Useful and Interesting Health IT News from the Last Week – 17/05/2009.

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

First we have:

Deficient network at the heart of swine flu response

Karen Dearne | May 12, 2009

THE NetEpi data system and communication networks at the heart of the nation's swine flu response were found deficient during a live trial in NSW last year.

Hunter New England Health tested emergency departments and medical teams across 36 sites in a week-long pandemic training exercise.

While users found NetEpi had been improved since an exercise in 2006, organisers say a new system is needed, "including, but not limited to, a case and contact data collection system".

"We need a system that manages rumour surveillance, influenza-like illness data, population data, geographic mapping, anti-viral usage, adverse events data and staffing capacity to ensure an effective and efficient response," an interim report says.

"Staff found NetEpi difficult to use, data entry was problematic, and analysis and reporting functionalities could not be utilised."

NetEpi is open source web-based software designed to help public health authorities investigate and manage outbreaks of communicable disease as well as other chronic illnesses.

More here:

http://www.australianit.news.com.au/story/0,27574,25464237-15306,00.html

Yet again we find the potential of e-Health not being exploited by the Government. I wonder how long it will be before they ‘get it’.

Second we have:

Who will pay the price for electronic health records?

Rachel Lebihan, ZDNet Australia News

01 November 2000 03:47 PM

Tags: electronic health records, transaction fees, government, funding, australia

The National Electronic Health Record Taskforce estimates that funding in excess of AU$400 million would be required to put an electronic health record (EHR) system in place and to run it over a 10 year period.

Whilst industry sentiment is rife that the government needs to fork out initial funding for the project, it still isn't clear how the network will be financed in the long run.

"Long-term funding is still an open issue at the moment," director of information policy at the Department of Health and Aged Care (DHAC), Paul Fitzgerald, told ZDNet.

However, Philip Hagan, also from DHAC, said a nationwide EHR system "would have to be self-sustained in the long run".

This means that consumers and health providers would incur transaction fees for use of the network.

More here:

http://www.zdnet.com.au/news/soa/Who-will-pay-the-price-for-electronic-health-records-/0,139023165,120106640,00.htm

I could not resist this – found it a day or so ago. NOTE the date in the header! How long have we been at this!

Third we have:

Security logs, medical records and missile data discovered in disused hard drives

Study involving university researchers in the UK, US and Australia, discovers an assortment of private data on ebay

Kathryn Edwards 13 May, 2009 12:15

A third, or 34 per cent, of disused hard drives still contain confidential data according to a new study, which found missile defence system data and media records on ebay purchases.

The study, sponsored by BT and Sims Lifecycle Services, researched by Wales’ University of Glamorgan, America’s Longwood University and Australia’s Edith Cowan University, also dug up secret data from the German Embassy in Paris and business dealings from a US bank.

Around 300 hard drives from the UK, America, Australia and other countries, bought through computer auctions and on eBay were studied.

“It is clear from the sensitive information revealed by this study that a wide range of organisations, businesses and individuals all over the world are fundamentally failing in their duty to properly manage sensitive data when their IT equipment passes outside of their control,” Sims Recycling Solutions Kumar Radhakrishnan said.

More here:

http://www.computerworld.com.au/article/303011/security_logs_medical_records_missile_data_discovered_disused_hard_drives?eid=-6787

There is an important message for all those that hold confidential data on their Hard Disks. That must be many of us!

Fourth we have:

Australia: E-Health & Privacy Update

11 May 2009

Article by Alison Choy Flannigan

E-health and privacy update – including the Law Reform Commission Report and Freedom of Information Reform.

The journey towards individual electronic health records has progressed with the federal HealthConnect initiatives and the publication by the National E-Health Transition Authority Limited (NEHTA) of its 'Privacy Blueprint for the Individual Electronic Health Record' for public comment in July 2008.

The National Health and Hospitals Reform Commission Interim Report published in February 2009 has stated that 'an electronic health record that can be accessed - with the persons agreement, by all health professionals and across all settings is arguably the single most important enabler of truly person-centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia.'

Healthcare providers should keep abreast of the developments in e-health to ensure that they are well placed to adopt the technology upon its introduction.

Proposed changes in privacy laws will also affect healthcare providers who may need to review and update their privacy policies and procedures when they commence.

Full article here (free registration required):

http://www.mondaq.com/article.asp?articleid=79396&login=true

This is a useful summary of the current state of play in the area from DLA Phillips Fox – a major national law firm.

Fifth we have:

GPs face Medical Director fee hike after ad removal

Elizabeth McIntosh - Friday, 8 May 2009

GPs relying on Medical Director for their prescribing software will face annual subscription fee hikes of at least 50%, as the company moves to recoup the costs of pulling pharmaceutical company advertising from its product.

And, in a move likely to disappoint part-time GPs, Health Communication Network (HCN) – which produces the software – has also announced it will no longer offer a discounted rate to part-timers, opting instead for a flat rate.

HCN CEO John Frost attributed the price increase to intense lobbying for an advertising withdrawal by the RACGP, AMA and the National Prescribing Service.

More here:

http://www.medicalobserver.com.au/News/0,1734,4507,08200905.aspx

While it is hard to know it seems HCN might just be padding its margins a little given its competitors have been able to be competitive even with HCN having the extra income. Alternatively I guess it is possible there was very little revenue involved which would have one wonder why it took so long for this to happen. We probably will never know.

Sixth we have:

Online therapy the latest tool to beat the blues

• Tim Lott
• May 17, 2009

Most people with depression need some kind of therapy, but could a computer program replace a counsellor? Tim Lott logged in to find out.

ALTHOUGH I am not depressed — I am merely someone who has experienced a depressing amount of depression — I have just completed eight weekly sessions of a cognitive behavioural therapy course

Big deal, you might well remark. But this course is unusual because I didn't have to leave my desk or even talk to another human being. The therapy is administered entirely by a computer program. Beating the Blues is an attempt by Britain's national health service to meet the growing demand for mental health treatment without spending a fortune on face-to-face therapy.

My instincts were against it; I was insulted by the idea that my difficulties could be solved online. So I logged on to my first session with some trepidation. I was introduced by a honey-voiced computer to five other "co-sufferers" — Andrew, Elaine, Jean, Bob and Heather — who were going to share my journey.

They were played by quite convincing actors, although their characters all seemed a bit feeble. I unkindly branded them as — to use a non-clinical term — "losers". They couldn't get a grip on their lives, they blamed themselves for everything, they couldn't take on goals, and they thought they were failures.

More here:

http://www.theage.com.au/opinion/online-therapy-the-latest-tool-to-beat-the-blues-20090516-b6r7.html

This is a useful article to explain the online counselling process. A pity the article did not explore the evidence base that shows this approach really works!

Seventh we have:

Threading to boost Firefox on multi-core chips

Turns up in the nick of time

John E. Dunn (Techworld) 11 May, 2009 08:31

Mozilla's developers have announced plans to add application multi-threading to Firefox over the next two years, a feature already partially enabled in its main rivals, IE8 and Google Chrome.

As well as allowing the software to take advantage of multi-core microprocessors to boost responsiveness, the enhancement would also improve browser stability, the company said in a news blog on the subject.

More here:

http://www.computerworld.com.au/article/302625/threading_boost_firefox_multi-core_chips?eid=-255

This is very good news for all the Firefox Users out there!

Eighth we have:

Conroy rejects NBN cost analysis

Coalition comms minister furious

Darren Pauli 12 May, 2009 17:04

Communications Minister Stephen Conroy has rejected the need for a cost benefit analysis for the National Broadband Network (NBN).

He said during question time the country is "crying out" for the NBN infrastructure and that additional studies are unnecessary.

“We don’t need any more studies, any more cost benefit analysis,” Conroy said.

More here:

http://www.computerworld.com.au/article/302872/conroy_rejects_nbn_cost_analysis?eid=-255

While I am pretty sure that the NBN will have benefits I would really like to understand the costs. Seems that for a project of the scale of $43Billion it would be a worthwhile thing to be doing. I note Lindsay Tanner said a day or so ago that $43B is the upper end cost.

See here:

http://www.businessspectator.com.au/bs.nsf/Article/KGB-INTERROGATION-Lindsay-Tanner-pd20090514-S29ZU?OpenDocument&src=sph

SB is Business Spectator Commentator Stephen Bartholomeusz

LT is Finance Minister Lindsay Tanner.

“SB: Lindsay, you referred to the national broadband network a moment ago. That’s the one big chunk of the $22 billion of infrastructure spending in the budget which didn’t go through the Infrastructure Australia process and which doesn’t appear to have had a business case developed for it. Are you comfortable about the economics of a $43 billion network? I mean you’re the Finance Minister. You’re comfortable with the detail?

LT: Yes. Well, it is my job to be comfortable I suppose about these things. Look, the first point, Steve, is that $43 billion is the outer limit of the estimate and it’s got a pretty sizeable chunk of contingency built into it, because obviously projecting forward eight years into a project of that scale; it’s very difficult to come up with specific estimates about what labour costs might be in eight years time or whatever and there’s a vast array of detail underneath the whole proposition and of course that’s the reason why we’ve put in place an implementation study, so that a lot of those things can be fleshed out.

The big variable of course is Telstra’s approach and whether it decides to seek to negotiate an accommodation with the government, so that it’s in the tent or whether it decides to go it alone and oppose what the government’s doing and fight it in the market place. So, there are lots of variables, but we just formed the view that in effect we had to make the clear decision that said this is the outcome we are going to achieve come hell or high water, because it is of fundamental importance to the future of the Australian economy, it is qualitatively different from a new freeway or a rail upgrade or something which are fairly straightforward to compare with other potential applications of capital of a similar nature to a different rail project or a different road project.

It is a standalone thing that will transform the Australian economy, so yes there are risks and there are uncertainties. The question of the nature of private sector involvement of course is not absolutely certain and the implementation study will bring to light detailed issues that we will have to give consideration to, but to me it broadly is equivalent to something like electrification and it’s broadly equivalent to saying well, are we going to have a society where access to electricity for businesses and households is near universal or not? It’s of that magnitude.

SB: Does that mean that the actual economics of the network, particularly in that formative period, are less important than just building it?

LT: Oh look, they are crucial – ultimately you’ve got to have people paying for things, you’ve got to have a cash flow that’s got to be commercial, but so it’s not less important. It’s just that we felt that there’s been so much delay, so much obfuscation, so much money wasted on rubbish programs trying to make people think the government was doing something about it – I’m referring to the previous government of course – and there is so much structural regulatory inefficiency in the industry that we believe that you will see a dramatic transformation. I just think that for any telco, Telstra or anybody else and anybody who’s at all connected with the digital world, the opportunities that this is going to create will be enormous.

I saw a health expert claim the other day that the network once up and running would reduce the need for hospital beds in Australia by 25 per cent. Now, I’ve got no way of assessing the accuracy of that, but what I immediately thought of was well, if that’s true, that means that 25 per cent of hospital activities or activities associated with hospitalisation are now going to be delivered in some form, in some application by people online. That’s a whole lot of activity that currently doesn’t exist, that currently doesn’t happen, that currently doesn’t have businesses and people doing things that will be now occurring online and if you’re Telstra or if you’re Optus or any of these other telcos, that represents huge opportunities for you to innovate to create new applications, new business models, all kinds of things. In the same way that the emergence of the mobile phone, you know, and the Internet have created those opportunities and we’ve seen those flourish, so I believe this is just a unique situation that it’s only comparative that I can think of is the roll-out of electricity starting in effect in the 1920s.”

I would be curious to know what the cheapest estimated cost was! The whole article is well worth a read on a range of budget topics. It is interesting the scale of impact on the health system the Government seems to be hoping for! Has someone told the Health Minister I wonder?

More commentary is found here:

http://www.computerworld.com.au/article/302790/nbn_challenges_lay_ahead_report?eid=-255

NBN challenges lay ahead: report

Challenges include difficulty of achieving a return on investment, pricing

Kathryn Edwards 12 May, 2009 05:11

Lastly the slightly more technically orientated article for the week:

Secure your USB drives with BitLocker To Go for Windows 7

• Date: May 13th, 2009
• Author: Greg Shultz
• Category: Performance, Security, Windows 7
• Tags: Password, Microsoft Windows 7, Microsoft Windows, USB Flash Drive, BitLocker, Greg Shultz
• Special Reports » See more posts on: Windows 7, Vista Report

When Microsoft introduced Windows Vista, one of the big security features in that operating system was BitLocker, a hard drive encryption scheme designed to protect sensitive data from being accessed on lost or stolen computers — mainly laptops.

With the huge increase in the use of very small, large capacity, USB drives, the potential for sensitive data to be lost or stolen has really become more of a problem because it is much easier to lose or steal a device no bigger than a package of Wrigley chewing gum. To protect sensitive data stored on USB drives, Microsoft Windows 7 features the encryptions scheme called BitLocker To Go.

In this edition of the Windows Vista and Windows 7 Report, I’ll introduce you to BitLocker To Go and show you how it works on a 1GB USB thumb drive.

This blog post is also available in the PDF format as a free TechRepublic Download and as a TechRepublic Photo Gallery.

How it works

Basically, BitLocker To Go allows you to encrypt a USB drive and restrict access with a password. Without the password, the USB drive is worthless. When you connect the USB drive to a Windows 7 computer, you are prompted for the password and upon entering it, can read and write to the drive as you normally would.

During the encryption process, Windows 7 installs a special reader onto the USB drive. When you connect the USB drive to a computer running XP or Vista, the BitLocker To Go reader takes control, prompts for the password, and then basically makes the USB drive a read-only device.

BitLocker To Go can be used by both home and business users. In a Domain system, IT administrators can configure a policy that requires users to apply BitLocker protection to removable drives before being able to write to them. Furthermore, the policy can specify password length as well as complexity.

Much more here:

http://blogs.techrepublic.com.com/window-on-windows/?p=1176

This looks like a useful addition to Window 7 to ensure data on USB keys can be properly protected when necessary. The article explains how to use it and it looks very user friendly and straightforward.

Here we see how important this feature is:

Govt agencies losing portable data: Privacy Commissioner

New research red flags portable storage, guide released

Rodney Gedda 08/05/2009 08:51:00

Tags: privacy commissioner, privacy, federal government, data loss

Many Australian government agencies do not have appropriate controls covering the use of portable storage devices (PSDs) for the handling of personal information.According to new research by the Office of the Privacy Commissioner, this personal information is being lost at an alarming rate.

While agencies have policies regarding the transfer of personal information, more care needs to me taken to protect data on USB keys, PDAs and optical disks. More than (58 per cent) of agencies have experienced the loss or theft of an agency-issued PSD within the past 12 months.

Australian Privacy Commissioner Karen Curtis said three-quarters of government agencies have policies covering the transfer of records containing personal information, however, there is “definitely room for agencies to improve their safeguards governing the use by staff of portable storage devices”.

More here:

http://www.techworld.com.au/article/302500/govt_agencies_losing_portable_data_privacy_commissioner

More next week.

David.

Report Watch – Week of 11 May, 2009

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

First we have:

Study on the requirements and options for RFID application in healthcare

Identifying areas for Radio Frequency Identification deployment in health care delivery: A review of relevant literature

By: Anna-Marie Vilamovska, Evi Hatziandreu, Helen Rebecca Schindler, Constantijn van Oranje-Nassau, Han de Vries, Joachim Krapels

This document is the first deliverable of the RFID & Health project. It provides an overview of the state of the art in RFID (Radio Frequency Identification) applications in healthcare delivery.

Some 325 sources have been reviewed in order to draft three ‘long-lists’ of applications, enablers and barriers of RFID deployment. In the next phase of the project, these will be validated and prioritised through expert interviews and a Delphi survey. Case studies will be used to further assess the costs and benefits of the most promising applications.

The list of sources which have been reviewed for this report is believed to cover all important scientific publications, policy documents and relevant articles from the professional press, in Europe, North America and Asia, related to the topic of RFID applications in healthcare. In addition, more general literature on RFID — technology, market, enablers and barriers — has also been covered.

More here (including direct report download links)

http://www.rand.org/pubs/technical_reports/TR608/

Second we have:

Technologies C-Level Should See

May 5, 2009

Health care best practices research firm ECRI Institute has listed 10 technologies it says hospital C-suite executives should be watching.

A new report from the Plymouth Meeting, Pa.-based firm explains each technology and why it bears a close look. The technologies are:

* electronic medical records,

* ultrahigh-field strength MRI and premium-slice CT,

More here:

http://www.healthdatamanagement.com/news/executives-28159-1.html?ET=healthdatamanagement:e861:100325a:&st=email&channel=business_intelligence

For the report, "Top 10 Hospital Technology Issues: C-Suite Watch List for 2009 and Beyond," click here. The report is free but registration is required.

Additional information is also here:

http://www.healthcareitnews.com/news/research-firm-lists-top-technologies-impacting-hospital-c-suite-executives

Research firm lists top technologies impacting hospital c-suite executives

May 05, 2009 | Molly Merrill, Associate Editor

It is good to see EHRs at the top of the list.

Third we have:

Project HealthDesign Overview

Project HealthDesign is a $10-million national program of the Robert Wood Johnson Foundation (RWJF) created to stimulate innovation in personal health information technology. During the first round of funding, which received additional support from the California HealthCare Foundation, nine multidisciplinary teams created a range of tools that addressed specific but complex self-management tasks – from a cell-phone-enabled medication management system to alert children with cystic fibrosis when to take certain medicines, to a personal digital assistant that collects and supports self-reported pain and activity data. For information about the first-round grantee projects, see http://www.projecthealthdesign.org/projects.

In the second round of Project HealthDesign, RWJF will award a total of up to $2.4 million in grants to as many as five grantee teams. Teams will work to demonstrate how to improve the health and wellbeing of people with chronic disease by helping them capture, understand, interpret and act on information about the patterns of their everyday lives. During the two-year initiative, teams will work with clinical partners and patients with two or more chronic conditions to:

§ Identify, capture and store several types of ODLs for their target patient population;

§ Analyze and interpret ODL data to extract clinically useful information;

§ Use this information to provide feedback to patients so that they can better manage their conditions and improve their health;

§ Enable patients to share this information with their doctors, nurses and other members of their clinical care team;

§ Present the information to clinicians in ways they can easily integrate into their clinical work flow; and

§ Identify and explain opportunities and challenges associated with this overall approach to policymakers and clinical leaders

The program is supported by the Foundation’s Pioneer Portfolio, which funds innovative projects that can lead to fundamental breakthroughs in the health and health care of all Americans.

More here:

http://www.projecthealthdesign.org/about/overview

Not so much a report but an initiative to help understand where and how PHRs can really make a difference. Very important work before one just rushes in to implement in my view.

Fourth we have:

Health Spending Is Taking Up Bigger Chunk of National Purse

Cheryl Clark, for HealthLeaders Media, May 4, 2009

Though the rise in healthcare spending has slowed, it's taking up a much bigger space in the nation's budget, says a new report from the California Healthcare Foundation.

The report showed that national healthcare spending reached $2.2 trillion, or $7,421 per person, in 2007 representing more than 16% of the gross domestic product. Continuing at the same pace, it will reach 20.3% of the country's gross domestic product by 2018.

"Although there has been some moderation in health spending growth in recent years, its share of the economy continues to grow," the report says.

"This report shows the very trend that's behind a lot of the financial woes of the healthcare industry," said CHF senior program officer Marian Mulkey. "The fact that we are spending more and more on healthcare services translates into higher premiums, and makes it harder for businesses and employees to afford coverage. This documents the problem that is at the heart of the debate about health reform."

Mulkey said that the report, the sixth one in a series of annual reports, called Health Care Costs 101, is based on data from the Centers for Medicare and Medicaid Services.

More here:

http://healthplans.hcpro.com/content.cfm?content_id=232423&topic=WS_HLM2_HEP

The figures are really just staggering.

The report and a few back for 5 years are found here:

http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133630

Fifth we have:

Thursday, May 07, 2009

Health Information Management Profession Needs To Double in Size

by Linda Kloss

It is apparent to a growing number of concerned health care professionals that the transition from paper to electronic health records is central to health care reform, just as resolving the health information work force gap is vital to broad EHR implementation and optimization. Unfortunately, too often the understanding ends there.

The problem is this lack of understanding could very likely create confusion -- or worse, disinterest or unawareness -- among the very people health care needs to recruit in order to close the health information management (HIM) work force gap in time to accelerate the national implementation of an EHR system. If we are to reach the goal of an EHR for every American by 2014, we will most likely need to double the estimated 75,000 educated and credentialed HIM specialists engaged in managing health information and health records management today.

Ours is a field in a period of dynamic change as health care shifts from paper to EHRs. HIM professionals work across all types of care settings, including:

• Hospital and integrated delivery systems (about 60%);
• Medical groups and other ambulatory facilities (12%); and
• Long-term care and specialty care (5%).

The remainder work for IT vendors and consulting services, pharmacological manufacturers, insurers, colleges and universities, and public health and other governmental agencies.

More here with links to background information:

http://www.ihealthbeat.org/Perspectives/2009/Health-Information-Management-Profession-Needs-To-Double-in-Size.aspx

Last we have:

Proper incentives key to P4P success: study

By Rebecca Vesely

Posted: May 7, 2009 - 12:00 pm EDT

Pay-for-performance can be effective if physicians get the right incentives, according to a study by Bridges to Excellence published in the American Journal of Managed Care.

The report used statistical data from Bridges to Excellence pay-for-performance programs with more than 13,500 participating physicians in four cities: Albany, N.Y.; Boston; Cincinnati; and Louisville, Ky. The two programs focused on improving patient care while reducing medical errors in medical practices, and improving care for diabetes patients.

Physician participation rose as the potential rewards increased, but there was no “cutoff” pinpointing the exact reward driving participation. Sufficient rewards for one type of program may not be sufficient for another type of program. The more health plans offering pay-for-performance, the better the physician participation, the study concluded.

Vastly more here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090507/REG/305079966

Link to article is in text.

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

David.

International News Extras For the Week (11/05/2009).

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

First we have:

A Road Map to Electronic Medical Record System Implementation
Jeff Spitzer - May 1, 2009

Originally published - May 28, 2008

Today, health care organizations are looking to adopt time-saving technology. Electronic medical record (EMR) software uses online technology to deliver automated processes that can save health care organizations a lot of time and resources.

Not only does an EMR solution reduce the amount of paper used by a health care facility (because it no longer needs to make as many copies of documents), it helps the facility to save on resources too, including transcription and storage costs. In addition, nurses and doctors spend less time searching for patient data, because it is stored on servers in digital format, taking up a minuscule amount of space. This enables health care organizations to convert valuable space, previously occupied by file cabinets and paper storage systems, into areas for patient care and treatment.

All this helps to reduce patient waiting times, and physicians are able to see more patients daily.

This article lists and discusses the guidelines a health care organization should follow when implementing an EMR system. These guidelines will explain what health care organizations should expect, and they will help to ensure a smoother transition from manual to electronic processes. However, following these guidelines still cannot guarantee that your implementation will be a complete success; some problems are likely to arise regardless of the measures you take to avoid them, and should be expected.

More here (registration required):

http://www.technologyevaluation.com/Research/ResearchHighlights/health-care/2009/05/research_notes/TU_HC_JS_05_01_09_1.asp

This is a good review of the basics of implementing EHRs. How to select an EHR is covered here:

http://www.technologyevaluation.com/Research/ResearchHighlights/health-care/2008/04/research_notes/TU_HC_JS_04_14_08_1.asp

Second we have:

Predicting Flu With the Aid of (George) Washington

By DONALD G. McNEIL Jr.

The best way to track the spread of swine flu across the United States in the coming weeks may be to imagine it riding a dollar bill.

The routes taken by millions of them are at the core of a computer model at Northwestern University that is predicting the epidemic’s future. Reassuringly, it foresees only about 2,000 cases by the end of this month, mostly in New York, Los Angeles, Miami and Houston.

In the past decade, the Internet has allowed health agencies to spot emerging viruses much sooner: local public health reports posted on the Web along with items from newspapers and radio stations are harvested by keyword-scanning programs. Now, in tandem with that, supercomputers are being enlisted to predict their spread.

Such models are too new to have established a track record, but last week two separate teams — the one at Northwestern and a friendly rival at Indiana University, using different algorithms — both made predictions that matched almost exactly: flu from Mexico, if left utterly unchecked, would infect only 2,000 to 2,500 people in the United States in four weeks.

Although the number of cases appears to be rising faster than the two models predicted, the Northwestern projection was “still in the ballpark” as of Sunday, said Dirk Brockmann, the engineering professor who leads the epidemic-modeling team at the Northwestern Institute on Complex Systems. The model projected 150 to 170 cases by Sunday, compared with the 226 confirmed by the Centers for Disease Control and Prevention.

“If it was an order of magnitude off, like 1,000 cases instead of 10,000, I’d be worried,” Dr. Brockmann said.

At the heart of his simulation are two immense sets of data: air traffic and commuter traffic patterns for the entire country, and the yield of a whimsical Web site, Where’s George?

Where’s George? was started more than 10 years ago by Hank Eskin, a programmer who marked each dollar bill he received with a note asking its next owner to enter its serial number and a ZIP code into the Web site, just for the fun of seeing how far and fast bills traveled. By 2006, the site had the histories of 100 million bills.

Much more here:

http://www.nytimes.com/2009/05/04/health/04model.html?_r=2

Good to see many angels are be being tried to keep tabs on how bad this might wind up being!

Third we have:

Friday, April 24, 2009

Halamka Warns That Move to EHRs Will Be Full of Challenges

At the SAS Healthcare and Life Sciences Executive Conference Thursday, John Halamka -- CIO of Harvard Medical School and chair of the Healthcare Information Technology Standards Panel -- emphasized that the transition to electronic health records will not be easy, the Triangle Business Journal reports.

In his keynote address, Halamka, however, said moving to EHRs would save millions of dollars, make the health care system more efficient and create as many as 50,000 new jobs.

To help the process along, Halamka said work developing health IT standards needs to continue so health care providers can share data. He also said that regional health IT centers that use "cloud computing" might be a more effective way to facilitate health IT adoption than installing "servers and exchanges" in physician offices.

Halamka also noted that physicians will have to use their own funds to cover the cost of new EHR systems because federal incentive payments included in the economic stimulus package for EHR use will be disbursed over five years.

Reporting continues here:

http://www.ihealthbeat.org/Articles/2009/4/24/Halamka-Warns-That-Move-to-EHRs-Will-Be-Full-of-Challenges.aspx

This is certainly true. I wonder if Ms Roxon has noticed the job creation possibilities. Probably no I guess!

Fourth we have:

Soon, cell phones to monitor heart patients

2 May 2009, 1820 hrs IST, ANI

In a bid to encourage heart patients to complete their rehabilitation programs after surgery, Australian scientists have come up with a new technique that will see nurses monitoring them via a mobile phone.

The trial, being run by the CSIRO's Australian E-Health Research Centre (AEHRC) and Queensland Health, uses a mobile phone to collect and send health-related information about patients'' activities at home to a central computer.

AEHRC chief executive officer Dr Phil Gurney said that less than 20 pct of the heart surgery patients complete their six-week rehabilitation program, following the need for patients to return regularly to the hospital for the rehab program.

"We are largely using technology that is available, but we have customised it to our purposes," ABC Science quoted Gurney as saying.

The mobile phones have an inbuilt accelerator that measures physical activity such as the number of steps walked.

More here:

http://timesofindia.indiatimes.com/Lifestyle/Soon-cell-phones-to-monitor-heart-patients--/articleshow/4476225.cms

Why on earth is this being reported in India and not made a fuss of here in OZ? We really are in a global village despite the GFC!

Fifth we have:

Critical access to IT

Because Medicare incentives under the federal stimulus law vary by type of hospital, rurals expect to see fewer dollars for health IT

By Jessica Zigmond

Posted: May 4, 2009 - 5:59 am EDT

Soon after Congress allocated upward of $19 billion in health information technology funding as part of the economic recovery package, a commentary from the Rural Wisconsin Health Cooperative of 35 free-standing facilities said that the law would leave rural hospitals to make “the best of a bad situation.”

That’s because, according to the report, the differences in Medicare incentives between prospective payment system hospitals and critical-access hospitals are “dramatic,” and the Congressional Budget Office estimates the incentives will result in only half of all critical-access hospitals reaching “meaningful user” status by 2019.

Other healthcare leaders, however, say the legislation’s structure is fair, and that this funding is only a down payment from the federal government for health IT, with additional funds to come later. According to the CBO, total IT funding via the stimulus pipeline could eventually top $34 billion.

Meanwhile, the rural health community continues to improve its IT capabilities—and, in some cases, with financial help from other federal funding sources.

“I think it provides a good benefit” to both types of hospitals, Don May, vice president for policy at the American Hospital Association, says of the health IT funding in the American Recovery and Reinvestment Act of 2009. “It is different and does structure it differently, but I think it provides good financial incentives for both types of hospitals. I think a lot of the reason that you may be hearing some concern is there are more unanswered questions than there are answered questions,” he says.

Some of those questions relate to the definition of terms included in the legislation. For example, the law stipulates that both PPS hospitals and critical-access hospitals are eligible for Medicare incentives if these facilities are able to demonstrate that they are meaningful users of certified electronic health-record technology.

Last week, the Healthcare Information and Management Systems Society, or HIMSS, published its definitions of “meaningful use of certified EHR technologies” as outlined in the stimulus law. It then sent two definitions—one for meaningful users of certified EHR technologies, which focuses on physicians, and one covering meaningful use for hospitals—to the Office of the National Coordinator for Health Information Technology and the acting CMS administrator. In both definitions, the recommendations call for use of an EHR certified by the Certification Commission for Healthcare Information Technology, or CCHIT.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090504/REG/905019995

This is a good discussion of where thinking is up to with implementation of the US Health IT stimulus planning.

Sixth we have:

Monitoring Tools Can Boost E-Health Record Systems Performance

Federal stimulus money is pushing health care providers to implement e-medical record systems, but keeping the technology performing to doctors' satisfaction is the larger concern.

By Marianne Kolbasuk McGee, InformationWeek
May 5, 2009
With federal stimulus programs waving a $20 billion carrot in front of health care providers, it's a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.

E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.

Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians' satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.

"It takes a lot to ask nurses and doctors to change their workflow and adopt computerized systems for patient care, they put all their trust that these systems will be reliable and high performing," said Barry Runyon," a health care analyst and VP of research at Garter.

More here:

http://www.informationweek.com/news/showArticle.jhtml?articleID=217300190

This is a very sensible article that explores some important issues.

Seventh we have:

NHS contract leaves BT with painful results

The government has handed the telecoms giant a £100m advance despite its dire record on delivering computer systems, reports Simon Bowers

• Simon Bowers
• The Observer, Sunday 3 May 2009

The Department of Health has handed BT almost £100m in advance payments for its work computerising patient records despite years of delays, system failures, and overspending on BT's £1bn NHS contract in London.

Industry insiders suggest the up-front sum is substantially above what such a contract ought to cost. Health minister Ben Bradshaw told parliament the payment was "in line with Treasury rules, and in return for a reduction in payments to be earned for future successful delivery".

The cash advance, revealed by Bradshaw in a parliamentary answer, comes just days ahead of BT's full-year results. These will next week include a painful writedown reflecting a catalogue of troubles that have dogged BT's work on IT upgrades for hospitals and GP surgeries in the capital.

The NHS-related writedown is expected to be larger than the £336m wiped off the combined value of 15 other BT Global Services IT contracts three months ago. The contract has been so costly and problematic that BT is thought to have discussed the possibility of quitting altogether as recently as March.

The government's £92.8m advance appears to largely relate to a bolt-on contract BT won in March, through which Global Services has taken over management of IT systems at eight major NHS trusts outside London abandoned by Fujitsu. The Japanese firm had quit as a health service contractor in a bitter legal row.

More here:

http://www.guardian.co.uk/business/2009/may/03/nhs-bt-contract-it-systems

The news from the NHS seems to be getting worse and with the UK economic situation one must be a little anxious about the ultimate fate of their plans. At least Scotland and Wales seem to have achieved well on a more limited budget.

Eighth we have:

What's Holding Back Online Appointment Booking?

Donatello Bianco - May 1, 2009

Introduction

Have you ever asked yourself why you can use the Internet to book a flight, a hotel room, or even a seat at the theatre, but if you need to make an appointment with your doctor, you have to do it by phone? Do you ever find yourself on a Sunday morning or Tuesday evening wanting to arrange a check-up, but having to wait until the doctor's office opening hours before you can make the call? And when you finally make the call, have you ever wished you had more time or options to help you make the right choice? Have you wondered how much easier making appointments could be if only we had access to a dedicated online scheduling system?

I first asked myself these questions years ago and have since asked the same questions to about a hundred doctors, hospital and clinic directors and call centre managers. And their answer is always the same: "Yes, it would be good to overcome these problems", which was often followed by "but it's complicated" or "it's still too early".

Having been involved in several successful patient relationship management (PRM) implementations over the last few years, I have discovered that by avoiding some simple mistakes, an appointment scheduling system can actually be significantly less complex than generally perceived within the health industry. And it is certainly not too early, by any means, to implement one.

With a little effort, any hospital, clinic, doctor's office, or individual doctor can save a considerable amount of its own and its patients' time, make its services easy to use, and reduce non-attendance significantly.

Long full article here (registration required) :

http://www.technologyevaluation.com/Research/ResearchHighlights/CRM/2009/04/research_notes/MI_CR_XDB_05_01_09_1.asp

This is an interesting article reviewing the range of barriers that need to be overcome to get improved patient booking systems in place.

Ninth we have:

Few hospitals go paperless using free VA software

Electronic record system helps W. Va.

By Lisa Wangsness, Globe Staff | May 4, 2009

WASHINGTON - In a country where just 1.5 percent of US hospitals have fully computerized records, one of the poorest and least technologically advanced states has created a paperless records system for its state-run hospitals and nursing homes serving the indigent elderly and mentally ill.

West Virginia did it on the cheap by using an electronic medical records system built by the Veterans Administration with taxpayer dollars, saving millions in software licensing fees charged by commercial software vendors. The VA software, known as VistA, is open-source software - its code is freely available to the public and is constantly being improved by users - and it includes important features, such as a bar-coding system to track drug dispensations, to help improve patient safety.

But very few US hospitals have taken advantage of it. Wealthier hospitals have opted to buy more expensive, custom systems from private vendors, while smaller and more rural hospitals often stick with paper records.

"I would think there would be a tremendous opportunity for using this as a platform, particularly for smaller hospitals that have a real challenge in coming up with the money for electronic medical records," said Dr. William Weeks, an associate professor at Dartmouth Institute for Health Policy and Clinical Practice and Veterans Administration psychiatrist in Vermont.

Much more here:

http://www.boston.com/news/health/articles/2009/05/04/few_hospitals_go_paperless_using_free_va_software/

I suspect that as the financial incentives kick in we may see more use!

Tenth we have:

Apollo launches new technology to capture multimedia from legacy systems

May 01, 2009 | Eric Wicklund, Managing Editor

FALLS CHURCH, VA – When a doctor in a remote town needs help analyzing an X-ray of a child’s broken leg, the last thing he or she should worry about is whether the image can be read by a specialist thousands of miles away.

Apollo, a Falls Church, Va.-based developer of clinical multimedia solutions, seeks to solve this issue with the release of Apollo Enterprise Patient Media Manager (EPMM), a so called “device-agnostic” software platform that’s designed to collect distributed patient media into one unified record.

“It looks at the problem from a clinician’s perspective, bringing it all to the clinician’s desktop,” said Mark Newburger, the company’s CEO. “It really is a multimedia manager.”

Launched in 1993 as a telemedicine company, Apollo created digital pathology management and telepathology solutions for clinical and research laboratories before moving into the PACS market in 2003. Newburger said the company focuses on coordinating data from older, legacy systems so that it can be read easily and quickly – a critical issue at a time when hospitals and other healthcare providers don’t have the funding to purchase new hardware or software.

More here:

http://www.healthcareitnews.com/news/apollo-launches-new-technology-capture-multimedia-legacy-systems

This looks like really useful work indeed.

Eleventh for the week we have:

Monday, May 4, 2009

Medical records software provides security

Lauren Whetzel

People underestimate how vulnerable their medical records are, even on paper, said Dr. Brian Wicks, an orthopedist who heads a Washington state medical practice.

"Just about anybody walking by the records room in a hospital, for example, could potentially get a hold of a patient chart …," said Dr. Wicks, president of the Doctors Clinic, practice that is making the transition to electronic health records at all of its locations.

Dr. Wicks says the chances of unauthorized personnel gaining access to a computer at a clinic would be small because electronic health records have a very high level of security and require passwords at every step.

Nigel Jones, director of the Cyber Security Knowledge Transfer Network in Britain, is less confident. "Nothing is 100 percent risk-free. Sensitive information always has the possibility of being released by an insider, an Internet hacking or accidentally.

"If I were someone giving medical details electronically," Mr. Jones says, "I want to know where the data is held, how it is stored and if it is being held in one place."

The question of electronic security has become more compelling as private companies, with big incentives from government, relentlessly push the technology in the medical and public health fields.

More here:

http://washingtontimes.com/news/2009/may/04/securing-medical-records/

A good discussion of the various ins and outs of medical record security.

Twelfth we have:

iSOFT wins A$ 5m (US$ 3.54m) deal in England for a hospital information system

May 4th, 2009

Sydney/Chennai, Monday, 4 May 2009: iSOFT, an IBA Health Group Company, today announced that it has won a contract for a hospital information system with a National Health Service (NHS) trust in southern England worth £2.4 million ( A$5 million) (US$3.54m) over five years.

The contract with Heatherwood and Wexham Park Hospitals NHS Foundation Trust is for iSOFT’s i.Patient Manager (i.PM) PAS and a technical refresh of an existing iSOFT clinical solution, i.Clinical Manager (i.CM). i.PM is replacing an outdated third-party system.

The trust elected to contract directly with iSOFT for a replacement PAS instead of waiting for a solution under England’s National Programme for IT. This is one of the first major deals in the Southern Cluster, which was formerly serviced by Fujitsu.

Jonathan Pearce, the Trust’s Director of Infrastructure, said: “We are delighted to be working with iSOFT on this very important programme for Heatherwood and Wexham Park Hospitals NHS Foundation Trust. We already have a strong working relationship with iSOFT as we already use its clinical information system, i.CM. We very much value our partnership with iSOFT and look forward to strengthening this and working with the company to deliver the new PAS solution to the trust.”

More here:

http://press-releases.techwhack.com/36100-isoft-7

It is interesting that some NHS trusts are going outside the NHS program to purchase their systems.

Thirteenth we have:

Industry Weighs in on Definition of Meaningful Use

Carrie Vaughan, for HealthLeaders Media, May 5, 2009

Healthcare providers are antsy to start working toward becoming "meaningful users" of electronic health record technology so that they can claim some of the American Recovery and Reinvestment Act's financial incentives when they become available in fiscal year 2011 and 2012. While providers wait for the government's definition of "meaningful use" of EHR technology, which ultimately is the only definition that matters, they did receive some guidance this past week as just about every association and industry group released their own definition of what meaningful use should include. Here's a breakdown of those recommendations.

Much more here:

http://www.healthleadersmedia.com/content/232545/topic/WS_HLM2_TEC/Industry-Weighs-in-on-Definition-of-Meaningful-Use.html

This is an excellent summary of the view being offered by a large range of stakeholders.

Fourteenth we have:

The Downside of E-Health Records

By Gautham Nagesh 05/05/09 12:03 pm ET

With all the excitement surrounding electronic health records in the new administration, including the $19 billion in the stimulus bill set aside to further their adoption, it's easy to forget the potential risks of moving our health information online.

One striking example of the possible downside came to us on Monday from Wikileaks via the Washington Post's Security Fix blog:

Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.

Wikileaks reports that the Web site for the Virginia Prescription Monitoring Program was defaced last week with a message claiming that the database of prescriptions had been bundled into an encrypted, password-protected file. Wikileaks also printed a copy of the ransom note:

I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.

The state discovered the attack on April 30 and soon after shut down the Web site. They are in the process of restoring the systems but no word yet on whether the attacker has been identified.

Much more here :

http://techinsider.nextgov.com/2009/05/the_downside_of_electronic_hea.php

This must have IT execs all over the country a bit nervous. It is certainly a pretty huge breech!

Fifteenth we have:

International Comparisons

mbitious goals are not new, but they have proven difficult to achieve at the scale in the U.S.

By Archie Galbraith

"Necessity, who is mother of invention." -- Plato, The Republic, 380 BC.

In the past, the differences between health care ecosystems across the world have been large enough to make it difficult to share a range of patient-oriented software. This article questions whether the current pressures and emerging goals of the U.S. health system will increasingly result in breaching these barriers.at least to the extent that practical and low-cost applications and solutions from outside the U.S. might be worth considering.

Assume that the most effective health information technology is developed in response to the clinical and business requirements immediate to the developer. The question is whether the requirements of a hospital in Taiwan are close enough to those of a hospital in Tennessee to mean that the clinical or business systems developed for either might be relevant to both.

We are facing demands by a new administration for integrating care, disease management, visibility and cost containment. At the same time the resources which are being made available allocated across 6000 hospitals and 921,904 licensed physicians will be inadequate to achieve these goals across the hospitals, clinics and doctors' offices in the United States. This might be a good time to think differently.

More here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199065

A very good and interesting article from an obviously thoughtful Health CIO.

Sixteenth we have:

Connecting Stakeholders to Improve Care

The concept formally called the "patient-centered medical home" is gaining momentum.

Medical Home Connects Healthcare Stakeholders to Improve Care

Sathya Rangaswamy

With each passing day, a concept formally called the "patient-centered medical home" is gaining momentum. Under this concept, a primary care practice would be the patient's regular source of care or "medical home," with teams composed of primary care physicians (PCPs), registered nurses, nurse practitioners and physician assistants who coordinate services across the continuum of care. The goals are to improve outcomes and reduce overall costs by promoting preventive care; maintain patient health by leveraging information technology to foster clinical collaboration and data exchange; streamline follow-up visit requests and referrals to specialists, hospitals and other care settings; and empower patients to participate in and make better health care decisions.

Very much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199070

A good article on current thinking in the “medical home” area.

Seventeenth we have:

GE Launches 'Healthymagination'; Will Commit $6 Billion to Enable Better Health

Created May 7 2009 - 12:45pm

WASHINGTON, DC - May 7, 2009 - GE announced today that it will spend $3 billion over the next six years on healthcare innovation that will help deliver better care to more people at lower cost. In addition, the company will commit $2 billion of financing and $1 billion in related GE technology and content to drive healthcare information technology and health in rural and underserved areas. These investments are the foundation of GE's healthymagination initiative, which is built on the global commitments of reducing costs, improving quality and expanding access for millions of people.

More here:

http://www.fiercehealthcare.com/node/35936/print

This is a long a detailed agenda that is really very encouraging indeed!

Fourth last we have:

"Star Trek" Scanner Tested

May 4, 2009

The National Space Biomedical Research Institute, federally created to develop treatments for those on long-duration missions, is working on a "Star Trek" type of scanning device to noninvasively conduct metabolic tests.

The sensor and portable monitor is called the "Venus prototype." Placed on the skin, it uses near infrared light (just beyond the visible spectrum) to take measurements.

More here:

http://www.healthdatamanagement.com/news/medical_devices-28155-1.html?ET=healthdatamanagement:e861:100325a:&st=email&channel=decision_support

As every year goes by we seem to get closer to the Rodenberry vision. Given he was imagining the 23^rd Century we may get there more quickly than he imagined!

Third last we have:

Agency Urges Patients to Quiz Their Doctors

Tuesday, May 5, 2009

People are more likely to demand information about a restaurant entree or a cellphone deal than about a doctor's diagnosis. At least that's the opinion of the federal Agency for Healthcare Research and Quality, which recently launched a campaign aimed at getting Americans to research and ask questions of their health-care providers.

The public service announcements (one has a picture of a waiter captioned, "You'll ask him about the side dish," then a picture of a doctor that reads, "But you won't ask him about the side effects") are meant to prompt people not only to ask questions but also to think about what those questions might be ahead of time, says Carolyn Clancy, director of AHRQ. To help, the agency has a sort of menu that helps you create a list of questions based on the nature of your visit to the doctor. (At http://www.ahrq.gov/questionsaretheanswer, click "Do You Know?") The site offers nine categories, each with suggested questions for such encounters as getting a new prescription or getting a recommendation to have surgery.

More here (with links):

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/01/AR2009050103218.html

All I can say is what a good idea!

Second last for the week we have:

Bury using SCR for end of life care

05 May 2009

The Summary Care Record will start to hold information on end of life plans in the next few months, according to NHS Connecting for Health.

The IT agency has set out its plans to develop the SCR for end of life care and the progress that has been made at NHS Bury, one of the early adopter primary care trusts for the SCR.

Writing in the European Journal of Palliative Care, Dr Gillian Braunold, clinical director of the SCR, and colleagues from CfH, said a National Audit Office report published last year highlighted ‘severe shortcomings’ in relation to end of life care.

One of the issues it highlighted was that the wishes of people approaching the end of their life were not always conveyed to those who needed to know them.

The authors said that the SCR could “easily be used to communicate patient wishes and end-of-life care plans” because any coded information and associated free text entered in the GP IT system could be sent as part of the ‘GP summary’ to the SCR.

Much more here:

http://www.ehiprimarycare.com/news/4810/bury_using_scr_for_end_of_life_care

This seems like a sensible use of a summary health record. As long, of course, if it is carefully kept up to date!

Last for this week we have:

NHS Evidence launches

01 May 2009

The National Institute for Health and Clinical Excellence has launched NHS Evidence, an online source of “fast, free, relevant and trustworthy” information for health and social care staff.

The new service was promised in the final report of Lord Darzi’s Next Stage Review of the NHS, High Quality Care for All and is being promoted as a way to spread innovation across the health service.

Speaking at the launch, Lord Darzi said: “in my strategy for the future of the NHS, I made it clear that if quality was to become the organising principle of the NHS, its staff and patients must have a way to access the latest authoritative clinical and non-clinical evidence and best practice.

“NHS Evidence will ensure that whatever you do within the NHS you will always have access to the best information you need to deliver the highest quality care to your patients.”

Much more here:

http://www.ehiprimarycare.com/news/4806/nhs_evidence_launches

What a pity we don’t have a similar service for Australian Health Professionals. That at least could be afforded in these CFC constrained times!

There is an amazing amount happening. Enjoy!

David.

AUS Health IT Gets Some Facts Wrong on ACT Health – Sorry!

I got this e-mail from the CEO of ACT Health a little while ago.

----- Begin quote:

Dear Dr More

Your statements re ACT Health's E-Health Budget are inaccurate.

Re Your quote [from p212 ACT Budget Paper 4, Technical Adjustments]

"2009/10 $350,000

2010/11 $1,381,000

2011/12 $1,061,000

2012/13 $11,050,000.

So no serious expenditure until 2012/13."

If you go to the next page in the ACT Gov't Budget paper (page 213, Budget paper 4, Budget Policy Adjustments) you will see

An E-Healthy Future

09-10 7m,

10-11, 25m

11-12 35m

12-13 23.1m

[TOTAL 90m]

You are free to criticise, denigrate and mock the genuine efforts of a small jurisdiction to invest in e-heath if that makes you feel good.

However , I suggest that you get your facts right before you do so.

I suggest you correct the record.

Mark Cormack

Chief Executive

ACT Health

GPO Box 825

Canberra 2601

02 6205 0825

02 6205 0830

----- End quote.

I replied, after investigation.

----- Begin quote

Mark,

Thank you for the comments.

I have posted a comment someone sent with the same facts.

I have just checked my source - which was the .pdf of the health section of the budget. It has page 213 just simply not shown. The figures seem to be on page 218. That is how I missed it. Sorry. Attached so you can check.

(Found here:

http://www.treasury.act.gov.au/budget/budget_2009/files/paper4/12health.pdf)

Looking at the .rtf - I see page 213 as you describe. For some reason the pages are different between the 2 files which is why I have missed it.

Sorry to have offended you but without any apparent details of the plans behind the expenditure - except some figuring that seemed very large for 2 hospitals I was quite skeptical.

Is there some more detail of how the funds are planned to be expended in the public domain or that you can make available? If you are genuine with this and there is a credible plan I will make a huge fuss on the blog of your good plans..Take it from me - my motivations are to encourage investment not discourage it.

If you actually read the bulk of my blog it is aimed at encouraging investment passionately!

David.

----- End quote

I am sure many readers would be interested in more details of ACT’s plans. Maybe they could be provided in the ACT Health Web site? This still seems like a huge investment for just two hospitals and I, for one, am wondering how it might be spent!

Sorry again, to all, for my scepticism. It is the first time in a while there has been such positive news for quite a while, given the latest Federal Budget for example.

David.

p.s. Note this is an example of how I am true to the words in the blog 'About Me'. Tell me I have got it wrong, or apparently wrong, and I will be totally open about it.

D.