News Alert: Serious Differences Seem To be Emerging Between NEHTA and Some Clinical Messaging and Software Providers

I am hearing, from multiple sources, there are ructions emerging between those who are meant to be delivering the software for the DoHA Secure Messaging PIP program and NEHTA.

The differences seem to centre around some pretty fundamental technical issues and approaches. Specifically whether one secure messaging environment should be used for all secure messages versus different approaches for different message domains.

FWIW I reckon one should be enough! Feels like another example of NEHTA making things harder than they need to be.

How these differences are resolved will show just how consultative the “new” NEHTA has become!

David.

The Future of the UK National Program for Health IT Seems to Be Under a Cloud.

The following appeared in the Financial Times a day or so ago.

Turmoil over NHS records scheme

By Nicholas Timmins, Public Policy Editor

Published: December 6 2009 20:59 | Last updated: December 6 2009 20:59

The world’s biggest civilian IT project was thrown into turmoil on Sunday after Alistair Darling, the chancellor, implied that it was going to be scrapped.

The chancellor told the BBC’s Andrew Marr Show the £12.7bn NHS IT programme – already running years late – was “something that I think we don’t need to go ahead with just now”.

Treasury officials rushed to explain that the government was looking for “significant savings” of up to perhaps £600m over the medium term by cutting back some features that are less important for patients.

A senior health department official, meanwhile, said bluntly that “the chancellor mis-spoke” in saying the project to create an electronic medical record would be scrapped.

Much more here (subscription required):

http://www.ft.com/cms/s/0/71d29630-e2a5-11de-b028-00144feab49a.html

This has been also covered here:

Troubled £12bn NHS IT system to be scaled back

The government is to scale back its £12bn NHS IT system in what the Tories are calling a "massive U-turn".

Chancellor Alistair Darling said he would be delaying parts of the scheme in Wednesday's pre-Budget Report as it was "not essential to the front line".

The move may save hundreds of millions but Mr Darling admitted it was only a fraction of total spending cuts needed.

The Tories and Lib Dems have been calling for the IT system, which has been hit by costly delays, to be axed.

Mr Darling told BBC One's Andrew Marr show he was determined to halve Britain's budget deficit over the next four years and as a result public spending would be "a lot tighter than it was in the past".

He stressed that the pre-Budget report was not a spending review, but added: "I do think it is necessary for me to indicate areas where we are going to cut spending or where we're not going to spend as much as we were.

"For example, the NHS had a quite expensive IT system that, frankly, isn't essential to the front line.

Lots more from the BBC here:

http://news.bbc.co.uk/2/hi/uk_news/politics/8397854.stm

And some detailed commentary here:

NHS IT scheme to be scaled back

Tony Collins

Monday 07 December 2009 08:42

The chancellor Alistair Darling and the Treasury are to scale back spending on the NHS's National Programme for IT.

Although the BBC reports that the NPfIT "may be cancelled in Wednesday's pre-Budget report", the Treasury has said that only parts of the programme will be scaled back.

Alistair Darling told the BBC yesterday that the NPfIT "isn't essential to the frontline" . This contradicts the previous position of health ministers and officials: that the national programme will help avoid unnecessary deaths by giving doctors information on allergies, drugs that can cause adverse reactions, and other important information at the point of care.

The e-prescriptions part of the NPfIT is aimed at cutting the number of deaths caused by errors in medications.

Darling said: "I'm not doing a spending review just now. But I do think it is necessary for me on Wednesday to indicate areas where we are going to cut spending, or where we're not going to spend as much as we were.

"For example, the NHS had a quite expensive IT system that, frankly, isn't essential to the frontline. It's something that I think we don't need to go ahead with just now. But I will be setting out a clear direction of travel because it's important that we do that."

More here:

http://www.computerweekly.com/Articles/2009/12/07/239598/nhs-it-scheme-to-be-scaled-back.htm

It will be interesting to see what impact this has on the work being undertaken by iSoft and Cerner as key software providers for the program.

I note Gary Cohen of iSoft is reported by the Australian Financial Review saying that the changes could be a positive – although the share price today has not really reflected that view (-3.4% today vs Market down -0.19%) Usual disclaimer about having a few shares.

With so much progress having been made one hopes the UK will avoid the ‘baby and bathwater problem’. That outcome is always a risk as governments cast around to save money.

David.

Details of the New National Partnership on e-Health.

I have now had an opportunity to browse this document.

It is downloadable from this page:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/index.cfm

As best I can tell what we get is an Health Identifier (HI) service which for the next few years will be operated my Medicare Australia (MA) – and the MA CEO becomes the HI Service Operator.

The HI Service will be established under its own Federal Act of Parliament, which is yet to be finalised and will be issued in draft for more discussion and consultation.

The service is to commence July 1, 2010.

The governance mechanism is basically via the Australian Health Minister’s Council (AHMC) – assisted by the Australian Health Ministers Advisory Council (AHMAC).

Reports on how things are going to come to AHMC from MA and the Privacy Commissioner each September as I read it.

Just where the private sector fits in all this is simply not apparent at all!

The funding seems all to have been provided – via the grant to NEHTA - late last year.

If ever there is going to be a situation where the devil is in the detail of how all this will work it is this!

NEHTA needs to start a massive both consumer and professional education program real soon now!

I have also to say calling this whole thing a National Partnership for E-Health seems a little over the top to this observer!

David.

COAG Again Does Not Endorse the NEHTA IEHR Business Case – When Will They Give Up?

The outcomes of the Council of Australian Government Meeting today are here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/index.cfm

As far as e-Health we have:

E-Health

Delivering a safe, patient-centred e-health system is one step closer today, with COAG affirming its commitment to the introduction in 2010 of national healthcare identifier numbers and agreeing to release for further consultation draft legislation for establishing the healthcare identifiers.

Healthcare identifiers are unique numbers that will be given to all healthcare providers, healthcare organisations and healthcare consumers. The healthcare identifier will enable a person’s health information to be linked uniquely to them, no matter how many different health care providers they see. This new system will provide a new level of confidence when communicating patient information between private and government healthcare providers and systems.

COAG also considered feedback from the first phase of public consultations held in July-August 2009. Following these consultations and feedback, further work has been done on the identifiers to clarify and strengthen patient privacy, including limiting the use of information, clearly outlining who has access to information and providing penalties for any misuse of information.

COAG also agreed a National Partnership on e-Health, setting out the objectives and scope for the Healthcare Identifier Service to be operated by Medicare Australia, as well as relevant governance, legislative, administrative and financial arrangements. The identifiers are an important building block for the future introduction of a patient-controlled Individual Electronic Health Record.

So:

Baby steps and no IEHR for now at least, and probably forever.

This comment is a bit of a worry:

"The identifiers are an important building block for the future introduction of a patient-controlled Individual Electronic Health Record."

They are still going on with the stuff that we know is of low priority and off the agenda!

Note there is also still more work to do on privacy etc for the IHI.

The IHI etc won’t happen at any scale next year I believe. I wonder what this framework that has been agreed actually looks like? It is not clear from the communiqué.

This is, of course, all a smokescreen by Ms Roxon and Mr Rudd for having no clear health reform agenda sorted out after 2+ years in office. The NEHTA CEO said ages ago that the concept of a national EHR system delivered by Government was probably dead.

See here:

http://www.theaustralian.com.au/news/governments-change-direction-on-health-e-records/story-e6frgal6-1225786043408

David.

NEHTA, Yet Again, Just Misses the Point With Approach for Conformance and Certification.

In the last few days we have had the following press release from NEHTA

Industry heavyweights unite on Australian e-health software standards

4 December 2009. Consensus reached on a new direction for product compliance and conformance assessment.

Four peak industry groups have joined with the National E-Health Transition Authority (NEHTA) to develop a standards assessment approach for medical software in Australia.

A joint statement released this week defines the principles on which compliance, conformance and certification of software products will be based and outlines a cost-effective pathway to standards development using existing industry mechanisms.

The consensus statement represents a landmark agreement between heavyweights in Australia’s medical software and standards compliance industry including the Medical Software Industry Association (MSIA), Australian Information Industry Association (AIIA), National Association of Testing Authorities (NATA) and Joint Accreditation System of Australia & New Zealand (JAS-ANZ).

It also addresses issues of concern for the commercial software industry, helping to clarify market confusion around roles and processes, and guiding NEHTA in the development of Australia’s premier e‑health conformity assessment scheme.

Conformity assessment will be based on existing national and international standards and will focus on the specific software functionality components that align with NEHTA requirements.

A tiered system, ranging from self-assessment through to accredited external assessment, will be introduced to minimise the time and cost of compliance in line with product risk.

Where appropriate, external third-party assessment will be undertaken by independent agencies accredited through internationally-recognised accreditation organisations, such as NATA and JAS-ANZ in Australia.

NEHTA Chief Executive Peter Fleming applauded the agreement as a milestone in private-public sector collaboration and a significant step in the development of a national e-health infrastructure for Australia.

“The development and adoption of national specifications, and a supporting standards framework, is critical for improving patient care and healthcare delivery for all Australians,” he said.

“When systems work better together, the efficiency and accuracy of transactions improve, which creates a positive flow-on effect for clinical safety and quality.”

Read the Consensus Statement here.

Release is here:

http://www.nehta.gov.au/media-centre/nehta-news/569-cca

And when you follow the link you arrive here:

http://www.nehta.gov.au/connecting-australia/cca

E-Health Compliance and Conformance

To achieve the promised benefits that e-health offers, it is important for healthcare providers and medical software vendors to comply with e-health specifications and standards.

Compliance with these standards has two requirements:

• conformance in the way medical software systems implement the relevant e-health specifications and standards
• compliance by organisations that operate an e-health system or supply an e-health service with the relevant laws, codes of conduct, industry standards and principles of good governance.

Conformance, which relates to how products and services implement e-health specifications, is generally conducted through self-assessment by the party implementing the software system or by an independent third party such as a test laboratory. Conformance may also be assessed by a second party, such as a healthcare provider that is evaluating a software system prior to purchase.

Compliance, which ensures consistency among e-health specifications, usually takes the form of self-assessment, but may also be performed by an independent inspection body.

Assessment scheme
NEHTA is creating an Assessment Scheme for each of its major e-health specifications. The documentation will describe the process for assessing compliance and conformance for NEHTA’s e-health specifications and the assistance that NEHTA provides to organisations performing the assessment.

The Assessment Scheme documentation will give the following information:

• who may perform assessment (e.g. the scope of self assessment and the role of independent test laboratories and inspection bodies)
• guidance concerning assessment methods, test specifications and test tools
• levels of conformance and the timeframes for achieving conformance
• guidance concerning conformance claims by implementers and the presentation of assessment results.

For most e-health specifications, NEHTA will also provide conformance test specifications and a comprehensive list of test cases to be used in conformance testing. NEHTA may also provide test software and assistance in understanding e-health specifications.

Assistance for procurers

NEHTA provides assistance to healthcare providers procuring an e-health system with regard to tender specifications and evaluation. In particular, NEHTA can help in correctly stating compliance and conformance requirements in tender specifications. NEHTA also makes available to procurers its conformance test specifications and test tools to assist in evaluating candidate e-health systems.

Contact

David Manfield, Manager: Compliance, Conformance and Accreditation –david.manfield@nehta.gov.au

A slightly different consensus statement – with signatures and all is found here:

http://www.nehta.gov.au/component/docman/doc_download/908-cca-consensus-statement

This reads:

Leaders in Medical Software and Compliance, Conformance and Accreditation working together for e-health

Leaders in the Australian health software industry and compliance, conformance and accreditation (CCA) community demonstrate their ongoing commitment to the development of e-health by a declaration of consensus to work towards compliant and conformant e-health systems in the industry.

This statement is a commitment to the collaborative development and adoption of national e-health standards and the supporting CCA framework to improve patient safety and the quality of healthcare delivery for all Australians.

The Medical Software Industry Association (MSIA), Australian Information Industry Association (AIIA), National Association of Testing Authorities (NATA), Joint Accreditation System of Australia & New Zealand (JAS-ANZ) and the National E-Health Transition Authority (NEHTA) have achieved consensus on the following:

1. The focus in e-health for Conformity Assessment will be on specific functional capabilities of software products.

2. International and Australian standards will be used as the basis for conformity assessment.

3. A tiered approach to conformity assessment will be undertaken when applying conformity assessment for quality, safety and risk-based measures.

- Contingent on the risk involved, conformity assessment may consist of options from self-assessment through to accredited external assessment.

- Conformity assessment will be commensurate with risk and geared to minimise resources and time.

4. Accredited conformity assessment bodies (CABs) will be responsible for accredited external testing and certification.

5. Accreditation of CABs will be carried out by internationally recognised accreditation organisations, such as NATA and JAS-ANZ.

6. It is not the intention of NEHTA to become or perform the function of a CAB.

7. Existing and future conformity assessment bodies, such as AHML, will be leveraged as the basis for e-health conformity assessment.

8. Successful completion of an appropriate CCA process will be publicly recognised.

9. Whilst the CCA Framework’s primary focus is safety and quality, it will guide and assist other processes such as procurement and healthcare practice improvement.

10. The CCA Framework will focus on the foundations for e-health underpinning innovative development.

Signatures

End document.

Presumably this is all done in response to this undertaking:

Month: July

Initiative

Conformance, compliance and accreditation

Explanation: (Ensuring that software complies with Australian Standards and NEHTA specifications)

Outcome

A document describing how a national certification authority for eHealth related software will function will be completed during July.

See here:

http://aushealthit.blogspot.com/2009/12/what-did-nehta-promise-senate-to.html

By way of contrast in the last few days we have also had the following from Canada

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/508-canada-health-infoway-expands-certification-services

Canada Health Infoway expands Certification Services

'Infoway Certified' mark shows products meet pan-Canadian standards

November 30, 2009 (Toronto, ON) – Canada Health Infoway (Infoway) has added four new offerings to its pre-implementation Certification Service. Health information technology vendors can now receive certification for consumer health applications, client registries, provider registries, and immunization registries.

Receiving the 'Infoway Certified' mark provides vendors of health information technology products a competitive advantage in the marketplace by signalling their commitment and leadership to pan-Canadian standards and best practices.

"The certification mark signals a level of quality to buyers," says Richard Alvarez, CEO of Canada Health Infoway. "It tells the buyer that a vendor’s solution meets pan-Canadian standards and will increase the recognition, acceptance and adoption of trusted, interoperable health information technology solutions in the Canadian marketplace."

Infoway is the only organization in Canada certifying health information technology systems against pan-Canadian electronic health record (EHR) standards. Having produced national interoperability standards and a technology framework for the sustainable development of an interoperable EHR system across Canada, Infoway is well positioned to ensure current and emerging products provide required privacy and security and can interoperate with the EHR systems being implemented across the country.

The four new offerings join the pre-implementation Certification Services for consumer health platforms, which was launched in February 2009.

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada. Fully respecting patient confidentiality, these secure systems will provide clinicians and patients with the information they need to better support safe care decisions and manage their own health. Accessing this vital information quickly will help foster a more modern and sustainable health care system for all Canadians.

Backgrounder

Go to the e-Health Certification Section

Release here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/508-canada-health-infoway-expands-certification-services

and this from the CCHIT is the USA

Three EHR systems pass stimulus certification

By Joseph Conn / HITS staff writer

Posted: December 1, 2009 - 11:00 am EDT

Three electronic health-record systems are the first to pass muster with the Certification Commission for Health Information Technology under its new preliminary testing program for compliance with the "meaningful-use" criteria under the American Recovery and Reinvestment Act of 2009, the Chicago-based not-for-profit organization has announced.

The three products are eHealth Made Easy, Version 3, by eHealth Made Easy, supporting two of 27 applicable meaningful-use objectives for eligible providers and two of 24 applicable objectives for hospitals; KIS Track, Version 5.1, by Kaulkin Information Systems, supporting two of 27 applicable objectives for eligible providers; and Medios, Version 4.5, by IOS Health Systems, supporting 27 of 27 applicable objectives for eligible providers, according to CCHIT.

The new testing regime differs from previous CCHIT certification programs in that it does not require that a vendor pass all test criteria. Checklists of those criteria passed for each product are listed on the CCHIT Web site.

More here:

http://www.modernhealthcare.com/article/20091201/REG/312019985

Similar news is provided here:

CCHIT Certifies First EHR Programs Under Federal Standards

John Commins, for HealthLeaders Media, December 1, 2009

The Certification Commission for Health Information Technology today announced the first group of four electronic health records programs certified under its two programs—CCHIT Certified 2011 Comprehensive and Preliminary ARRA 2011.

Both programs inspect EHR technology for the first time against proposed federal standards to support providers in qualifying for 2011-2012 incentives under the $787 billion American Recovery and Reinvestment Act.

"These first four health IT companies, demonstrating their compliance with the proposed federal standards, are now able to offer certified products to providers who wish to purchase and implement EHR technology and achieve meaningful use in time for the 2011-2012 incentives," said commission Executive Director Alisa Ray. "We've had about 25 applications in our 2011 programs and inspections are continuing. Look for additional announcements from these early applicants in the upcoming days and weeks."

More here:

http://www.healthleadersmedia.com/content/242778/topic/WS_HLM2_TEC/CCHIT-Certifies-First-EHR-Programs-Under-Federal-Standards.html

What to say?

First, we still – months late - do not really have an explanatory document worthy of the name.

Second we learn we are to be certifying for compliance with “relevant laws, codes of conduct, industry standards and principles of good governance.”, and second that we are looking for conformance with NEHTA Standards once the assessment mechanisms are worked out.

Vendors are hardly going to push into illegality and defiance of codes of conduct etc!

Third – to the amazement of all – where is Standards Australia and IT-14 in all this? As I read it they seem to not be involved, did not sign off, and one can only ask why as the legal Commonwealth Standards setting entity, from which NEHTA claims to be a Standards taker from seems to out in the cold?

Fourth MSIA is hardly an organisation which has supported interoperability and data portability to date (think GP practice systems) and the other organisations do not – as far as I know have any specific e-Health expertise as far as standards etc are concerned.

Fifth, why are not clinical useability, functionality, contribution to patient safety of software and system etc at the top of the agenda. The answer is that compared with the Canadians and Americans the NEHTA technocrats are in a totally different and clinically detached space.

Sixth, what is all this about self assessment? That is hardly a way to ensure things are done right. As President Regan said “Trust but verify!”

So what we have is a silly announcement from a group that excludes the key player and which does not address the real issues around clinical software and its optimal use!

And people wonder why sometimes I am just a little bit grumpy.

David.

More Evidence Regarding the Silliness of the NHHRC and NEHTA Approach to EHRs.

The following press release appeared a few days ago

Fujitsu releases Research Report into Health Reform

Survey Highlights Key Health Reform Agenda – Prevention Is Better Than Cure

Sydney, 1 December 2009 — Fujitsu Australia and New Zealand, a leading provider of business, information technology and communications solutions, today released its latest research report into Electronic Health Records, revealing that alarmingly many Australians are not willing to take greater responsibility and control for their personal health outcomes and more Australians need to take ownership of their own health records.

The survey examined 5,600 Australians aged between 45 and 64 (Baby Boomers), which researched their attitudes towards their ownership of their own health outcomes and their awareness of Electronic Health Records. Over 40% of Baby Boomers identified they should take more responsibility of their health record but an additional 31% were unsure, because they did not really understand what this meant for them. About a quarter of respondents did not want to take any further responsibility for their own health, or health record.

Regarding taking control of personal health care records, over 60% of those surveyed did not want to take control of their record, as opposed to 38% who did want to take control. When we examined this further, less than 10% of Baby Boomers wanted to manage specific information into their health record. Results also identified that not many respondents understood what a health record was, and 26% had no idea who had access to their health record.

Highlights of the survey include:

Access to information on health - The first conclusion is that if people are going to take greater responsibility for their own health, there needs to be a different approach to providing quality information on health concerns. Today there is no single authoritative source to provide this information and the public’s thirst for knowledge on personal health topics is not being met.

Care from home – The second conclusion of the report identifies that if improvements in chronic illness management could be achieved in a home setting, this has the potential to improve well being and make a major positive impact in health budgets. Many care providers could invest in technologies to help people live at home longer.

Individual responsibility – The third conclusion highlights that while there is some acceptance amongst Baby Boomers that they should take more responsibility for their own health, this does not translate into a strong willingness to own or manage their own health record, because the concept is not widely understood and there are some concerns about the security of electronic information. This highlights both the gap and opportunity about building enthusiasm for and acceptance of electronic health records.

Over the next decade, Baby Boomers are likely to consume the bulk of Healthcare expenditure. If we are able, from a policy perspective, to encourage them to take more personal responsibility, focus on wellness, and proactive strategies for health then there is a chance the Health sector will be able to deliver an acceptable standard of care for all. If not, then the estimate 9% of GDP Australia spends on healthcare services will rise, whilst services will be degraded and standards of care compromised.

“Fujitsu believes that health reform must encompass the entire health eco-system,” states Martin North, Executive Director of Industry at Fujitsu Australia. “There is clearly demand to provide technology to enable smarter hospitals. There is opportunity for development of lean process change in for example, the management of an operating theatre. But it is also going to be essential to consider the community context – and Baby Boomers are right in the eye of the storm.”

Adoption of Electronic Health Record, if it requires Baby Boomers to step up, will require significant education and incentive. This suggests that strategies which are centred on the individual rather than the health professionals will take longer to gain momentum. However, extending the envelope of care into the community setting, shifting the agenda to prevention together with offering consumers access to information and the right monitoring environment offers a path to better health outcomes and a better use of resources.

It is feasible to provide a range of simple to use health monitoring equipment, wirelessly enabled to be able to pass data into the health system, to enable smart monitoring of individuals health status. If this is linked to information portals and peer benchmarking data, it is feasible to provide a supportive “wellness” environment together with tools and advice in the case of adverse indications. To work this must be simple to use, and become in essence part of a daily routine.

Sue Thomson, National Professional Development Manager, The Australian College of Health Service Executives (ACHSE) states “ACHSE has worked collaboratively with Fujitsu Australia and New Zealand for the past few years because we recognise the importance and the usefulness of this type of research in shaping future policy. It also plays an important role in informing the sector about how we can manage health services more effectively now and into the future. As the largest professional body representing health management in Australia, we commend Fujitsu for its commitment to this industry and in particular for its capacity to undertake this research role.”

To download a copy of the report, click here

---

About Fujitsu

Fujitsu is a leading provider of IT-based business solutions for the global marketplace. With approximately 175,000 employees supporting customers in 70 countries, Fujitsu combines a worldwide corps of systems and services experts with highly reliable computing and communications products and advanced microelectronics to deliver added value to customers. Headquartered in Tokyo, Fujitsu Limited (TSE:6702) reported consolidated revenues of 4.6 trillion yen (US$47 billion) for the fiscal year ended March 31, 2009.

For more information, please see: fujitsu.com

About Fujitsu Australia and New Zealand

Fujitsu Australia and New Zealand is a leading service provider of business, information technology and communications solutions. As the third largest ICT Company in the Australian and New Zealand marketplace, we partner with our customers to consult, design, build, operate and support business solutions. From strategic consulting to application and infrastructure solutions and services, Fujitsu Australia and New Zealand have earned a reputation as the single supplier of choice for leading corporate and government organisations. Fujitsu Australia Limited and Fujitsu New Zealand Limited are wholly owned subsidiaries of Fujitsu Limited (TSE: 6702).

For more information, please see: fujitsu.com.au

About the Fujitsu Baby Boomers Surveys

In the first year we showed that many had not thought about how they would pay for their healthcare needs in later life. Last year we examined their savings strategies and concluded that many were unlikely to be able to support themselves into old age because they had not saved enough, a trend exacerbated by the Global Financial Crisis and consequent fall in asset prices.
We surveyed 5,600 Baby-boomers (in tranches from 40-64) to understand their views of health records and their use of online services. We discussed our preliminary findings from this research with a number of Senior Health Professionals during a working session at the Australian College of Health Service Executives Conference on the Gold Coast in August 2009. ACHSE is Australia's largest professional body representing health management and it aims to develop and foster excellence in health service management through education and ongoing professional development for existing and potential health service managers. As a result of this session, and a number of other discussions we have had across the sector including NEHTA – the National E-Health Transition Authority.

For more information, please see: http://www.nehta.gov.au

The release is found here:

http://www.fujitsu.com/au/news/pr/archives/2009/20091201-01.html

It is very much worthwhile to download the full report.

It really makes a total joke of the NEHTA and the NHHRC claims about all of us wanting a patient owned and controlled record. Most baby boomers (those who use 80% of health resources and are aged between 45 and 65) really don’t use the internet all that much compared with the younger cohorts, want the clinician to look after their record and are a long way from the wellness agenda just yet!

Many thanks to Fujitsu for debunking the silliness we have had from NEHTA and the NHHRC.

As I have been saying endlessly we need to focus on supporting care providers with quality systems – this is where the pay dirt is – and possibly at the same time commence the education and awareness program for the younger boomers and below about how PHRs can help. A 10 year project I suspect!

David.

The Council of Australian Governments Meets Tomorrow on The Fate of the Health System.

It might just be a big day for the Australian Health System tomorrow.

Bligh leads COAG talks on health reform

December 6, 2009 - 9:59AM

AAP

Queensland Premier Anna Bligh will outline five areas for reform in the nation's health system at Monday's Council of Australian Governments (COAG) meeting.

Ms Bligh is to share her vision on how state and federal health responsibilities could be redefined with her fellow state leaders on Sunday night, ahead of COAG's first ever meeting in Brisbane.

The state leaders have been working through the recommendations of the final report of the National Health and Hospitals Reform Commission.

.....

The five key areas Ms Bligh has nominated for reform are: better funding to match growing demand; fixing aged care to take pressure off hospitals; the disconnect between GPs, hospitals and community health; workforce shortages; and disease prevention.

Queensland will argue that the commonwealth should fund all aged-care services regardless of where they are provided, and all primary healthcare services, such as GPs.

More here:

http://news.smh.com.au/breaking-news-national/bligh-leads-coag-talks-on-health-reform-20091206-kce2.html

Here is another report:

Anna Bligh's tonic a hard sell

Article from the Sunday Mail

December 06, 2009 12:00am

FEDERAL and state governments keep throwing billions and billions of dollars into the nation's health system. But they still can't get it right.

Waiting lists for our public hospitals get longer and longer, doctors and nurses are exhausted from extended shifts and there is never enough money from our politicians.

Queensland has declared: Enough is enough. Premier Anna Bligh is taking an ambitious reform package to the first Council Of Australian Governments meeting in Brisbane tomorrow in a bid to fix our ailing health system.

Bligh will be up against it. State and territory leaders have their own agendas and trying to get them all to agree on reform measures will be tougher than a quadruple bypass.

But Bligh is on the right track by suggesting the Commonwealth fund aged care services. In Queensland alone, 336 nursing home patients take precious hospital beds every night. A hospital bed costs $698 a day compared to $290 for an aged-care bed. Bligh has also called for more funding for GPs and more training places.

More here:

http://www.news.com.au/couriermail/story/0,23739,26445615-13360,00.html

And we find the NSW position now being obsolete I guess being from an ex-Premier.:

NSW plan for national health care control

NICK MILLER AND LOUISE HALL

December 3, 2009

NSW has fired the first public shot in the health reform debate before next week's COAG meeting, by proposing to unite all health funding in one pool that is divided between regional health authorities.

The plan is similar to one rejected by the Federal Government's reform commission.

Premier Nathan Rees announced in Parliament yesterday that he would propose a national health commission, to be run by federal and state officials, clinicians and local community representatives.

The commission would set health policy and act as a funnel for all Commonwealth and state health funding including Medicare, aged care, hospital and community care.

The money would be divided between large regional health authorities that would deliver all health care - from prevention and screening, through to GPs and allied health, hospitals, rehabilitation and community aged care.

Mr Rees said the plan would keep NSW involved in health provision while reducing its responsibility for the political minefield of public hospitals.

He said he would take it to the Council of Australian Governments meeting on health reform in Brisbane on Monday.

Mr Rees, whose Government has been hammered for hospital scandals, crowded emergency departments and long waiting lists for elective surgery, said the plan would ''provide a seamless patient journey, ensuring care matches patient needs, rather than bureaucratic silos''.

''The current incentives for cost-shifting and blame-shifting would be reduced, if not eliminated,'' he said.

Mr Rees said the key to the NSW plan was the regional health authorities, based roughly on the state's existing area health services - which Victoria did not have.

Lots more here:

http://www.theage.com.au/national/nsw-plan-for-national-health-care-control-20091202-k6ci.html

The Crikey.com.au health blog also has some useful thoughts: See:

http://blogs.crikey.com.au/croakey/

They are here:

http://blogs.crikey.com.au/croakey/2009/12/01/health-memo-to-coag-part-four-forget-about-the-ideology/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-three-heres-a-way-forward-in-the-critical-area-of-primary-health-care/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-two-beware-the-nhhrcs-advice/

and here:

http://blogs.crikey.com.au/croakey/2009/11/30/health-memo-to-coag-part-one-its-time-to-tackle-waste-and-inefficiency/

Given the comment reported here:

http://www.abc.net.au/worldtoday/content/2009/s2739638.htm

“NICOLA ROXON: In December we're holding a specific health COAG (Council of Australian Governments) meeting, heads of government, to discuss reforms with the States and we will then present our national reform plan in early 2010.

Our preference is to work with the States and Territories to deliver this reform plan but if they won't join us on this journey we will seek a mandate from the Australian people at the next election to pursue necessary change.”

It looks like this meeting will have all the ambit claims put up – and we will hear in the New Year what is actually planned.

It will be important to keep a close eye on the communiqué which will appear late in the day here:

http://www.coag.gov.au/

- as you can bet there will be some strong hints in what is finally agreed in that communiqué. Could be a big day!

One outcome may just be that the NEHTA Individual EHR gets funded - it is with COAG we are told in recent presentations. Now there is a scary possible outcome!

David.

A Little Bit of E-Health That Can Make A Difference.

In a short note to www.6minutes.com.au a very useful link was provided. The note states:

“Written asthma action plans are important. We have had much better rates of usage since we made a web-based utility to generate customised versions for patients.

Anyone can use the utility and can find it here.

There is also a downloadable version which can be used offline.

Prof Mike South,

Paediatrician & Intensivist,

Professor of Paediatric

Medicine,

University of Melbourne”

I am sure 6minutes won’t mind if I make the link available here as well:

http://www.rch.org.au/clinicalguide/forms/asthmaPlan.cfm

Having been the, and from time to time the very worried, father of an small asthmatic daughter a few years ago now I know that every little bit helps.

David.