Sometimes I Just Want to Scream!

The following appeared on the Croakey blog site a day or so ago. (Croakey is the Health Sector Interest blog of www.crikey.com.au and is accessible from the web front page.)

The big bang lies with e-health proposals

July 28, 2009 – 11:19 am, by Croakey

Philip Davies, Professor of Health Systems & Policy at the University of Queensland’s School of Population Health, is encouraged by the National Health and Hospitals Reform Commission proposals around e-health. He writes:

“Much of the debate following the release of the National Health & Hospital Reform Commission’s (NHHRC) report A Healthier Future For All Australians will inevitably, and rightly, focus on issues of health care governance, funding and models of service delivery. Some of the Commission’s most far-reaching recommendations could, however, be those relating to e-health.

The Commission is to be commended for providing one of the clearest, most powerful and potentially most effective statements of how to move the national e-health agenda forward. Its key recommendation is that every Australian should be offered the opportunity to have a person-controlled electronic health record (PEHR) – a comprehensive electronic repository of health-related information generated by, and accessible to, themselves and their health care providers.

There’s not much new in that idea. The concept of electronic health records has been around for a very long time; but the Commission’s approach has two distinctive, new features.

First, it suggests quite categorically, that Governments should play no part in “designing, buying or operating IT systems” to support PEHR. That’s a job which, according to the Commission, can safely be left to the private sector. Governments, in turn, should focus on the essential tasks of defining standards for those PEHR systems and regulating their use. State and Territory Governments will also need to continue developing ‘in-house’ patient administration, communication and other IT applications to enable their public hospitals to interface with PEHR systems.

Second, the Commission proposes a series of deadlines for public and private sector health care providers to become e-enabled and able to write to, and read from, individual patients’ PEHR.

To reinforce the point, the Commission goes on to recommend that Government funding in the form of Medicare subsidies or direct payment for public hospital services should be withdrawn from any provider who fails to meet the relevant deadline.

Lots more here:

http://blogs.crikey.com.au/croakey/2009/07/28/the-big-bang-lies-with-e-health-proposals/?source=cmailer

Now we all have to be a bit careful here.

Consider this recent article from the NY Times I cited the other day.

Op-Ed Contributor

Lost in the Cloud

By JONATHAN ZITTRAIN

Cambridge, Mass.

EARLIER this month Google announced a new operating system called Chrome. It’s meant to transform personal computers and handheld devices into single-purpose windows to the Web. This is part of a larger trend: Chrome moves us further away from running code and storing our information on our own PCs toward doing everything online — also known as in “the cloud” — using whatever device is at hand.

Many people consider this development to be as sensible and inevitable as the move from answering machines to voicemail. With your stuff in the cloud, it’s not a catastrophe to lose your laptop, any more than losing your glasses would permanently destroy your vision. In addition, as more and more of our information is gathered from and shared with others — through Facebook, MySpace or Twitter — having it all online can make a lot of sense.

The cloud, however, comes with real dangers.

Some are in plain view. If you entrust your data to others, they can let you down or outright betray you. For example, if your favorite music is rented or authorized from an online subscription service rather than freely in your custody as a compact disc or an MP3 file on your hard drive, you can lose your music if you fall behind on your payments — or if the vendor goes bankrupt or loses interest in the service. Last week Amazon apparently conveyed a publisher’s change-of-heart to owners of its Kindle e-book reader: some purchasers of Orwell’s “1984” found it removed from their devices, with nothing to show for their purchase other than a refund. (Orwell would be amused.)

Much more here:

http://www.nytimes.com/2009/07/20/opinion/20zittrain.html?_r=1

It also seems I am not the only one who cautions a bit of care.

Davis: privatising records 'dangerous'

28 Jul 2009

Former Conservative home secretary David Davis has slammed his own party’s reported plans to hand health records to commercial IT companies as “naïve” and “dangerous.”

Writing in The Times yesterday, the MP for Haltemprice and Howden said the first time he read about the policy his “heart sank.”

“The policy described was so naïve, I could only hope that it was an unapproved kite-flying exercise by a young researcher in Conservative HQ,” he wrote.

“If not, what was proposed was both dangerous in its own right, and hazardous to the public acceptability of necessary reforms to the state’s handling of our private information.”

A number of papers reported at the start of July that the Conservatives might give patients the option of transferring their health records to personal health record platforms such as those run by Microsoft and Google.

The reports followed a Centre for Policy Studies paper that recommended such a move, alongside a wider use of cloud computing and decentralised IT systems.

Much more here:

http://www.ehiprimarycare.com/news/5066/davis:_privatising_records_%27dangerous%27

Before we go rushing in to signing up the public to PEHRs we would want to be certain the information was not going into some nebulous cloud – but that it is in a secure, inaccessible, un-data-minable environment where the terms of service were such that the public would be entirely comfortable to have their information stored by whoever provided the service.

I suspect that may mean that only local, well established and technically very sophisticated providers will want to be involved and that if we want long term reliability and security there are going to be real costs! I think most would also like to be sure their information is actually held in Australia.

I am as keen as the next man to have patients be able to keep track of their health information and to have ownership of that information but this is not as simple as it is made out and as I have discussed in previous blogs, while be case for provider used EHRs / EMRs is robust, the same simply is not the case for PEHRs.

Commentators who do not grasp the difference, and the implications of those differences, really should not be leaping into print.

I also think it will be very important to think through the various interfacing and communications issues as well as ensuring that clinician workflow is not made problematic during information transmission etc. Timing of just when information is sent from the EHR to the PEHR may need careful thought.

Additionally, I think that any penalty regime to foster information sharing is likely to simply be counter-productive. The architects of a final plan need to think much more ‘outside the box’ to come up with an approach that works and the clinicians are comfortable with.

Can I also suggest that the economic fundamentalist approach of this commentator may not be the best way to move e-Health forward.

The idea of the PEHR is possibly a very good one but we do need to think carefully about how we go about it for the benefit of all. This needs to be fully thought through and all the wrinkles identified and resolved.

Hasten slowly.

David.

Now We Have the NHHRC Report - What Has to Happen Next?

Well it has been a big 24 hours for e-Health in OZ and I suspect many of us are now asking the question “what next?”.

There has been a lot of press coverage of yesterday’s release. Typical of the e-Health coverage have been the following:

NHHRC reboots e-health plan

Karen Dearne | July 28, 2009

AUSTRALIA'S e-health strategy has been endorsed by the National Health and Hospitals Reform Commission, which also puts the federal government back in the driver's seat after disastrous delays through the Council of Australian Governments process.

"We want our future health system to be powered by the smart use of data and enabled by the electronic flow of essential information between individuals and health professionals," the commission says.

"Data should enhance decision-making, drive improvements in clinical practice, guide how resources are deployed and provide feedback to promote improvements across all health settings.

"Key to this is a structured, robust communication matrix that connects all participants with relevant, accurate and secure information, in real time."

The commission says it concurs with the direction of the National E-Health Strategy -- produced by Deloitte and adopted by the nation's health ministers at COAG late last year. The strategy is yet to be publicly released.

A copy obtained by The Australian shows the commission has backed Deloitte's recommendations and costings in full.

"There is a critical need to strengthen the leadership, governance and resources committed by governments to giving effect to the (Deloitte) action plan," the commission says.

"This includes providing support to public health organisations and incentives to private providers to augment takeup and successful implementation of compliant e-health systems.

"It should not require government involvement with designing, buying or operating IT systems."

The current lack of interoperability standards, and the inability to send and receive high-quality data -- even within healthcare settings -- should be addressed as a matter of urgency.

The commission estimates an extra $1.2 billion to $1.9bn is needed to fund an e-health system, including between $600 million and $900m for national e-health standards; $500-$800 million for training and support for medical practitioners; $35m-$65m for consumer education, and up to $100m for new research, performance monitoring and governance programs.

These priorities and costs mirror Deloitte's estimated costs of $1.5bn over the next five years for foundation standards, awareness campaigns and a new e-health governing body to replace the sometimes troubled National E-Health Transition Authority.

Lots more here:

http://www.australianit.news.com.au/story/0,27574,25843275-15306,00.html

and here:

Electronic health records to save lives

Clancy Yeates

July 28, 2009

BY 2012, every Australian should have an electronic health record, a Federal Government report advises.

As the health system braces for the greying population, moving the system away from paper-based records should be a key priority, the National Health and Hospitals Reform Commission said yesterday.

The move is part of broader growth in ‘‘e-health’’ measures, which could radically change the experience some patients have with their doctors, eventually leading to activities such as electronic prescribing.

Meanwhile, electronic health records will speed up the time it takes for doctors to obtain details about their patients.

Although critics have raised privacy concerns, supporters of the proposal argue that moving medical records into the digital age will save not only money but also lives.

More here:

http://www.theage.com.au/national/electronic-health-records-to-save-lives-20090727-dysd.html

and here:

Australia must spend $1.2 to $1.9b on e-health

Suzanne Tindal, ZDNet.com.au

27 July 2009 05:34 PM

Prime Minister Kevin Rudd and Health Minister Nicola Roxon released a report on the nation's hospitals today by the National Health and Hospitals Reform Commission (NHHRC) which recommends a $1.2 to 1.9 billion spend on e-health.

The report endorsed the recommendations of the National e-health strategy completed by Deloitte last year. Its figure for rolling out a National e-health agenda of $1185 to $1865 million roughly mirrored the consultant's original reported amount for implementing its national strategy.

In addition to Deloitte's recommendations, the NHHRC put out a plea for better leadership on e-health. "We urge the Commonwealth Government to take responsibility for accelerating and adequately resourcing implementation of a National e-health Action Plan which incorporates strengthened national leadership to direct and revitalise implementation and which values and actively seeks the expert guidance of key stakeholders," it said.

The report acknowledged that the work had been already completed but pointed out how far Australia had to go. "There is increasing frustration and mounting cynicism with the pace of action on implementing a national e-health platform. The lack of visible utility at the point of care has resulted in calls to stop the 'talkfest' and get on with setting a dedicated budget and definite delivery date with clear responsive and responsible governance for electronically enabling the health system: e-health."

There was still a "small window of opportunity" to capitalise on the money the nation had already spent on a national e-health system, it said. If that window were missed, the cost would be much higher.

Lots more here:

http://www.zdnet.com.au/news/software/soa/Australia-must-spend-1-2-to-1-9b-on-e-health/0,130061733,339297606,00.htm

Overall the coverage seems to be quite positive and supportive and it is good that there is recognition of the importance of the work done in 2007 by Deloittes that has now been extended and built on by the NHHRC.

In broad terms what would I like to see next?

First I would like to see, before any final decisions are made, an implementation planning group established within DoHA, but possibly externally resourced given the scale of the work involved.

This group would have the brief to consult widely within the health sector, in the light of the directions set by the other components of the NHHRC report to develop what I would term an Opportunity and Benefits Driven Implementation Plan and Business Case. (This is a small extension of the idea of a National E-Health Action Plan as provided by the NHHRC)

The idea is that all the proposals from Deloittes and the NHHRC would be considered carefully in the light of where we presently are, where the most bang for the buck can be found, what will work for both the public and providers and to then develop a real, pragmatic plan for implementation of these solutions and technologies.

My view is that this plan should draw the best from the NHHRC, NEHTA and Deloittes and put it together in a way that will most quickly and effectively achieve the ends of coherent e-Health support for the health system. The time for coming up with ideas is over – the time for getting going with a clear, well articulated and well funded direction has now arrived.

Most especially the timeframes, costs, and benefits need to be carefully considered to make sure expectations of all the stakeholders can reasonably be met.

I would envisage that once the plan was developed that a focussed group within DoHA would manage the development of the business case for implementation, have that approved and then move on to actual implementation of the agreed plan – using NEHTA and external resources as required – having been endorsed by COAG..

This group will need to be very aware of the various successes and failures (relative and total) that have been seen around the world and apply world’s best practice both to the planning and implementation tasks.

It might be that a group such as the Coalition for E-Health could assist in providing the breadth and scope of input needed to get this planning process right.

See here:

http://www.ceh.net.au/

This implementation task force group will require the co-operation of all the e-Health community as well as the broader health community and the public in general. For that reason it will need to be exceptionally well led and resourced appropriately – as well as given a clear mandate for action from both DoHA and COAG.

If there is not a coherent plan developed soon to leverage the momentum that has been provided by the report release then there is a real risk of the whole thing sinking into some terrible bureaucratic mire – and that would be very sad indeed having got this far!

Second, once this work is done – and it will take all of the six months Mr Rudd has allocated for the other systemic decisions, I would like to see the final Opportunity and Benefits Driven Implementation Plan and Business Case approved and funded as part of the overall reform process.

Anything less will be a betrayal of one of the key directions provided by the NHHRC.

David.

The National Health and Hospitals Commission Reboots Australian E-Health.

I believe this is a very good day for e-Health in Australia.

Today the National Health and Hospitals Commission (NHHRC) released its Final Report after some sixteen months work.

The report is found here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report

E-Health and the Use of ICT within the sector runs through the entire document and is really an embedded part of what is recommended.

The most important parts related to e-Health are found in the following spots:

1. The Executive Summary.

2. Section 5 of the Main Report.

3. Appendix G – Implementing Reforms.

4. Appendix H – Investing in Reform.

The Executive Summary (on E-Health) I posted earlier and it can be seen here:

http://aushealthit.blogspot.com/2009/07/core-recommendations-from-nhhrc-on-e.html

What is very interesting about the report is as you go through the detail – and there is lots in Section 5 and the Appendices – the balance moves, as I read it, further and further away from the almost total focus on the Person Controlled Health Record in the Executive Summary to a much more balanced holistic view of e-Health by the end.

By the time we reach the section on Funding (Appendix H) we have the following:

RECOMMENDATION 123

With respect to the broader e-health agenda in Australia, we concur with, and endorse the directions of the National E-Health Strategy Summary (December 2008), and would add that: There is a critical need to strengthen the leadership, governance and level of resources committed by governments to giving effect to the planned National E-Health Action Plan. This Action Plan must include provision of support to public health organisations and incentives to private providers to augment uptake and successful implementation of compliant e-health systems. It should not require government involvement with designing, buying or operating IT systems. In accordance with the outcome of the 2020 Summit and our direction to encourage greater patient involvement in their own health care, that governments collaborate to resource a national health knowledge web portal (comprising e-tools for self-help) for the public as well as for providers. The National Health Call Centre Network (healthdirect) may provide the logical platform for delivery of this initiative. Electronic prescribing and medication management capability should be prioritised and coordinated nationally, perhaps by development of existing applications (such as PBS online), to reduce medication incidents and facilitate consumer amenity.

Additional cost $1,185–$1,865 million

Costing Assumptions 1. $600–$900 million implementation and adoption of national standards including:

investment in bringing existing public and private systems to a level that will allow them to operate with a broader electronic health care system, including interfaces;

encouragement of the development and implementation of new e-health solutions that apply these standards and implement the interfaces necessary to allow broad integration. This would include solutions to allow consumers access to and use of their own personal health information.

Implementation of additional enablers of national information exchange, such as national indexing, strong privacy management and authentication services.

Investment in the industry infrastructure required to test and accredit the adoption of e-Health.

2. $500–$800 million e-health teaching, training, change management and support to health care practitioners targeting:

encouragement of the active use of high priority e-Health solutions prior to the mandated use of these solutions to provide data that can be integrated into a person-controlled electronic health record (such investment does not replace investments by the private and public sector in the development of their internal e-health solutions, but helps ensure that they can contribute to the national system);

health information training for clinicians, including in universities, continuing education and in specialist health contexts (such as hospital emergency departments);

workplace change, enabling new workplace practices that can only be adopted with e-health solutions in-place;

delivery of new tools and capabilities that leverage e-health information to deliver provider efficiencies (e.g. new electronic clinical registries) and enhanced health monitoring (such as bio-surveillance capabilities).

3. $35–$65 million consumer marketing program

4. $50–$100 million research, performance monitoring and governance

These costs are in addition to developments to date funded by COAG commitments of $318m and industry and individual practitioner investment and do not include hospital information system infrastructure.

---- End Quote.

When one compares what I asked for a few weeks ago as far as e-Health is concerned from the Final Report I must say what we have looks pretty good.

See here for my wish list:

http://aushealthit.blogspot.com/2009/07/nhhrc-final-report-will-be-released.html

It is also worth comparing the funding cited here with what the Deloittes work suggested.

See here:

http://aushealthit.blogspot.com/2009/05/what-should-be-in-budget-for-e-health.html

Overall the NHHRC is saying to Government get on an fund what is essentially the National E-Health Strategy – and interestingly does not seem to be asking for funds for the Personal Records – just the funds to make the possible. Do you think it is possible someone else will provide those records (Google or Microsoft perhaps?)

In section 5.0 there is also lots of mentions of some of my favourite topics (governance, leadership, education, workforce, knowledge portals and so on) which I can only be happy about.

Additionally it is clear the issues of privacy and security have received pretty comprehensive coverage. As always it will only if public trust is developed will any e-Health initiative succeed!

Appendix G seems to me to make it clear – as I have long suggested – that NEHTA is to become an implementation arm of DoHA under the Accord and to come back much more under Government control – what a good thing!

All in all my only concern is that we have to wait to see if Government will support these recommendations, fund them and get on with it.

The only two serious issues I might have are

1. I would still like to see an e-Health Australia entity established to be responsible and accountable for doing all this.

2. I really think trying to force clinicians to contribute data to personal EHRs is just a bad, bad idea.

There is so much that is good in this I am almost prepared to let these points pass!

Well done team. 9.7/10. I only hope Mr Rudd will now implement.

David.

Core Recommendations from the NHHRC on E-Health.

On page 8 of the Executive Summary of the NHHRC Final report we have the Key e-Health Recommendations.

The full report is found here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report

The relevant parts are these – so far!

Smart use of data, information and communication

Our third lever to support an agile, self improving system is the smart use of data, information and communication.

We are recommending a transforming e-health agenda to drive improved quality, safety and efficiency of health care.

The introduction of a person-controlled electronic health record for each Australian is one of the most important systemic opportunities to improve the quality and safety of health care, reduce waste and inefficiency, and improve continuity and health outcomes for patients. Giving people better access to their own health information through a person-controlled electronic health record is also essential to promoting consumer participation, and supporting self-management and informed decision-making. We want the Commonwealth Government to legislate to ensure the privacy and security of a person’s electronic health data.

Making the patient the locus around which health information flows is critical and will require a major investment in the broader e-health environment. Electronic health information and health care advice will increasingly be delivered over the internet. Broadband and telecommunication networks must be available for all Australians if we are to fulfil the real promise of e-health.

We are also recommending that clinicians and health care providers are supported to ‘get out of paper’ and adopt electronic information storage, exchange and decision support software. The Commonwealth Government must set open technical standards which can be met by the vendor industry while ensuring the confidentiality and security of patient information. Most importantly, we urge governments to expedite agreement on a strengthened national leadership structure for implementing a National Action Plan on E-health, with defined actions to be achieved by specified dates.

Access to good information is also vital to measuring and monitoring the health of our population. We are recommending the development of Healthy Australia Goals 2020 – the first in a rolling series of ten-year goals. We want all Australians to participate in setting these goals and working towards improvements in health outcomes at local, regional and national levels.

End Quote.

Comments on all this will follow after details digested.

David.

Update on NHHRC Report Release on July 27, 2009.

The following appeared in the Sunday Telegraph this morning.

PM to Unveil Health Plan.

Prime Minister Kevin Rudd is set to unveil his long awaited plans to fix state hospitals tomorrow, plans that are expected to fall well short of his election promise of a federal takeover.

Instead, Mr Rudd is tipped to reveal pared down recommendations from the NHHRC for a limited takeover of hospital outpatient services.

A spokesman for Mr Rudd would not confirm tomorrows launch, except to say the Prime Minister was scheduled to make a speech concerning health.

But invitations to the event – described by some participants as “looking like a wedding invitation” – have already been sent out to key health sector players,

The event, at the Australian National University, is billed as a prime ministerial speech, followed by a discussion with participants.

----- End Quote.

This sounds pretty well sourced to me so we can all plan a busy day tomorrow!

Thanks to ABC Insiders for the vision of the press report.

David.

PM Speech Alert on Future of the Health System.

Listening to Insiders on ABC TV today I noticed one of the guests mentioned that the Prime Minister is giving a speech on the future of the Health System tomorrow – Monday 27, July 2009.

It was suggested that the speech was going to announce the takeover of the non-hospital health sector. We shall see!

It would be nice if e-Health were to get a mention if this is a major directions speech. I notice that in the 6000+ words on policy published in the Herald and Age on Saturday 25 July there was mention of the need for reform but no mention of e-Health.

See here:

http://business.smh.com.au/business/the-road-to-recovery-20090725-dwg5.html?page=-1

I can’t find any confirmation on the web as yet – but the timing is what we were expecting for the timing of the release of the NHHRC Final Report. We were told a week or so ago the report was at the printers.

As they say – ‘Stay Tuned’.

David.

Useful and Interesting Health IT News from the Last Week – 26/07/2009.

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

First we have:

E-prescribing a ‘freaking mess’

23-Jul-2009

A race to sign up GPs to electronic prescribing systems is undermining the public good, independent observers say.

E-script software brands Medisecure and eRx are both calling on GPs to register with their software for free, and start using scripts with barcodes to reduce transcription errors at the pharmacy.

They say that once the Federal Government rolls out patient and provider health identifier numbers from next year, the e-scripts may start to replace paper scripts altogether.

But because the two systems are not interoperable, an e-script will only function if the pharmacist uses the same software as the GP.

Health IT specialist Dr David More said the situation was "a complete freaking mess".

.....

A spokeswoman for the Federal Health Department would not comment on whether GPs should start using either system.

Dr Mukesh Haikerwal, an advisor to NEHTA, said prescriptions needed to be readable one system to another, and not dependent on the supply of software.

"The problem is these two companies have beaten the standards setters to the post," he said. "They are not helping anyone."

More here (subscription required):

http://www.australiandoctor.com.au/articles/71/0c062a71.asp

Three points:

First your blogger is going to be a bit more reserved in chatting with journalists (but the quote is accurate)!

Second obviously NEHTA and DoHA are not all that impressed either with what is going on.

Third – does anyone remember this tender?

RFT 272/0809

REQUEST FOR TENDER

EPRESCRIBING AND DISPENSING OF MEDICINES BENEFITS REALISATION AND IMPLEMENTATION PLAN

LODGEMENT OF TENDERS (Refer Part A, Section 3.1)

Tenders must be lodged by “Tender Closing Date” (2.00pm local Canberra time on Thursday 23 April 2009).

I am told that it will still be a week or two before the contract to do this work is awarded – at the earliest – and given the work is to take 34 weeks we are looking at close to the middle of 2010 before DoHA will even have a plan of what to do. Just amazingly pathetic in my view!

Invaluable background is found here:

Canberra fails to follow the online script

Karen Dearne | July 18, 2009

Article from: The Australian

DOCTORS and pharmacists have lined up behind rival electronic prescribing systems that will eventually spell an end to paper scripts, despite an e-prescribing policy vacuum in Canberra.

Two main players have emerged to claim the new market, with the Pharmacy Guild's 50 per cent owned eRx Script Exchange first out of the blocks. MediSecure, endorsed by the Royal Australian College of General Practitioners, is not far behind.

At stake is a potential $60 million annually, with both players set to charge a 25cent fee for each transaction out of 240million prescriptions issued each year.

They are forcing the pace as federal Health Minister Nicola Roxon has yet to provide clear direction. As well, the Department of Health and Ageing is scrambling to complete internal investigations of key management and operational concerns.

A spokeswoman says the department is ``still considering'' the outcome of a tender earlier this year calling for consultants to draw up an e-prescribing business and implementation plan in response to a previous critical report from financial advisory firm KPMG last year.

But the spokeswoman indicates the department may play ball on transaction fees, an item certain to be on the agenda as the Pharmacy Guild sits down to thrash out the fifth community pharmacy agreement. Negotiations are gearing up now.

``The issue of payment arrangements will be considered if it arises, taking into account the business efficiencies that e-prescribing and dispensing provides,'' the spokeswoman tells Weekend Health.

Much more detail here:

http://www.theaustralian.news.com.au/story/0,25197,25796849-23289,00.html

Second we have:

Essential e-health is watertight

Article from The Advertiser

July 20, 2009 12:01am

THE implementation of a national e-health system may well save money and probably lives.

Eight in 10 Australians believe it is a good idea. But, as with any genuine reform, the Federal Government must be sure it gets the process right. Doctors and their patients must be satisfied that the system is secure and reliable.

In 2004, a national body was set up by the country's health ministers to drive e-health forward. In 2006, then-opposition health spokeswoman Julia Gillard attacked the Howard government for lagging on the issue. She said it was "dangerously close" to being an "expensive failure".

It was then spruiked at Prime Minister Kevin Rudd's 2020 Summit, and the details released in today's Advertiser are another important step forward.

Shared electronic records will give patients more control over their medical care by allowing them to easily access their own information, such as vaccination, prescription, and chronic disease information.

It will give doctors more control by helping to stamp out "doctor shopping" and allowing better continuity of care.

More here:

http://www.news.com.au/adelaidenow/story/0,22606,25807068-5006336,00.html

It is good to see we are now even seeing editorials on how useful e-Health could be. They do also not it has to be done right – that is where the risk lies right now!

Third we have:

AMA criticises plans for 'e-health' medical records reform

Plans to give Australians access to their health records online are being criticised by the nation's peak medical body.

The proposal has reportedly been put forward by the National Health and Hospitals Reform Commission (NHHRC).

Under the plan doctors would have to link patient records to a national database, with those who don't comply to miss out on lucrative medicare payments.

But AMA President Andrew Pesce says threats won't result in a quality system.

"It would be much better to provide adequate incentives to recognise there will be an initial financial outlay and cost to developing properly working medical records."

The NHHRC says an e-health system would save the government up to $8 billion over 10 years, making it easier to track the progress of chronic disease sufferers and store test results, scans and x-rays.

More here:

http://livenews.com.au/news/ama-criticises-plans-for-ehealth-medical-records-reform/2009/7/20/213407

Dr Pesce is dead right to point out that imposing penalties without some prior incentives is just crazy!

More AMA commentary is here:

http://www.news-medical.net/news/20090720/e-Health-revolution-will-give-Australian-patients-access-to-their-health-records.aspx

e-Health revolution will give Australian patients access to their health records

20. July 2009 01:01

The Australian Medical Association (AMA) which represents than 27,000 doctors across Australia has criticised the government's plans for 'e-health' medical records reform.

And here:

http://www.australianit.news.com.au/story/0,25197,25819833-15306,00.html

E-health vital to rural areas: AMA

Karen Dearne | July 22, 2009

E-HEALTH infrastructure in rural Australia must be a priority for federal and state governments, the new president of the Australian Medical Association, Andrew Pesce, has warned.

Fourth we have:

Experts warn of e-health privacy threat

22-Jul-2009

By Sarah Colyer

PRIVACY experts are warning of mayhem -- including greater identity theft and dubious secondary use of patient information -- when Medicare begins its rollout of electronic health identifiers next year.

The proposed system is designed to allow health professionals to send data to each other without the risk of the information being intercepted or corrupted by third parties.

In a discussion paper released last week, the Australian Health Ministers' Advisory Council said Medicare would introduce operational identifiers for patients and health providers from mid-next year -- before national privacy legislation had been finalised.

Existing federal, state and territory privacy laws would apply in the interim, it said, despite noting that the laws were inconsistent and confusing.

Chairwoman of the Australian Privacy Foundation's health sub-committee Dr Juanita Fernando (PhD) said, "in any kind of project management situation this would be laughed at".

Full article here:

http://www.australiandoctor.com.au/articles/c4/0c0629c4.asp

This debate has a while to run yet I believe.

Fifth we have:

Doctors issue deadly warning

David Bancroft | 23rd July 2009

IT seems incredible that a patient record system that aims to improve treatment could kill people, but that is a claim being made about a new system that is almost certainly going to be introduced into the Grafton Base Hospital next week.

Earlier this month, leading health officials from the Lismore Base Hospital wrote to the North Coast Area Health Service (NCAHS) claiming a new Surginet electronic medical record system that had been operating in the hospital for several months would 'inevitably' lead to the death of patients.

But the health service said changes had been made to the Surginet electronic medical record (EMR) system since the concerns were raised by the four senior clinicians on July 2, and the system had been operating 'satisfactorily' in Sydney without patient concerns being raised.

In their letter to NCAHS chief executive officer Chris Crawford, which was copied to the Minister for Health John Della Bosca, the four medical specialists said there had been recurring problems over several months and 'these have not improved'.

“This has resulted in unnecessary compromise of patient safety,” they wrote.

“There have been repeated well demonstrated cases of near miss disasters due to these problems.

“We believe that negative patient outcomes, including death, will inevitably result from the continuing use of this system.

“Surginet is fundamentally flawed.

“New technology should: improve the quality of our work; help us to be more efficient, and; make routine tasks easier.

“EMR Surginet does none of these; in fact it has had the opposite effect.

More here:

http://www.dailyexaminer.com.au/story/2009/07/23/doctors-issue-a-deadly-warning/

It seems there are some ongoing issues with these implementations in the rural areas. I will be interested to hear comments from those involved.

Sixth we have:

Crikey July 23, 2009

3 . Aboriginal patients may end up the real losers in ACC victory

Paul Smith, political editor of Australian Doctor, writes:

After a long-running legal tussle, a remote Aboriginal health clinic has lost its battle against the Australian Crime Commission (ACC) to safeguard the privacy of its patient records. Subject to another appeal, the clinic will have to hand over the records of eight Indigenous children to the ACC.

Whether those records contain information which is of sufficient importance to justify the protracted efforts of the country's most powerful crime-fighting organisation to seize them is one of many unanswered questions about this case. But I doubt the ACC bosses will have been celebrating its legal victory with much enthusiasm.

Firstly the court case itself has lifted the lid on activities it was desperate to keep secret. It used a series of gagging orders to stop anyone approached for medical records revealing to either patients or the wider public what was happening. The penalties were fines and jail sentences.

Secondly when you read the Federal Court ruling, you get a picture of an organisation that seemed to pay little regard to the implications of its actions -- for the clinic, the Indigenous community or the patients treated at the clinic.

The Federal Court found the ACC had a legal obligation to consider "the interests of the children" when forcing the clinics to hand over the records. It seems the commission managed to do this -- just. The Federal Court ruled that by acknowledging the clinic's concerns that the children and others may not seek medical attention if they discovered their files were being secretly handed over to crime investigators, the ACC had met its obligation.

But it is important to stress the court did not consider whether the commission had, for instance, carefully weighed the pros and cons and come to a well-informed, reasoned decision to issue its legal orders. The court never looked at that issue (it was not part of the appeal) even though it described ACC's attempts to document in the paperwork its reasons for seizing the records as "laconic, formulaic and often unhelpful", suggesting it may have been a "tick-box" exercise.

Much more here (subscription required):

http://www.crikey.com.au/2009/07/23/aboriginal-patients-may-end-up-the-real-losers-in-acc-victory/

This is an issue that still has a way to run. I don’t feel what was done here was in any way appropriate. The way the ACC went about this is repressive in the extreme I believe. As a commentator points out all sorts of similar records are likely to vanish unexpectedly at the first sign of a request for information of this kind!

Seventh we have:

HCL Axon bags Ramsay SAP deal

Fran Foo | July 21, 2009

HCL Axon has scored a gig worth almost $1.5 million with Ramsay Health Care for its multi-million-dollar SAP project.

Despite the economic crunch, Australia's largest private hospital operator in January began the selection process for a partner to undertake its ambitious SAP plan.

Ramsay is in the midst of deploying SAP ERP 6 for financials, purchasing and inventory management, as it moves to consolidate legacy systems gained through acquisitions.

Half of Ramsay's sites run on an older SAP platform, while Pronto Software, a Melbourne-based ERP player, powers the other half.

According to Brian Pereira, HCL Axon's head of Asia-Pacific, Japan and Middle East, Ramsay will be able to standardise business processes and information currently not possible, as the two systems are structured and configured differently.

"Key benefits will be the elimination of duplication in data, reporting and processes," Mr Pereira said. "Ramsay went through a selection process in January and the actual project commenced in March 2009. Our consulting services component is worth nearly $1.5m."

In Australia, SAP will be deployed in three stages -- until March next year -- covering about 70 Ramsay sites.

More here:

http://www.australianit.news.com.au/story/0,24897,25810041-15306,00.html

Here we have a large hospital chain doing the other important aspect of e-Health, improving efficiency and information flows in the administration of their hospitals.

Eighth we have:

Medical mix-ups add to patient's misery

Laurann Yen | July 25, 2009

Article from: The Australian

WHEN Doris Lessing, the 2007 Nobel Prize winner for literature, was asked whether she was still writing, she said she didn't have the time at her age.

She was either at the doctor, chemist, physiotherapist or taking someone else to see them.

People living with chronic illnesses need to manage the logistics of their many appointments and the complex nature of their treatment. It can be a full-time job. Patients who live at home might take more than 30 medicines a day. They struggle to balance their health with the demands of everyday life.

The health round table, an industry benchmarking collaborative, has shown that regardless of the reason for admission, people with multiple illnesses have longer stays in hospital.

Governments have attempted to improve the clinical quality of care through guidelines and incentives, but patients are burdened with services that are delivered by myriad players with different agendas and rules.

Making life manageable for people with chronic illnesses requires reform in the organisation and delivery of health care. There needs to be better co-ordination between all involved, from patients to senior specialists.

A focus on inter-professional learning and practice in a system that is patient-focused may offer our best hope of achieving change.

Patients need comprehensive and co-ordinated care across all jurisdictions, but they don't get it. The Pharmaceutical Benefits Scheme, for example, may list a medication but not include appliances needed to administer and monitor the drug. States and territories have different rules about what a resident is ``entitled'' to and funding depends on different definitions of comparative need and risk.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,25829258-23289,00.html

Another recognition of the importance of e-Health in improving patient safety.

Ninth we have:

Stephen Conroy is confronting a tangled web

Jennifer Hewett | July 25, 2009

Article from: The Australian

STEPHEN Conroy is not a man to concede too many problems. So the fact that Kevin Rudd has given his Communications Minister a seemingly impossible task doesn't appear to have dinted Conroy's confidence that he can deliver high-speed broadband to every home in Australia.

The era of POTS -- Plain Old Telephone Service -- has long been relegated to the dinosaur era. But the official message is that Australia's move to high-speed broadband will transform the way society and the economy work. It is a popular line with the public and it will be repeated by the government from now until the next election. The Prime Minister already likes to refer to it as his legacy to the country. What lies beneath the rhetoric is considerably more messy.

The government is about to announce the chairman of the national broadband network company, as well as the lead adviser for the six-month implementation study on how to pull off the "nation-building" project. Melbourne, Sydney and Brisbane are jostling to host the headquarters. A chastened Telstra is being extremely polite about its determination to engage with Canberra and to become involved with the grand vision for the country's telecommunications. No more aggressive talk of protecting shareholders from the depredations of oppressive government regulation. The new Telstra would rather wash its ducts out with soap and water than even hint at criticism of government.

Even the voters don't appear to have been blinked at the theoretical price tag massaged into shape via the Department of Finance and then finessed into a $43billion headline figure by Conroy and his department. And an army of lawyers and financial and technical advisers on the project have their own version of government stimulus spending to keep them busy while private sector opportunities remains so dismal.

Much more here:

http://www.theaustralian.news.com.au/business/story/0,28124,25830445-5013565,00.html

This is an excellent article that highlights just how difficult this may be to move forward.

Lastly the slightly more technical article for the week:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

Microsoft wraps up Windows 7, declares RTM

Freezes code, signs off on build, hands over to OEMs

Gregg Keizer 23 July, 2009 07:59

As anticipated, Microsoft this afternoon announced that it had finished work on Windows 7, declaring that the new operating system had met the "release to manufacturing" (RTM) milestone.

"Today, after all the validation checks were met, we signed off and declared build 7600.16385 as RTM," said Microsoft spokesman Brandon LeBlanc in a message that will be added later today to the company's Windows 7 blog.

Microsoft also announced that Windows Server 2008 R2, the server software companion to Windows 7, reached RTM today. Both Windows 7 and Server 2008 R2 are slated to launch Oct. 22.

"The RTM code will be delivered to our partners within the next few days who will then start preparing to deliver some amazing new products timed to hit at General Availability (GA) of Windows 7," said LeBlanc today, referring to the Oct 22 public debut.

Much more here:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

I have to say this seems to be going very smoothly. The following article makes the point that if you are an Win XP user the upgrade is a major pain – so find out details before leaping.

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

For Some, Move To Windows 7 Will Be Tough

By WALTER S. MOSSBERG

On October 22, Microsoft will finally release a new version of Windows that will be as good as the deeply disappointing Windows Vista should have been when it came out in January 2007. The new edition, called Windows 7, is a big improvement over both Vista and the sturdy, 2001-vintage Windows XP still widely in use. It will give Apple’s long-superior Mac OS X operating system a run for its money (though Apple might maintain its edge with a new version, called Snow Leopard, due in September).

Full article here (subscription required):

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

More next week.

David.

Report Watch – Week of 20, July, 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:

Monday, July 13, 2009

Health Care Stimulus Funding Process Picking Up Speed

by Helen Pfister and Karyn Bell, Manatt Health Solutions

Since the American Recovery and Reinvestment Act was signed in February, the federal government has been moving relatively rapidly to get balls rolling on multiple fronts. In health care, the process is picking up speed in several areas as a result of recent efforts, including:

The release of the Office of the National Coordinator for Health IT implementation plan for health IT;

• The release of CMS' implementation plan (including guidance on Medicare and Medicaid electronic health record incentive payments);
• The development of a definition of "meaningful use" as it pertains to stimulus payments; and
• Broadband access.

Full article here :

http://www.ihealthbeat.org/Features/2009/Health-Care-Stimulus-Funding-Process-Picking-Up-Speed.aspx

Clearly after the legislation was passed things are happening. The following documents show where things are up to at present:

• EHR Incentive Payment Timetable (.pdf)
• ONC Implementation Plan Timeline (.pdf)
• FCC rural broadband report (.pdf)

Second we have:

Rand report focuses on RFID in health

Tags: European Commission RFID

15 Jul 2009

A major new research report commissioned by the European Commission has detailed the opportunities for, and barriers to, the deployment of auto-tracking technology in European healthcare systems.

The report, which focuses on Radio Frequency Identification (RFID), says that despite being a useful tool in logistics and operational management it is so far “less successful in patient care and quality of care improvement.”

The report states: “Compared to logistics, patient care delivery applications face greater implementation problems. Interference of RFID and other wireless equipment with electronic equipment remains the single biggest obstacle to RFID roll-out in healthcare.”

The study titled: “Requirements and options for Radio Frequency Identification application in healthcare,” was conducted by RAND Europe, the US-based policy research organisation.

The report includes an assessment of expert views from the healthcare industry and seven case studies from healthcare organisations in Italy, the Netherlands, Germany, Switzerland, America and the UK in order to establish the cost benefits of existing RFID applications.

It stresses that RFID is not unique in many of its functionalities and that other more consolidated auto tracking technologies, such as bar coding and DataMatrix [2-D bar coding], provide similar capabilities, often for a lesser cost.

....

The report concludes that the benefits of RFID depend largely on organisational, financial and technical considerations and that, in particular, strong commitment of senior management and direct engagement of all relevant interests are essential.

More here:

http://www.ehealtheurope.net/news/5032/rand_report_focuses_on_rfid_in_health

Report Link

Study on the requirements and options for Radio Frequency Identification application in healthcare

Interesting indeed! Not surprisingly, the report points out you have to choose the application to get the benefits – and also review alternatives!

Third we have:

Calif. P4P program sees IT improvements: report

By Rebecca Vesely / HITS staff writer

Posted: July 17, 2009 - 11:00 am EDT

The largest private pay-for-performance program in the country has had major successes, including health information technology adoption, but has overall "fallen short of expectations," according to a retrospective report.

The Integrated Healthcare Association's California Pay for Performance program, now in its seventh year, today includes eight health plans, 35,000 physicians and 11.5 million HMO members.

In a report looking at its achievements since 2006, Oakland, Calif.-based IHA concludes that patient experience gains have been marginal and costs should have been a consideration earlier on.

Although average clinical performance has steadily improved, there are significant regional variations across the state, according to the report.

On a brighter note, IT to support better care has substantially improved. In 2007, two-thirds of physician groups participating showed some IT capability for measuring pay-for-performance, about double since 2003. And one-third have robust care-management processes, according to the report.

More here:

http://www.modernhealthcare.com/article/20090717/REG/307179991

This is an interesting report – again highlighting the need to measure what you are doing if you are to know if you are getting anywhere!

Fourth we have:

E-Health Intelligence Report – WHO

July 14, 2009

eHealth Worldwide

:: Afghanistan: Telemedicine in Afghanistan (8 July 2009 - Federal Telemedicine News)
Roshan the leading telecom operator in Afghanistan announced that telemedicine is expanding beyond Kabul to include provincial hospitals. Bamyan Provincial Hospital (BPH) will be the first provincial medical facility linked to the telemedicine project to use broadband technology, wireless video conferencing, and digital imaging transfer.

Reports and Articles (30+) continue here:

http://www.who.int/goe/ehir/2009/14_july_2009/en/index.html

Large collection of useful and interesting material

Fifth we have:

Policy Post 15.13, July 13, 2009

A Briefing On Public Policy Issues Affecting Civil Liberties Online from The Center For Democracy and Technology

Government Information, Data.gov and Privacy Implications

A full copy of the memo upon which this Policy Post is based is held here.

1) Government Information, Data.gov and Privacy Implications

2) De-identification ad Re-Identification of Data Sets

3) Key Principles for De-Identification and Use of Data Sets

The article is found here:

http://cdt.org/publications/policyposts/2009/13

Much of this is applicable to health data and there are links provided to more information

Lastly we have the:

100 Most Wired Report for 2009.

Start Browsing the Information from here:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2009/0907HHN_Coverstory&domain=HHNMAG

Lots of useful and interesting information on the impact of Health IT on Quality, Safety etc.

Enough for one week!

Enjoy!

David.