

The welfare agency's IT security team has spent more than three years and $560,000 developing the smartcard authentication protocol, dubbed Protocol for Lightweight Authentication of ID (Plaid), which it claims is stronger, faster and more private for contactless applications than similar protocols now in use.

Plaid uses two cryptographic algorithms in rapid succession in its scrambling process, making it extremely difficult to read with hacking devices, Centrelink said.

Plaid was highly resistant to ID leakage, private data leakage, replay attacks and man-in-the-middle attacks, the agency said.

The protocol already has the seal of approval from Human Services Minister Joe Ludwig.

More here:

http://www.australianit.news.com.au/story/0,24897,25394321-15306,00.html

Seems like this is useful authentication technology that may have some e-Health Applications.

Eighth we have:

CSIRO developing 100Mbit wireless broadband

Could provide key to last mile NBN

Tim Lohman (CIO) 27 April, 2009 11:59

Wireless technology currently in development by the CSIRO may be the key to bringing a cost effective National Broadband Network to regional and rural Australia, according to the national science organisation.

The technology, dubbed Broadband to the Bush, is designed to make use of analogue television infrastructure already in place within Australia, Alex Zelinksy, group executive information and communication sciences and technology at the CSIRO said.

“What we are proposing to do is use the broadcast towers and UHF and VHF frequencies that will be left when analogue television is switched off,” he said. “The whole idea is that there is no comms gear in that space as it has been used for TV and we can reuse the broadcast infrastructure.”

In this way, wireless broadband would be available anywhere a current analogue television signal could be received, Zelinksy said.

The CSIRO’s technology uses orthogonal frequency division multiplexing (OFDM) – a modulation scheme used in wireless LAN standards such as 802.11g – and, multiple input multiple output (MIMO), which uses multiple antennas to transmit and receive multiple data streams.

Combined, the CSIRO’s OFDM-MIMO technology could offer significant efficiencies over existing wireless and prove to be a valuable addition for reaching the last 10 per cent of the population as part of the National Broadband Network, Zelinksy said.

“With normal wireless technologies you would need 36 base stations to cover what we can do with one, so you reduce your capital costs,” he said. “We believe [the broadcast range] could cover 100 square kilometers and at rates of between 12 and 50 megabits per second, but it could scale up to the full 100Mbps (equal to the proposed speed of the fibre NBN).”

More here:

http://www.computerworld.com.au/article/300793/csiro_developing_100mbit_wireless_broadband?eid=-6787

This is interesting and may help with the problem raised in the next set of articles.

Ninth we have:

Cyber highway slows up in regional areas

• Debra Jopson Regional Reporter
• April 26, 2009

HUNDREDS of towns across NSW, including those home to sea-change professionals who rely on internet services, will receive only the snail-paced version of the Federal Government's broadband roll-out, the Opposition says.

As part of its $43 billion scheme the Government has announced services of 100 megabits per second for cities and towns with more than 1000 people.

But 284 NSW towns, which are home to 140,523 people, have populations lower than that, the parliamentary library has determined using raw data from the last census.

Towns such as Tooleybuc in the Riverina, with 199 people, or Macmasters Beach on the Central Coast, with 994, will get satellite and wireless services with almost one-tenth of the speed, the Opposition spokesman for broadband communications, Nick Minchin, said.

He called on the Government to provide coverage maps so people could see who would get what.

"The Government has declared that towns with around 1000 people or more will get fibre-to-the-premise connections and the rest won't, so smaller communities quite rightly want to know whether they will be included," he said.

More here:

http://www.smh.com.au/national/cyber-highway-slows-up-in-regional-areas-20090425-aiqq.html

This is going to be interesting. There are a lot of towns with less than 1000 souls who will be pretty unimpressed about missing out, assuming it actually happens. I note in Tasmania the Premier has said the State Government will step in to ease the pain. A bit of a political nightmare I suspect.

More coverage of the politics here:

http://www.theaustralian.news.com.au/story/0,25197,25389258-7583,00.html

Broadband's losers could vote Labor out

Glenn Milne | April 27, 2009

Article from: The Australian

THE political debate surrounding Kevin Rudd's nationalised broadband plan so far has centred largely on its financial viability in times of stressed budgets and mounting public debt.

A former communications minister also has a view:

http://www.theaustralian.news.com.au/story/0,25197,25389254-7583,00.html

It's folly to replace one telco behemoth with another

Richard Alston | April 27, 2009

Article from: The Australian

WITH the Government's game-changing promise to introduce a new gorilla into the marketplace, telecommunications in Australia will never be the same again. And nor should it.

Tenth we have:

No need to shy away from web therapy

Online programs developed to treat social phobia can be as effective as face-to-face contact with a therapist, reports Lynnette Hoffman | May 02, 2009

Article from: The Australian

ONE moment Stewart Coad was proposing to a woman at the Eiffel Tower during a holiday in Paris.

The next he was homeless and living out of his car. Coad, 58, blames his riches-to-rags story -- the loss of his once-successful telecommunications business and two failed marriages -- on something he has been battling most of his life: social phobia.

Social phobia is an anxiety disorder characterised by an intense fear of being judged, criticised or embarrassed in social or performance situations.

The diagnosis is contentious; some critics say that many -- if not most -- cases that are diagnosed simply represent people who are shy, and that although it's fine to seek to change those aspects of their personality, it doesn't mean they're sick.

In their 2005 book, Selling Sickness, Ray Moynihan and Alan Cassels argue that social anxiety disorder or social phobia is just a fancy name for shyness invented by drug companies to increase the sales of antidepressants. That view is shared by University of Adelaide associate professor of psychiatry Jon Jureidini.

"If people are dealing with aspects of life they don't like, such as they're shy and they want to overcome it or make sense of their suffering, that's fine; but whether that's actually a discrete problem is another issue," Jureidini says.

"What they're doing is labelling a normal variation of personality as sick."

Lots more here:

http://www.theaustralian.news.com.au/story/0,25197,25410284-23289,00.html

It is good to see commentary supporting approaches to using e-Health that has a strong evidence base. Worth a read.

Lastly the slightly technical article for the week:

Developers to get Windows 7 RC this week

The general public will be able to download the software on May 5

Nancy Gohring (IDG News Service) 27/04/2009 05:20:00

Some Microsoft developers will be able to download a near-final version of the company's Windows 7 operating system this week, Microsoft said Friday.

Starting on April 30, MSDN and TechNet subscribers will be able to download the Windows 7 Release Candidate, Microsoft said in a Windows Team blog post.

Release candidates are typically feature-complete and stable, and suggest that the final version of a product will be available very soon.

The company recently posted information accidentally on its Partner Program Web site saying that the Release Candidate was already available to developers and would be released to the general public on May 5.

More here:

http://www.techworld.com.au/article/300735/developers_get_windows_7_rc_week

It seems clear Microsoft is very keen to get this operating system available. It is amazing that the freely downloadable release candidate will run for over 12 months before expiry. That should be enough time to check out if you are happy with it!

More next week.

David.