NEHTA’s National Product Catalogue (NPC) Still Rolling Along – Like A Glacier!

More news on the National Product Catalogue arrived a few days ago.

Pfizer Australia joins the NEHTA National Product Catalogue

7 October 2009. Australia’s number one consumer healthcare company and a leading provider of prescription medicines, Pfizer Australia, has committed to a national approach to e-health supply chain reform by including approximately 1000 products in NEHTA’s National Product Catalogue (NPC).

In line with NEHTA’s goal to drive the uptake of e-health systems nationally, the inclusion of an organisation like Pfizer Australia committing to being part of a primary source of data is a positive step.

Australia is one of the first countries in the world to develop a single, national product catalogue and it provides significant benefits for the Australian health sector. NEHTA’s NPC uniquely identifies healthcare products, including medicines and medical devices and equipment, and records important supply chain and clinical information about those products such as the components of products and pack sizes. Suppliers populate one catalogue with standard data and globally unique identifiers.

This product data, through the NPC, is then made available to procurement areas from public health departments and private organisations who have signed up to the NPC. The NPC reduces the duplication of effort and data errors which is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.

It is NEHTA’s objective that the NPC will be the primary source of data for all health-related purchasing in Australia which will remove the need for around 750 public and 280 private hospitals (among other healthcare purchasers) to maintain their own product data.

To date, more than 225 healthcare suppliers have now loaded products to the NPC.

For more information on the Supply Chain work program go to

http://www.nehta.gov.au/connecting-australia/e-health-procurement

The press release is found here:

http://www.nehta.gov.au/media-centre/nehta-news/545-pfizer-australia-joins-the-nehta-national-product-catalogue

There is previous commentary provided on the progress of this glacial program found here:

http://aushealthit.blogspot.com/2009/06/nehta-national-product-catalogue-seems.html

and here:

http://aushealthit.blogspot.com/2009/01/glacial-saga-of-e-procurement-in-health.html

and here:

http://aushealthit.blogspot.com/2007/10/nehta-provides-annual-report-for-2006-7.html

The issue here is, of course, the spin in this release.

It says, very carefully, “To date, more than 225 healthcare suppliers have now loaded products to the NPC.” What it does not say is that these suppliers have loaded ALL their products and it does not point out that there were, even in the late 1990’s, over 700 significant suppliers in the pharmaceutical industry sector alone when the issue was examined by the PeCC study.

See here:

http://www.dbcde.gov.au/Article/0,,0_4-2_4008-4_15124,00.html

Also not mentioned is that in the 2006/07 Annual Report NEHTA said as one of its major outcomes:

“Australia’s National Product Catalogue was released, with over 50 of Australia’s top medical and pharmaceutical product suppliers taking advantage of the improved ability to communicate up-to-the-minute information about their products directly to current and potential customers.”

Over two years later we are now getting press releases when one supplier joins. At this pace the system will reach critical mass somewhere after 2015 I reckon.

At what point does the Auditor General decide to look at things like this I wonder.

In June 2007 NEHTA was claiming:

“What is happening?

• Most large suppliers indicate they will be NPC compliant by 30 June 2007 –significant effort and resources invested.
• States and Territories working to be able to utilise NPC data from 1 July 2007 –significant resources being invested –need the NPC populated for it to be a viable single source of data.”

Source: Ken Nobbs Presentation 27 June 2007.

Now in the new NEHTA Strategy (Oct 2009) we read:

Planned Actions (Till Mid 2011)

1. Deliver the NPC working with suppliers so that they are populating the NPC with product offerings;

2. Alignment of the NPC with the Australian Medicines Terminology;

3. Increase the adoption of the NPC by the private sector;

4. Extension of the adoption of the NPC with health Jurisdictions;

5. Rollout the e-Procurement solution with WA Health;

6. Rollout the e-Procurement solution across other Jurisdictions and promote uptake by the private sector; and

7. Investigation of further supply chain solutions for health, which may be leveraged from international experience and other industries.

I read this as saying we have really yet to get started 2 years later. Fixing the supply chain was in the original NEHTA mandate from now 5 years ago by the way.

This area actually matters and if properly done can save a lot of money – but clearly no one gives a hoot. Hopeless.

David.

Note: "The PeCC Story: Project Electronic Commerce and Communication for HealthCare- 2000” seems to have disappeared from the web. It is a valuable document on what should be done with Supply Chain Management and its principles have been widely adopted in other areas. Sadly it seems to be rather stalled in Health.

Download here:

http://www.moreassoc.com.au/downloads/PeCC%20Story.pdf (2.7Meg)

Enjoy.

D.

Alert: E-Health on the ABC's 7.30 Report Tonight (October 13, 2009).

Tonight the 7.30 Report ran a long piece on e-Health, EHR Privacy, the IHI, the lack of consumer involvement in the planning process (which was justified by Ms Roxon saying citizens would not understand all this technical stuff so there is no need to ask them!) and so on.

I am sure all this will be up later tonight or early tomorrow at:

http://www.abc.net.au/7.30/

There will be vision downloads and transcripts as usual.

Enjoy.. and note just how condescending our Health Minister is of the ordinary public. She could single-handedly set e-Health back a year or so with such stupid comments.

The transcript is here:

http://www.abc.net.au/7.30/content/2009/s2713265.htm

Here is the last bit of the discussion with the Health Minister and others (note bits in italics):

MARY GEARIN: According to the Health Minister, the new health-care identifier may be accessed by a smart card or pin, but won't have health information directly stored against it. The number is meant to simply serve as a link for authorised users.

NICOLA ROXON: People have a very high acceptance of the use of a Medicare number. This will obviously be different to that, and not using the Medicare number. But I think when it comes to health, people have a very good understanding of why you want to keep comprehensive records and why that ultimately helps you as an individual.

DAVID VAILE: As a database developer, I know that if you get the single number you can use that to tie everything together. And so even if they are distributed around the planet, you know, in 100 different systems, if you have got one number, it become almost impossible to properly control the use and access and reuse, the distribution, the transmission around the world of that information.

NICOLA ROXON: Sometimes I think we jump a little bit too much at shadows, that this is a way to improve patient care, save a lot of time for the patients and health professionals, and reduce a lot of wasted expenditure for extra tests and repeat tests that don't need to be done.

MARY GEARIN: In a submission on the issue two months ago, the office of the privacy commissioner noted that enabling such easy and accurate linking of data could create an environment in which linking might be done excessively and sometimes without adequate justification. The office called for greater certainty around the secondary uses of the information.

Will it be illegal for instance, employers or life insurance companies to have access to this material?

NICOLA ROXON: Again, I think these are really quite ridiculous questions when we are talking about patient-controlled information of your personal health records. Putting that into an electronic form doesn't change the law related to every other situation.

DR MUKESH HAIKERWA: The issue of secondary use of data is not covered by these provisions at this point in time. But any use of data that will be gleaned from this has to be with the patient's agreement.

MARY GEARIN: It's planned that whoever accesses the records will leave electronic fingerprints, but the minister admits many details, such as how potentially sensitive information is stored is yet to be thrashed out.

Juanita Fernando is frustrated by a process that has seen only invited advocacy groups including hers involved in the development of the system.

JUANITA FERNANDO: We need to hear a consumer voice - and there's no consumer voice.

NICOLA ROXON: I think trying to have the public intimately involved with every piece of technical advice that we are getting on how the different pharmacy information and GP information, hospital information will link up is probably beyond the interests of most people. So I don't think that sort of discussion has to be had publicly.

DAVID VAILE: They have not taken people into their confidence and they haven't put solving the privacy risks for real people in a way that is persuasive and reliable, they haven't put that at the heart of the process when it should have been.

DR MUKESH HAIKERWA: The paramount building block is confidentiality, if you don't have that people won't square up with you and you don't get the full information.

MARY GEARIN: For Jim Morgan, e-health and its promises of efficiency can't come fast enough.

JIM MORGAN: Yes I'd prefer others didn't get access to it, but what on earth are they going to do with it anyway?

---- End Transcript

Ms Roxon clearly thinks no one has the right to ask questions they see as important

David.

NEHTA Reveals it is Totally Clueless - It is Really Very Sad.

Today we have two articles based on discussions held with NEHTA last week at the MSIA meeting. What we learn from these is enough to make the most robust of e-Health in Australia proponents just break down and weep.

A healthy start on e-records

The world according to Peter Fleming | October 13, 2009

IT is about a year since Peter Fleming became Australia's e-health boss with a mandate from the nation's health ministers to speed up electronic reform of the notoriously fragmented health sector, and enable doctors to securely send and receive patient health information.

Set up in 2004 as a not-for-profit company, the National E-Health Transition Authority is developing the technical standards and regulatory frameworks to underpin the widespread adoption of e-health systems.

Fleming's experience in large technology projects in retail, banking and pharmaceuticals was seen as a welcome balance to the organisation's earlier academic focus, and he has been out talking to doctors, software developers and consumers ahead of a shift towards delivery.

Now that you have released NEHTA's strategic plan for the next three years, what happens from here?

First, the strategic plan should not take anyone by surprise. It's really just enunciating things we've been talking about for a while.

It's still fairly high-level, I accept that, but we're trying to follow a process and avoid confusing people. While we will publish the detail, we want to articulate the big-picture stuff first, so that when people do look at the detail it's in context.

The overall plan obviously will be influenced by feedback from stakeholders but I'm expecting to present that to the NEHTA board when it meets on the October 27.

We have been doing quite detailed work on the business and technical architectures, talking to the software people about the technical issues and helping clinicians understand the business architecture and process issues.

As part of defining the strategy for each of our audiences, we're producing a series of documents that puts things in context for a general practitioner or a consumer representative.

It's an iterative process and clearly that dialogue is starting with the peak bodies.

Phase one is already well under way. I was working through a draft of the business architecture last week, and we're ready to take it to stakeholders for feedback.

I can't give you a date for its public release, but I expect it will be this year.

I saw a draft of the GP document late last week. There's a lot more work to be done there but it should be released within the next two months.

The other aspects involve the more detailed timelines you'd expect to see for each of our main projects, as well as who is responsible for doing what. Clearly that also has to be linked into planning by each of the jurisdictions.

Many more amazing responses to important questions here:

http://www.australianit.news.com.au/story/0,24897,26200137-24172,00.html

and we also have this:

Governments change direction on health e-records

Karen Dearne | October 13, 2009

GOOGLE, Microsoft and other new providers will host Australians' electronic health records as the federal and state governments back away from funding a nationwide scheme.

National E-Health Transition Authority chief executive Peter Fleming said the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly.

The Council of Australian Governments is yet to make a decision on the business case for individual e-health records put to it by NEHTA a year ago, but Mr Fleming said the health ministers were pushing the organisation to take "a far more commercial approach".

"Five years ago, there was a strong view that there would be an e-health record for all Australians held on a massive database somewhere," he told the Medical Software Industry Association conference in Sydney last week. "That's no longer the view.

"When and if the e-health record is approved, we'll enter into detailed planning around the architecture, but undoubtedly people will have an option to choose health records from a range of sources and their medical information will be stored in a number of locations."

Mr Fleming said the foundation work on healthcare identifiers, secure messaging and other technical standards would support a rollout of personal health records by 2012, although a new indexing service would be needed to bring disparate files together at the point of care.

To cater for emergency situations, a health summary containing key medication and allergy data could be linked to the index. "Certainly there needs to be a viable financial model for the private sector, in terms of margins or incentives, but I would see those things occurring," Mr Fleming said.

"One of our directions now is how we engage the private sector and move these things forward."

NEHTA has released to public discussion its strategic plan for the next three years to 2012.

More here:

http://www.australianit.news.com.au/story/0,24897,26200249-15306,00.html

What are we to make of all this?

First it is clear if you want to comment on the NEHTA Strategic Plan you had better be quick. The NEHTA Board is getting feedback on the 27^th of this month.

Second the interval between finalising the Strategy and now has been long enough for the putative “Individual Electronic Health Record” to morph from something that might have been managed and funded by Government to something that will be undertaken by Google and Microsoft and will provide Personal Health Records for the populace.

Just what healthcare providers are to do seems simply to have been just ignored. And there is an apparent expectation they it will be the providers who will provide the information to populate the Personal PHRs.

Given the benefits case for e-Health depends on automation of providers and not consumers this is just absurd there is not a plan to assist them and facilitate upgrade and adoption..

We now seem to have NEHTA building an e-Health infrastructure for something that is not going to happen, and which will not assist providers much at all.

The total lack of a strategic architecture in which to put all these pieces is something that is just absurd.

And as for providing a Strategy and not having the supporting documentation developed and available. What was the material that supported the conclusions that were reached in the core document then?

The is just not the way you develop the plans for or undertake a National e-Health implementation of any sort!

The bottom line here is that NEHTA simply does not have a plan, has no idea where to go next and has failed to attract any funds from Government. The time for a new inquiry into NEHTA and just what it is doing has really arrived in my view.

Read the full articles and you will see just how confused and directionless all this is!

David.

Is Thomas Beale Really Onto Something that NEHTA and Standards Australia Have Missed?

A week or so ago Dr Sam Heard of Ocean Informatics alerted me to the fact that the technical architectural lead of openEHR had started a blog to provide commentary on Health IT standards among a very diverse range of other things.

The blog can be found here:

http://wolandscat.net/

Tom describes his blog thus:

About

“Greetings. My real name is Thomas Beale. As a Leo, I naturally gravitate to cat-like personalities, and there is no better exemplar of such in the literary universe than Woland’s cat, Behemoth, from Mikhail Bulgakov’s ‘The Master and Margarita’.

I have some thoughts to share in various areas, ranging from my current domain of work (e-health standards, systems, and related technology) to philosophy (particularly of science), to linguistic and other amusements. Anything I say is meant in the spirit of debate, if not dialectic engagement, and no matter how controversial, is offered with the idea that we may still have a beer* together afterwards.”

What Tom is saying about Health IT Standards setting I believe is pretty important as he is a smart, well informed and pretty committed insider to all this.

In the two long posts he has put up so far there has been a lot of material. To let him speak for himself here is his summary of where he has got to.

The crisis in e-health standards II

In my last post I made three basic points:

1. that the committee-based process used by official standards organisations is not designed to be used for standards development and will not generate the required outcomes in e-health;
2. that the process of ‘choosing standards’ by governments (or anyone else) will not result in an integrated set of specifications on which widespread e-health interoperability can be based.
3. a new way of producing standards for e-health is needed.

Although for most engineering and other technical people, these points are obvious, it is nevertheless reasonable to present some evidence.

And at the end of the same very long post he says the following.

Conclusions (so far)

What does the above teach us? I would suggest that the evidence is clear for my points at the top of the post: developing standards inside SDOs doesn’t work; choosing a selection of standards to create a generalised ecosystem doesn’t work, although carefully engineered ‘profiles’ can be made to work for specific use cases. From the above we can see some of the features needed of an organisation(s) that can try to solve the problem of a standards ecosystem for e-health.

To my many colleagues in this field, I will simply finish this post with a comment an Australian colleague made some years ago, when he told me he had stopped putting ‘with hope for progress BIR’ (before I retire) at the end of emails in his health organisation, and instead was putting ‘BID’.

In the next post I will look more closely at what might be needed to ‘really solve things’ in the future.

----- End Quotes.

Also mandatory reading is found in the comments to Tom’s first post found here:

http://wolandscat.net/2009/09/17/the-crisis-in-e-health-standards/

From my observation of the Australian and International Standards setting processes over the last decade or two I cannot but agree that there has to be a better way to get real working outcomes that serve the needs of patients and clinicians. We are simply not getting stable, clear, future proof standards available and implemented in anything like the time frames that are needed. This is not to blame anyone but more to say that the task is ‘brain snapingly’ hard and it is just possible the complexity is such that, at the level of achieving genuine interoperation and semantic preservation it might approach being just ‘too hard’.

As I believe I have said in the past – ‘If this stuff was reasonably easily doable it would have been done long since’ – and I still think that is right.

With the number of years it has taken for NEHTA to deliver much that is actually operational and useful, and the ongoing strain the workload from IT-14 is putting on the volunteers I cannot but agree we had better figure out a better way and quick.

I await with some anticipation the third post when we are to be told ‘what might be needed to ‘really solve things’ in the future’.

As to the solution to all this all I can do is quote another blogger (Paul Roemer) well out of context and say “Here’s where I leave my pay-grade and need your help to see if this dog (of a new paradigm) can hunt.”

See here:

http://healthcareitstrategy.com/2009/09/18/how-about-552446474061128648601600000/

When you consider how long it seems to have taken to have SNOMED CT, HL7, openEHR and others to have an impact compared with the standards developed by the W3C (the WWW Consortium) , IETF and OMG there is at least a prima facie case for a change in approach! One has to ask is it the problem we are trying to solve that is too difficult or the way we are going about it?

I can’t wait to see what Tom (and others) are able to come up with!

David.

Interest in National E-Health Strategy Exceeds My Expectations.

Just a short blog to let readers know that the National E-Health Strategy has been downloaded 403 times as of 5pm on Monday 12 October, 2009.

If you do not have your copy please follow the link below:

http://moreassoc.com.au/downloads/National%20E-Health%20Strategy%20REPORT%20-%20Final%20Release%20300908%20v1.pdf

I would be keen to hear, via comments, what people think of it.

Enjoy!

David.

Useful and Interesting Health IT News from the Last Week – 11/10/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

Rushing to hospital? Don't forget medicines

DANNY ROSE

October 5, 2009

IF YOUR loved one is about to be rushed off in an ambulance, research shows there is something you can do to cut the risk of them facing a ''prescribing error'' in hospital.

An Australian study has shown that patients are better off carrying their prescription medications with them to the emergency department.

Having the drug packets on hand led to fewer errors in the recording of a patient's medication history and also reduced the chances of a patient receiving the wrong drug or dose errors during their hospital stay.

''Bringing a patient's own medication to the emergency department was associated with less than half as many prescribing errors on admission medication charts,'' said pharmacist and PhD candidate Esther Chan. Ms Chan and fellow researchers studied the cases of 100 patients admitted to Melbourne's Austin Hospital during a month in 2006.

They counted 428 different medications that arrived with the patients, and a 13 per cent error rate occurred when it came to their recording or ongoing delivery. The patients were also taking a total of 372 medications that they didn't carry with them - resulting in a prescription error rate of 25 per cent.

More here:

http://www.theage.com.au/national/rushing-to-hospital-dont-forget-medicines-20091004-ghwt.html

The level of error makes it clear just the level of impact accessible electronic records for the patients could provide.

The full paper can be found here:

http://www.mja.com.au/public/issues/191_07_051009/cha11452_fm.html

Second we have:

Beacon website shines light on e-health

October 7, 2009 - 12:04AM

The stresses of managing a budding acting career and her Year 12 studies is something Home and Away's Samara Weaving knows a little about.

The young star has helped launch a groundbreaking website which will help guide people, young and old, through the myriad of mental and physical e-health applications now available online.

The Beacon web portal, developed by a team at the Australian National University, is a world-first compilation of online mental and physical e-health programs.

Not only does it provide access to e-health programs for health professionals and members of the community, the site also provides a description and scientific rating of the effectiveness for each.

Weaving says she was happy to lend her support to the launch, adding that for her and others of her generation, the internet is where they get a lot of their information.

More here:

http://news.brisbanetimes.com.au/breaking-news-national/beacon-website-shines-light-on-ehealth-20091007-gljn.html

The portal is found here:

http://www.beacon.anu.edu.au/

This is a great idea – pity the press reports did not mention the link

This page explains the program well.

http://www.beacon.anu.edu.au/users/about

Third we have:

E-therapy moves in on the shrink's couch

ADELE HORIN

October 7, 2009

INTERNET therapy programs for depression and anxiety can be twice as effective as seeing a psychologist or psychiatrist in person, studies show.

A series of internet programs delivered to more than 1000 people appears to have produced better results than gained by seeing a specialist at one of the country's best mental health clinics, and much better results than reported in the scientific literature.

''We're doing something unnerving,'' said Gavin Andrews, professor of psychiatry at the University of NSW, and the director of the Clinical Research Unit for Anxiety and Depression at St Vincent's Hospital. He joked about ''the end of psychiatry as we know it''.

The apparent success of the programs poses fundamental questions for professionals for whom the patient-therapist relationship is considered integral to treatment.

More here:

http://www.smh.com.au/technology/etherapy-moves-in-on-the-shrinks-couch-20091006-glfb.html

More real world commentary on the mental health side of the portal cited above.

Fourth we have

Global Health extends Geelong reach

E-health solutions developer Global Health has been selected to provide its ReferralNet connectivity solution to the Geelong Medical Imaging practice. The system will be used as a secure messaging platform enabling the transmission of radiology results and reports to clients in the Geelong region.

More below:

E-prescription fix for Vic practice

The Coliban Medical Centre in Kyneton has completed a trial of an electronic prescription service provided by MediSecure. The installation was undertaken by Argus Connect (www.argusconnect.com.au)

More here:

http://tc106.metawerx.com.au/Rustreport/rust_newsletter_story.jsp?id=1864

A couple of interesting short reports from smaller companies. (links found at URL above)

Fifth we have:

Launch of world-first lymphoma awareness centre in Second Life®

October 6, 2009

Protected: Health 2.0 – launch of world-first dedicated lymphoma awareness centre in Second Life®

With the support of leading health consumer organisations Lymphoma Australia and the Leukaemia Foundation, Roche Products is pioneering the provision of health information through the launch of an innovative online, pilot cancer awareness program.

More here:

http://smr.cube.com.au/wp-content/plugins/st_newsletter/stnl_iframe.php?newsletter=4&code=l82UKLFsVZBHPaToJtpO

Interesting set of downloads from the link. Interesting e-health based campaign.

Sixth we have:

iSoft expects sales growth in 2009/10

October 6, 2009 - 1:39PM

Health information technology company iSOFT Group Ltd has reaffirmed that it expects sales growth of 10 per cent in 2009/10.

ISOFT, formerly IBA Health, publishes patient information software for hospitals and other healthcare providers, which also delivers health-related information via the internet and mobile phone messaging.

Executive chairman and chief executive Gary Cohen told shareholders at the company's annual general meeting on Tuesday that the company was well placed for growth.

"iSOFT forecast sales growth of 10 per cent in 2009/10 - almost five times the industry average," Mr Cohen said.

More here:

http://news.brisbanetimes.com.au/breaking-news-business/isoft-expects-sales-growth-in-200910-20091006-gkvl.html

This is encouraging for those of us who want at least some reasonably scaled Australian Health IT software providers (and have a few shares)

Seventh we have:

NBN Tasmania overhead cables 'foolish'

Matthew Denholm, Tasmania correspondent | October 09, 2009

TASMANIANS, guinea pigs for the national broadband network, could lose their high-speed internet for days on end because overhead cabling is vulnerable to the state's wild climate, a senate inquiry has heard.

Digital Tasmania, Tasmania's residential and small business IT consumer group, told the Senate's NBN select committee yesterday 96 per cent of the network's "backbone" in Tasmania would be via overhead cable.

Spokesman Andrew Connor told the committee, taking evidence in Hobart, that while overhead cables allowed a cheaper, quicker roll-out, his and other IT groups would prefer the fibre optic cable to be buried.

"It's a necessary roll-out method to get the roll-out happening in a timely period - if streets had to be dug up to lay new conduit or if existing conduit had to be accessed, it may be at a very high cost," Mr Connor said.

"(But) aerial cabling is a non-preferred option for many and that is because it is more susceptible to interference from mechanical interference - car crashes, floods and storms, as we've seen in Tasmania recently." Asked by committee chairwoman, Liberal senator Mary Jo Fisher, whether this meant using overhead cables as opposed to underground might prove to be "pennywise but pound foolish", Mr Connor said "certainly".

More here:

http://www.australianit.news.com.au/story/0,24897,26185993-15306,00.html

How silly can it be planning to create 50-100 year infrastructure like this? It seems there is also trouble brewing on the Government / Telstra front.

See here:

http://www.smh.com.au/business/conroy-says-winwin-possible-20091009-gqvd.html

Eighth we have:

$23m blowout in NSW IT project

Fran Foo | October 07, 2009

A MAJOR government IT project in NSW that commenced eight years ago will cost taxpayers an additional $23 million due to chronic communication breakdowns.

The project, originally due for completion in 2005, has not even passed the halfway mark and is set to deliver $50m less in savings. It is now forecast for full implementation by 2014.

NSW Auditor-General Peter Achterstraat's report on the project, released today, showed a lack of project governance and ownership - both detrimental to its successful completion.

In 2001, the government licensing project (GLP) kicked off with the aim of standardising and simplifying the licensing processes of all agencies, bar drivers’ licences by the Roads and Traffic Authority.

Due to be completed in four years, it was meant to replace 40 licensing systems in 20 agencies with a common platform.

Combined, these agencies issue 300 different types of licences to four million people and businesses in the state.

Originally, the GLP was slated to cost $63m and provide a net benefit of $69m. However, that price tag is expected to balloon to $86m over 12 years, delivering a net benefit of only $19m.

So far, 15 legacy systems have been replaced and 102 licence types consolidated to 55. The new system has been implemented in six agencies that are collectively responsible for 1.7 million licences.

More here:

http://www.australianit.news.com.au/story/0,24897,26177826-15306,00.html

This makes most e-Health projects look just wonderful. What a shambles!

Lastly for the week a more technical article:

Windows 8: Dying gasp or next big thing?

By Tim Ferguson, silicon.com

09 October 2009 02:50 PM

Just as the marketing hype around Windows 7 heads towards its peak, a few details are starting to surface about its likely successor.

You may groan but work on Windows 8, as Microsoft CEO Steve Ballmer has referred to it, is already underway.

The next generation of Windows is unlikely to appear for a few years — probably by 2012 — but Microsoft is working on what comes next, even before Windows 7 hits the shelves.

Ballmer for one has implied there is still more to come. "In a sense there's still a lot of work to do [with the operating system]," he said recently in London.

The company remains tight-lipped about the work being done but Ballmer has suggested that improved management and voice recognition are development priorities. There is also speculation that it may feature a 128-bit architecture.

Clive Longbottom, analyst with Quocirca, predicts virtualisation will feature more prominently with Windows 8. He said: "With Citrix, VMware and Microsoft all looking at how to give the ultimate experience to the user, expect to see virtualisation within the OS providing enhanced support for virtual desktops, for streaming applications, for access to applications when untethered and unconnected to the internet and so on."

He added that Windows 8 could be "a big step forwards towards being a unified client operating system" with Windows Mobile, Windows Embedded and Windows Client all becoming more aligned in terms of their release schedule.

Despite these potential additions, Longbottom suggests businesses won't necessarily be looking for a big shift with Windows 8 as they generally just want an OS that allows people to do their work while also helping to save money and time, extend the life of assets and provide better support for business processes.

More here:

http://www.zdnet.com.au/news/software/soa/Windows-8-Dying-gasp-or-next-big-thing-/0,130061733,339298984,00.htm

And Windows 7 isn’t even quite out yet!

More next week.

David.

NEHTA postpones Conference on Civil Wars to Fall, 2010

Sorry, this was just too funny to pass up..

NEHTA postpones conference on civil wars to fall, 2010

Posted October 7th, 2009 by Janna Bremer

The Board of Directors of NEHTA has decided to put off the conference on “Civil Wars” until the fall of 2010. This decision was not made lightly, but was agreed upon by the Board and the Conference Committee as a way to ensure wide participation and a top-flight historical conference. Given the difficult economic times, we are hearing that a number of schools are struggling with budgets and requests for out-of-school conferences. We are convinced of the importance of offerings such as our fall conference, but also know that attendance would be impacted by budgets. Further, our delay of the conference from an early October date to November was designed to give more time for registrations. Unfortunately, we also lost our keynote speaker in the process. By putting off the “Civil Wars” conference until 2010, the Conference Committee will have time to redesign the conference. In the meantime, we hope the economy will begin to turn around.

More here:

http://www.masscouncil.org/node/220

I knew things were bad, but this is just ridiculous!

By the way, NEHTA stands for the New England History Teachers Association in this context!

They have been around for a while.

“Founded in 1897, the New England History Teachers Association (NEHTA) is the nation’s oldest association of teachers of history and social studies in the United States. Through our conferences, publications, and awards, the NEHTA provides teachers, students and academics opportunities to engage in meaningful conversations about the teaching and learning of history and its related disciplines.”

See here:

http://www.nehta.net/history.html

Sorry!

Just a hoot.

David

Report and Resource Watch – Week of 5, October, 2009

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

First we have:

Women With Diabetes at Increased Risk for Irregular Heart Rhythm

Kaiser Permanente study finds association between diabetes and atrial fibrillation

PORTLAND, Ore., Sept. 28 /PRNewswire/ -- Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.

While other studies have found that patients with diabetes are more likely to have AF, this is the first large study--involving nearly 35,000 Kaiser Permanente patients over the course of seven years--to isolate the effect of diabetes and determine that it is an independent risk factor for women.

"The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm," said the study's lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes."

Much more here:

http://www.prnewswire.com/news-releases/women-with-diabetes-at-increased-risk-for-irregular-heart-rhythm-62289407.html

The article abstract is found here:

http://care.diabetesjournals.org/content/32/10/1851.abstract

Again the Kaiser Computer Systems are making useful contributions to clinical knowledge.

Second we have:

Australia - Towards national indicators of safety and quality in health care

This report sets out recommendations for a set of 55 national indicators of safety and quality in health care. The report concludes the National Indicators Project, a major project funded by the Australian Commission on Safety and Quality in Health Care (the Commission) and undertaken by the Australian Institute of Health and Welfare (AIHW) in close consultation with the Commission and a wide range of clinical and other stakeholders.

Authored by AIHW.

Published 29 September 2009; ISBN-13 978 1 74024 961 4; AIHW cat. no. HSE 75; 286pp.; INTERNET ONLY

More here:

http://www.aihw.gov.au/publications/index.cfm/title/10792

There is much more detail and downloads available from the link above. These indicators, once finalised, will doubtless be used to shape a ‘pay for performance’ program in Australia.

Third we have:

Dutch health system retains ‘Best in Europe’ crown

Published: Tuesday 29 September 2009

The Netherlands has the best healthcare system in Europe, according to the annual Euro Consumer Index. Dutch healthcare was top of the list for the second year running, this time with an even bigger margin of victory.

Background:

The annual Euro Health Consumer Index compares health services in 33 European countries based on patient rights, e-health, waiting times, outcomes, range of services offered, and access to medicines.

Last year, the Netherlands edged out Denmark to take the title of Europe's best healthcare system (EurActiv 14/11/08), while Austria came out on top in 2007 (EurActiv 1/10/07).

Greater information sharing and patient choice have been highlighted by proponents of cross-border healthcare in Europe. The European Parliament passed a directive in April which paves the way for greater patient mobility (EurActiv 24/4/09)

In second place was Denmark, which performed strongest in providing patients with access to information and enforcing patient rights, but lost marks for having longer waiting times. While Sweden fared best in the analysis of health outcomes, its e-health investment was weaker. The Netherlands' performance was broadly strong in all categories.

Much more here:

http://www.euractiv.com/en/health/dutch-health-system-retains-best-europe-crown/article-185837

The link between e-Health and the better health systems is explicitly drawn.

The report can be found here:

http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf

Fourth we have:

Docs Miss Test Results -- Even With Alerts

Communication woes still plague medical system, researchers find

Posted September 28, 2009

MONDAY, Sept. 28 (HealthDay News) -- Even an advanced, computerized medical-record system with alerts cannot guarantee that patients will receive timely follow-up care when imaging tests turn up signs of trouble, new research suggests.

"Our findings suggest that an electronic medical record that facilitates transmission and availability of critical imaging results to the health care provider through either automated notification or direct access of primary report does not eliminate the problem of missed test results even when one or more health care providers read the results," write the authors of a study in the Sept. 28 issue of the Archives of Internal Medicine.

According to the authors, communication breakdowns are blamed in cases when doctors don't follow-up on abnormal test results. In some cases, all the doctors involved in a patient's care don't receive information about, say, a lung mass.

More here:

http://health.usnews.com/articles/health/healthday/2009/09/28/docs-miss-test-results----even-with-alerts.html

The article abstract is available here:

http://archinte.ama-assn.org/cgi/content/short/169/17/1578?home

Fifth we have:

EHR Implementation is a Journey, Not a Destination

Carrie Vaughan, for HealthLeaders Media, September 29, 2009

If you have seen one physician practice, you have seen one physician practice. I often hear that phrase when talking with healthcare executives about best practices and lessons learned from successful electronic health record implementations. Health systems, hospitals, and clinics all have their own unique personality that is shaped by their geographic and organizational culture. That means there is no set formula to guarantee a successful EHR implementation. Organizations must find the path that works best for them.

A recent report by healthcare market research firm IDC Health Insights analyzed how two Norwegian hospitals—St. Olavs Hospital in Trondheim and Ahus Hospital in Oslo—successfully adopted digital technologies. The study, "Best practices: Norway's hospital evolution—A tale of two cities," concluded that there wasn't a single template for successful health IT implementations. Both projects were full replacements of aging facilities, but they used different methods to realize the vision of a digital hospital.

For example, St Olavs chose a single-vendor and an outsourced solution, whereas, Ahus worked with multiple vendors, retained some of its legacy systems, and managed its IT transformation internally. Even though Ahus was able to adopt more mature technology, since it began its implementation two years later than St. Olavs' project, both systems are now fully operational and their digital transformations deemed a success by their staff members and communities.

More here:

http://www.healthleadersmedia.com/print/content/239750/topic/WS_HLM2_TEC/EHR-Implementation-is-a-Journey-Not-a-Destination.html

A useful report – the link is in the text.

Sixth we have:

Health IT prevents heart attacks?

Posted by Dana Blankenhorn @ 2:00 pm

Kaiser Permanente is pushing a study in today’s American Journal of Managed Care as proof that health IT saves lives.

It proves to me my pill regimen may be keeping me alive.

In the study 68,560 people with diabetes or heart disease were given a combination of generic statins and hypertension drugs, resulting in 1,271 fewer heart attacks and strokes.

But what’s the health IT angle?

• KP HealthConnect, the insurer’s Electronic Health Record system, was used to identify the patients at risk.
• The findings validate a computer-created model predicting that the bundled drugs would cut heart attack and stroke in the target population by 71%.
• Kaiser researchers conducted the study.

Much more here:

http://healthcare.zdnet.com/?p=2777

Link in the text. Kaiser strikes again!

Lastly we have:

Electronic medical records give early warning of domestic abuse

Posted by Elizabeth Cooney September 29, 2009 07:09 PM

Boston researchers reported today a novel use for electronic medical records -- using data in patient records, they say they were able to identify likely victims of domestic abuse an average of two years before a diagnosis was actually made.

Ben Reis, Dr. Isaac Kohane, and Dr. Kenneth Mandl of Children's Hospital Boston and Harvard Medical School studied six years of hospital admissions and emergency visits for patients over 18 years old. Based on the patient's history, including injuries and assaults, they determined whether patients met a definition of domestic abuse. Then they looked at actual diagnoses of domestic abuse.

"Our model predicted abuse two years before it appeared on medical records," Reis said in an interview. The article appears online in the British Medical Journal.

The risk factors linked to a future domestic abuse diagnosis differed between men and women. For women, the red flags were trips to the hospital to treat injuries, poisoning, and alcoholism. For men, depression and psychosis were associated with the greatest risk.

The researchers developed a visual display that could become part of a patient's electronic health record. The work is not ready to be implemented, they said, but the model could form the basis for an early warning system that would help busy doctors decide which patients need further screening and perhaps intervention.

"This is not a diagnosis but a screening support system," Reis said.

Their hope is to bring the wealth of information about a patient to the forefront during a doctor-patient encounter encumbered by competing demands. They plan to study other health problems, from diabetes to depression, that might lead to what they call "predictive medicine."

More here:

http://www.boston.com/news/health/blog/2009/09/post_31.html

The full report is here:

http://www.bmj.com/cgi/content/abstract/339/sep29_1/b3677

Good stuff!

Enjoy!

David.