ABC Australia Talks Covers Individual Electronic Health Records

The following was broadcast last night.

Individual electronic healthcare records

Legislation is currently underway to assign all Australians a health identification number by mid this year. It's regarded as the building block to creating personal electronic health records with your private health history by 2012. E-health is supposed to provide shared access to health information by medical and allied health professionals. So will electronic health records benefit patients and make health care more efficient? Or do you worry about privacy and security risks?

Here are more details of the show.

Guests

Dr Mukesh Haikerwal

National Clinical Lead, National E-Health Transition Authority and former head of the Australian Medical Association

David Vaile

Vice-Chair, Australian Privacy Foundation

Dr Steve Hambleton

Vice-President, Federal Australian Medical Association

Robert Whitehead

Director of E-Health policies Northern Territories, Department of Health and Families

Further Information

National E-Health Transition Authority

Australian Medical Association

Australian Privacy Foundation

Health and Hospital Reforms Commission Report

eHealth NT, Shared Electronic Health Record

Public Interest Advocacy Centre

Department of Health and Ageing

Here is the link.

http://www.abc.net.au/rn/australiatalks/stories/2010/2809035.htm

Here is the direct download of the audio.

http://mpegmedia.abc.net.au/rn/podcast/2010/02/ats_20100209.mp3

I have not listened yet but I am sure many will be interested.

David.

The Australian General Practice Network (AGPN) Pushes E-Health.

The following appeared a few days ago.

Primary care reform needs $830m kickstart: AGPN

Elizabeth McIntosh - Monday, 1 February 2010

THE Federal Government needs to make a “critical down-payment” on general practice with $830 million in infrastructure grants to fund health reforms, according to the AGPN.

As part of its 2010-11 federal Budget submission, the network has restated previous calls from United General Practice Australia for the Government to invest $530 million in general practice.

A further $300 million is also needed to help practices transform into comprehensive primary health care centres as proposed by the National Health and Hospitals Reform Commission, the AGPN submission claims.

Practices would be able to apply for tax-exempt grants of up to $500,000 for major capital works, up to $250,000 for equipment and up to $50,000 for minor capital works.

However, such grants would also hinge on practices meeting accreditation standards.

“Capacity building needs to be looked at as a quality improvement process,” AGPN chair Dr Emil Djakic told MO.

More here:

http://www.medicalobserver.com.au/News/0,1734,5854,01201002.aspx

I was interested to see whether e-Health was a focus and it was good to see it was.

Under GP Infrastruture there are 3 topic addressed.

• $830 million over three years for a General Practice Infrastructure Program (GPIP)
• $31 million over three years for implementing an eHealth ‘change and adoption’ strategy for primary health care
• $10.2 million over three years to support increased clinical training placements in general practice

The detail is found on the AGPN Site which is here:

http://www.agpn.com.au/__data/assets/pdf_file/0016/22426/20100114_sub_Federal-Budget-2010-11-Submission.pdf

The e-Health proposal reads as follows.

An eHealth ‘change and adoption’ strategy

Within the current climate of health system reform eHealth is acknowledged by many as a key enabler for better connected care and improved communication between health services. The National E-Health Strategy provides a significant, detailed eHealth roadmap for Australia that has been agreed to by Australia’s governments.

General practice, over and above other community providers, has adopted eHealth and has significant capacity to be a driver of greater information exchange and connectivity. The Network provides the ideal framework for implementing change in the primary health care sector.

AGPN and the state based organisations (SBOs) have a long history of active involvement in eHealth and have been funded by the Department of Health and Ageing, eHealth Branch, to deliver the eHealth Support Officer Program (eHSOP). Established in 2005 and funded until June 2010, the program builds on the Network’s successful support of eHealth infrastructure and improvements in the quality of clinical information. The program:

• Encourages and supports general practices and General Practitioners (GPs) to adopt best practice eHealth tools and systems while encouraging participation in eHealth Initiatives such as Individual Electronic Health Records, Unique Health Identifiers and secure messaging via Public Key Infrastructure
• Assists the Network to deliver programs to general practices that are supported by best practice information management solutions.

The Network has been successful in increasing the uptake of eHealth infrastructure and encouraging connectivity across the primary health care sector as a result of the program. However, opportunities for improvement still remain. Barriers such as an historical lack of a nationally consistent approach to eHealth, fragmented funding and variable levels of eHealth literacy have resulted in an eHealth landscape which, while containing pockets of excellence, lacks consistency. The levels of computerisation and eHealth uptake also vary across the primary health care sector: general practice is widely regarded as being highly computerised, allied health and specialist practices lag behind.

While the National E-Health Strategy offers a framework for the consistent and effective rollout of eHealth across Australia, its successful implementation - and indeed the broader health reform agenda - will be reliant on general practice and the wider health sector both adopting eHealth initiatives and contributing accurate, complete, quality data to national data sets and electronic health records.

To achieve this, AGPN recommends expanding the existing eHealth Support Officers Network (eHSON) to provide resourcing and personnel at the local GPN level as well as SBO and AGPN levels. The eHSON would incorporate 60 eHealth officers working at the GPN level to act as change agents, with leadership, coordination and support provided by officers at national and state levels.

The program will build on the accomplishments of 2009-10 to achieve:

A national approach to eHealth throughout general practice and the Network that aligns with the National E-Health Strategy

A collaborative approach between governments and other stakeholders at all levels (national, state/territory and local) to implement of the National E-Health Strategy

Adoption of an agreed data quality improvement methodology by general practice and the Network which in turn will lead to improved clinical data quality in general practice and improved GPN health information management capacity – for improved planning and monitoring purposes

Achievement of organisational efficiencies with the Network in the provision of eHealth programs within a quality improvement framework

Increased eHealth uptake and capacity amongst health care professionals’ including uptake by general practice and the Network of national eHealth solutions, initiatives and priorities as they become available

• Sharing of eHealth related information, resources, knowledge and innovations across the Network and increased sharing of quality clinical data by general practice
• Increased communication and connectivity between general practices, non-GP specialists, allied health professionals and health care facilities via secure messaging and other foundation tools
• The national Network E-Health program would provide consolidated and coordinated support and activity at all levels of the Network to include:
• A local-level focus on promoting the uptake of current and future eHealth initiatives by general practice, increasing the levels of secure electronic communication between health practitioners, and improving the quality of general practice clinical data
• A state level focus on strong engagement with jurisdictions to achieve strong integration between primary, acute and tertiary health care sectors, and to deliver support and education to general practice networks by acting as change agents
• A national level focus on policy development to enable eHealth implementation across the Network; leadership, coordination and support of Network eHealth initiatives, and effective engagement with national eHealth bodies in order to deliver a cohesive and consistent eHealth infrastructure

In this way, the proposed program will enable the Network, as a whole to fulfil its crucial role in supporting the ‘change and adoption’ strategic stream of activity of the National EHealth Strategy and move primary health care towards the more e-connected future required to implement the proposed health reforms.

AGPN estimates a primary health care eHealth ‘change and adoption’ program will cost $31 million over three years.

----- End Extract.

This is actually quite an interesting submission – given the AGPN makes it quite explicit that is is funded by DoHA, who must be assumed to have at least some influence on what was asked for – if not directly, at least via discussions over the last few months.

What we see here is essentially a plea to implement the National E-Health Strategy as envisaged by Deloittes and not a single solitary mention of NEHTA by name!

Who is trying to tell someone something here I wonder? The NEHTA Identifier and Messaging projects are mentioned – but only to say they need to get done and that the AGPN can assist with the “change management and adoption”.

I read this to say they are not all that happy with the way NEHTA is progressing and would probably support the Deloitte recommendations to improve leadership and governance of the whole sector and let NEHTA expire while getting the foundations done with a broader and better led and funded approach.

Good on them is all I can say!

David.

Major Trouble Seems to be Brewing in the e-Messaging Space in OZ.

Over the last few years one of the very few success stories in e-Health has been in the area of secure messaging between healthcare providers – especially pathology and radiology practices – and their referring GPs and to a lesser extent specialists.

This messaging has been provided by a range of for (some variable amount of) profit (think HealthLink, Medical Objects, Promedicus, eClinic and so on) entities, and also some virtually non-profit (essentially cost recovery) entities (think ArgusConnect).

(I apologise in advance if I have mischaracterised provider’s status – let me know!).

Most have utilised HL7 Version 2 messaging standards with variable levels data content dis-aggregation.

ArgusConnect has also played a significant role in supporting developments with NT Health in its (still pretty embryonic) work in the Shared EHR and e-Prescribing.

ArgusConnect (http://www.medisecure.com.au/index.html) is also a key partner in the Medisecure e-Prescribing hub.

Additionally we have eRx (http://www.erx.com.au/) who is providing an e-Prescription hub with secure messaging.

From their FAQ they say:

What standards does eRx use?

eRx has adopted existing messaging standards through the use of web services technology, the utilisation of HeSA PKI certificates and conforming to privacy legislation. eRx will adopt to emerging messaging standards as they become available.

See here:

http://www.erx.com.au/PDF/eRx-FAQ.pdf

Now a month or so ago I published a blog pointing to some issues that were arising in the ePIP program the requires Secure Messaging to be on the agenda of software providers used by GPs for an additional and reasonably useful payment.

See here:

http://aushealthit.blogspot.com/2009/12/news-alert-serious-differences-seem-to.html

Well a new document has come to light from my various sources that rather makes it clear that NEHTA has been less than open with all those it has had working on the PIP Working group.

----- Begin Extract

NEHTA Web Services Messaging Application (WMSA) Project Plan – 30 Jun, 2009.

Project Definition

Background

In the Northern Territory, secure electronic messaging underpins the following ehealth services:

• Shared Electronic Health Record (SEHR)
• Electronic Transfer of Prescriptions (ETP)
• Electronic Transfer of Referrals
• Communication of clinical information

Currently this messaging is provided by the Argus Messenger application which is a commercial messaging application installed at each of the participating sites. The Argus messenger application uses the Public Key Infrastructure (PKI) encryption and POP3/SMTP technology for the transmission of messages between a number of systems as well as from source systems to the SEHR. Source systems interact with the functionality provided by the Argus Messenger through a number of API’s.

The National eHealth Transition Authority (NEHTA) has developed a set of specifications for securely transferring health information using web services technology. As a result, to meet current and future needs in the Northern Territory, an opportunity exists for the development and implementation of a NEHTA specification compliant web services messaging application (WSMA) that could eventually replace the existing Argus messaging application. This will provide a platform on which further interoperability initiatives such as identity management, electronic referrals, discharge summaries, etc can be leveraged. This will also provide Northern Territory with a cost saving investment.

Initially this will be a generic web services messaging solution, however as NEHTA specify each type of clinical service, e.g. pathology required, pathology test results, discharge summary, referral, ePrescribing, etc, these will be implemented as discreet web services endpoints and the generic web services endpoint will be used for unspecified payloads.

Aim & Objectives

The objectives of the WSMA project are to:

• Develop a secure messaging application compliant with relevant NEHTA specifications, utilising web services technology.
• Develop and implement a generic web services endpoint solution, which will later implement distinct endpoints for each clinical event as NEHTA specifies them.
• to replace Argus secure messaging systems for Communicare & Pen computing sites in the Northern Territory;
• to replace Argus secure messaging systems for the SEHR

Strategic Alignment and Outcomes

The expected outcomes of the NT secure messaging project include:

• Successful implementation of a production web services solution for securely sending messages from Communicare & Pen Sidebar to the SEHR, which is compliant with the NEHTA specification.
• Future releases of WSMA will replace “Argus Messenger” at all the NT DHF sites
• Addressing current administrative and performance issues associated with the Argus secure messaging systems.
• Provides a platform on which further interoperability initiatives such as identity management (UHI, ELS), electronic referrals, discharge summaries, etc can be leveraged.

• The IP for the software developed in this project will be owned by the Northern Territory of Australia, and will be made available to other jurisdictions under open source licence the details of which will be defined later. It is envisaged that WSMA will be progressively deployed across other jurisdictions. (Creation of an open source .NET SDK for use by other Jurisdictions e.g. SA Health)
• Cost savings as sites are expected to require less administration and maintenance as well as the removal of the reliance on commercial messaging systems.

----- End Extract.

So what we have here is essentially NEHTA and the Jurisdictions all but declaring war on, and planning to replace, the current messaging providers for totally unclear reasons – especially when this area is one that has been gradually improving and where there has been co-operation to a considerable degree – unpaid – between NEHTA and the messaging providers.

It seems its Argus for now but essentially all commercial messaging system are on the nose as far as NEHTA is concerned. Sadly the plan offers no clues as to just how such replacement might work and just who would provide the hand holding and support that is needed in this sector. Is NEHTA wanting to get into messaging support? I think not!

This has a very much the flavour of a ‘my way or the highway’ approach from NEHTA that I cannot imagine will be well received by the vendor community.

Sounds like NEHTA has been playing both sides of the street and I would be surprised if there are not some commercial or legal outcomes of all this.

David.

British Telecom To Explain To Australian Clinicians about Clinical Risk in E-Health. What?

This just arrived!

BT wins health contract down under

BT has made significant strides in the Australian health care market after winning a contract to provide BT Health Sentry - a clinical risk management system -to the country's National E -Health Transition Authority (NEHTA).

The deal is a joint effort between BT Health and BT Australasia and builds on a previous contract where BT was required to audit NEHTA's clinical safety programme.

BT Health head of clinical risk management, Martin Ellis, said: "BT Health has a world class clinical risk management capability.

"We have delivered to the exacting requirements of the NHS National Programme for IT and contributed to the development of international standards and are now growing our profitable clinical risk management business.

"Our capability forms a cornerstone of BT Health's value in the market and is a key differentiator."

Secondment

BT says the deal represents an important next step into the health market within Australia.

BT Health will provide NEHTA with a licence for Sentry, consultancy to support its implementation, and the secondment of an interim clinical safety officer from BT Australasia to NEHTA.

The federal and state governments of Australia have given NEHTA the task of identifying and fostering the development of the technology necessary to deliver the best e-health system.

Martin said that by assisting NEHTA to establish this central clinical risk management function, he hopes Sentry will be recommended across Australia - opening the market for future business.

The press release is here:

http://www.btplc.com/Health/MediaandIndustry/Newsboard/Contractdownunder/index.htm

This is just staggering and is just an insult to all the clinicians who are familiar with clinical risk and e-Health in Australia.

Sorry to be a bit ‘jingoistic’ but we have plenty of expertise in this area at home.

As for NEHTA’s choice – where is the release that explains their process in awarding this work outside Australia?

Did anyone see a tender for this work that I missed?

We all need to remember that the National Program for Health IT in the UK, while a very good thing, is hardly blemish free.

Just what is the need and requirement Australia can't meet in this regard - having one of the best and safest health systems in the world - admitting it could still be better.

Heck even.

David.

How Is Successful Delivery of the HI Service Going to Be Defined?

We are now less than 5 months away from the time when Medicare / NEHTA are to deliver their bright shiny new HI Service upon an unsuspecting public and profession.

As I presently understand things the facts are these.

1. The legislation to establish the HI Service does not seem to be going to be introduced this session so the next session (of 3 weeks) when that might be possible begins 22^nd Feb and once this window passes the next session is the Budget Session in May.

It would seem after the 18^th of March the pollies do not come back until the 11^th May. So essentially if this is not in and passed at least the Reps by the 22^nd of February it probably won’t make it till quite this year – or possibly even before the election (Sept Oct seems to be the guess).

We also know the Opposition has indicated it does not want to rush consideration of the HI Service Bill.

2. There has been some bench top demonstrations of the proposed system but no pilot at any scale to assure that the system does not have either technical, security or process issues that need to be addressed before a full roll out.

3. If it has happened at all, serious consultation with the system providers on use of the Service has not really been engaged.

4. SA Health and others are planning to do without the HI service for a number of years to come.

5. No one has yet come up with a compelling reason why healthcare providers should get involved with the HI Service at their own expense and inconvenience.

6. The fact that the National Provider Registration Scheme does not start until July 1, 2010 means there will be no properly credentialed providers until after the Service was meant to have started.

7. We have some, apparently draft, ‘communications plans’ which should not really spend any money until there is certainty of what actually gets into law.

Take it from me. I reckon we are going to see success defined as an operating system on a bench and all else being defined as having been blocked by a slow parliament and health software providers who want some assurances of what they are getting into before spending money.

I reckon it will be 2-3 years at best before any useful HI service is actually being really used and probably longer than that.

July 1, 2010 is just a meaningless date which will pass with no substantive change to e-Health in Australia I reckon.

I look forward to watching the NEHTA spin attempting “redefining success”. I am sure it will be good fun for all.

David.

Can Anyone Actually Trust What the Bureaucrats Say? I Don’t Think So.

Last week the blog revealed that in March, 2009 there had been serious doubts about just how well the project to provide Health Identifiers was going.

This blog can be read here:

http://aushealthit.blogspot.com/2010/02/nehta-is-leaking-like-sieve-symptom.html

The key paragraph is here (from the Executive Summary):

“Review Approach

This report details the results of a project health check undertaken of the Unique Health Identifier (UHI) project at nehta. The project review was undertaken over 10 days and involved in-depth interviews of project team members, suppliers and senior managers and a review of key project artefacts. The report assesses the UHI project’s health in 14 key elements, notes any exceptions to these findings and makes recommendations for improving the health of the project. Annex A outlines the approach to interviews and questionnaires used in the review.

Using the intelligence gathered through the project health check (scored in Annex B), an assessment has been made of the project’s ability to deliver. Overall, the Unique Health Identifier project is rated as RED. Unless significant changes are implemented, this project will not deliver agreed scope within timeline or quality tolerances. There are critical issues and concerns that exist within the project that require management intervention by the project sponsor, programme management and other senior management.”

---- end quote

The one line summary is that the project is a major mess and that without major intervention the whole thing has a high likelihood of failure.

The review project took 10 days and so, and – having reported on March 13, 2009 – was probably actually undertaken in mid to late February. Even if not written up what had been found would certainly have been made clear, in broad terms, to NEHTA senior management at that time.

Consider now this post.

http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html

This blog reported on the proceedings of a Senate Estimates hearing.

STANDING COMMITTEE ON COMMUNITY AFFAIRS ESTIMATES

(Additional Estimates)

WEDNESDAY, 25 FEBRUARY 2009

CANBERRA

BY AUTHORITY OF THE SENATE

2 key items in the transcript is the following exchange:

----- Begin Quote

Blogger Comment at the time: Next there was this explanation of the NEHTA work program.

“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“

Blogger Comment at the time: This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?

Then there was discussion of the IHI as discussed previously in the blog. It was here we learnt:

“Senator BOYCE—So by the end of the year we should have the unique identifier?

Ms Halton—Yes, we should.

Ms Morris—Yes.”

Blogger Comment at the time: I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!

This was then followed by this:

“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.

So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?

Senator BOYCE—Yes.

Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”

Blogger Comment at the time: Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!

Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.

----- End Extract from Old Blog.

At the time these two senior bureaucrats were briefing the Senate – presumably under oath – we now know that NEHTA was sufficiently worried about the HI Service project to get a paid review and almost certainly had a good idea of what the review would say. Somehow this news just did not seem to make it to those fronting Senate Estimates – who were happy to state, for the record, it was all wonderful and December was looking good for identifiers.

We now know that both messaging and identifiers were not delivered in December (whatever delivery actually means) and still haven’t as far as one can tell.

Seems to me all this shows, at best, is an unacceptable lack of curiosity to actually find out what was going on, knowing there would be specific e-Health questions at Senate Estimates, and at worst a blatant misleading of the Senate.

However you look at it there is no reason I can see to ever believe anything we are told again! Do you?

David.

Addendum:

It is worth noting the issue of failure of communication between NEHTA and DoHA has been around for a while. See here:

http://aushealthit.blogspot.com/2009/03/nehta-ceo-disagrees-with-secretary-of.html

Really this lot would struggle to lie straight in bed!

D.

AUSHITMan Gets a Pat on the Back from Overseas.

Since the local commentary from the likes of NEHTA etc on the blog is so grim, it is always nice to have someone say something nice!

This arrived the other day via e-mail:

Hi Dr. More

I hope you’re well. I am just dropping you a line to let you know of a feature article we recently published over here at The Health Sensei titled, “Top 50 Healthcare IT Blogs”. I thought you and your readers at Australian Health Information Technology might be interested in taking a look. Please let me know if you have any feedback

http://mastersinhealthcare.org/2010/top-50-healthcare-it-blogs/

Cheers!

James J Atkinson

The Health Sensei

---- End E-Mail.

It is probably just a shameless troll for web traffic, but a few other sites are listed that seem quite useful and there are not advertisements all over the site, so it seems better than most.

Have a look and see what you think.

Nice someone cares! Flattery will get them at least a post!

Also can readers please answer the poll question on the health system - I would like to get as many responses as possible so it will have some validity.

David.

NEHTA Says AusHealthIT Blog is ‘Out of Touch’.

The following appeared today.

NEHTA rejects criticism of UHI project

Shannon McKenzie - Friday, 5 February 2010

THE National E-Health Transition Authority has defended its Unique Health Identifiers (UHI) project, following the leak of an independent review that raised serious concerns over the project’s management and progress.

The review, conducted by technology consulting firm SMS Technology in March 2009, gave a damning critique of the project, pointing to a lack of project management, a “dysfunctional project team environment” and “a lack of clarity on all aspects of the project”.

The report was leaked to health IT consultant Dr David More, who posted the executive summary on his blog, Australian Health Information Technology.

NEHTA clinical lead Dr Mukesh Haikerwal labelled the blog as “out of touch”.

“The study was done a year ago. We conducted the review, we spotted the problems and we dealt with them... Our UHI project is now ready to be delivered,” he said.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5888,05201002.aspx

Great to hear I am totally disconnected etc.

I will leave it as an exercise for the reader to answer the following.

1. What is the motivation for any healthcare provider to use the IHI given the time and inconvenience it imposes?

2. How can the HI service start before national registration of healthcare providers is operational and bedded down? Does not even start until July 1, 2010

3. What is the actual implementation plan for the HI Service – why secret 5 months before it begins?

4. Why is ‘spin’ needed to introduce this if it is such a wonderful idea? (see blogs over the last few days)

5. Who is funding the modification of all the software in client systems that is meant to look up the HI Service?

6. When NEHTA folds in a year or two are forward funds committed to support the HI Service? If not what happens next?

7. Just what exactly will be delivered by 1 July 2010 and how many lives do you expect it to save each year once it is operational?

8. Which clinicians have committed to use of the HI Service by July 1, 2010?

I look forward to the answers on all this! Public clarification would be good!

David.