If Ever There Was Some Research To Learn From This is It!

The following was published a day or so ago in the British Medical Journal.

Research

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Trisha Greenhalgh, director¹, Katja Stramer, senior research fellow², Tanja Bratan, research fellow², Emma Byrne, research fellow³, Jill Russell, senior lecturer², Henry W W Potts, lecturer³

¹ Healthcare Innovation and Policy Unit, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London E1 2AD, ² Division of Medical Education, University College London, ³ Centre for Health Informatics and Multiprofessional Education, University College London

Objective To evaluate a national programme to develop and implement centrally stored electronic summaries of patients’ medical records.

Design Mixed-method, multilevel case study.

Setting English National Health Service 2007-10. The summary care record (SCR) was introduced as part of the National Programme for Information Technology. This evaluation of the SCR considered it in the context of national policy and its frontline implementation and use in three districts.

Participants and methods Quantitative data (cumulative records created nationally plus a dataset of 416 325 encounters in participating primary care out-of-hours and walk-in centres) were analysed statistically. Qualitative data (140 interviews including policy makers, managers, clinicians, and software suppliers; 2000 pages of ethnographic field notes including observation of 214 clinical consultations; and 3000 pages of documents) were analysed thematically and interpretively.

Results Creating individual SCRs and supporting their adoption and use was a complex, technically challenging, and labour intensive process that occurred more slowly than planned. By early 2010, 1.5 million such records had been created. In participating primary care out-of-hours and walk-in centres, an SCR was accessed in 4% of all encounters and in 21% of encounters where one was available; these figures were rising in some but not all sites. The main determinant of SCR access was the identity of the clinician: individual clinicians accessed available SCRs between 0 and 84% of the time. When accessed, an SCR seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a rare but important positive impact on preventing medication errors. SCRs sometimes contained incomplete or inaccurate data, but clinicians drew judiciously on these data along with other sources. SCR use was not associated with shorter consultations or reduction in onward referral. Successful introduction of SCRs depended on interaction between multiple stakeholders from different worlds (clinical, political, technical, commercial) with different values, priorities, and ways of working. The programme’s fortunes seemed to turn on the ability of change agents to bridge these different institutional worlds, align their conflicting logics, and mobilise implementation effort.

Conclusions Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.

The full paper and extras can be accessed from this link.

http://www.bmj.com/cgi/content/abstract/340/jun16_4/c3111

Some early commentary is available here:

Hell-ish

16 Jun 2010

UCL has spent three years evaluating the Summary Care Record and has now issued a 234 page report on the subject. Fiona Barr reads how ‘The Devil’s in the Detail’ of this huge, but apparently disappointing, undertaking.

Long awaited and much anticipated, the final report of UCL’s independent evaluation of the Summary Care Record has just been published.

Just a look at the title – ‘The Devil’s in the Detail’ – tells you a lot of what the researchers want you to know. This is a complex issue with no simple outcomes or pat answers.

Nevertheless, the report’s discovery that there have been only modest benefits from the SCR and really no benefits from HealthSpace might lead to questions about why the two schemes should not be scrapped.

A key caveat – tucked away in a line at the beginning of the report – is that the evaluation was carried out at a time when few SCRs existed and the functionality of HealthSpace was much less than its creators hoped it would be.

This may enable those in favour of the projects to argue that the long term benefits have yet to appear - although, conversely, the argument that benefits will only come once a scheme becomes universally adopted has its own flaws.

Those in favour could also argue that emergency summary record systems have already been delivered elsewhere in the UK; so why should England not follow suit?

Although it is promising to consider the evaluation’s findings, the Department of Health sounds as if it has already made up its mind, and that the SCR programme will continue. A future for a functionally rich HealthSpace is harder to envisage.

However, if the DH decides its £1m investment in the evaluation is worth considering in detail, its final report has a wealth of information on what progress has been made so far and what it implies for the steps that will need to be taken in the future.

Lots more here:

http://www.e-health-insider.com/comment_and_analysis/600/hell-ish

The message for Australia, NEHTA and DoHA is crystal clear. Shared care summary records are a very difficult undertaking in a range of dimensions that far exceed the technical.

These conclusions say it all:

“Conclusions Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.”

If there is even the slightest pursuit of truth and honesty existing within NEHTA and DoHA they need to bring the full report to Government’s attention with their plans as to how they will overcome the issues identified in the UK.

To do less would just be dishonest. Australia must not replicate the mistakes made in England and the way to do that is to learn very carefully from their experience. No centralised system should be contemplated without good answers to all the issues raised in this evaluation.

The evaluation  full report is available here:

https://www.ucl.ac.uk/news/scriefullreport.pdf

Mandatory weekend reading!

(And before anyone feels the need to tell me about them, yes, I am aware of some simpler models that are apparently working better – but still with significant issues – in Scotland and Wales).

David.

I Don’t Think I Can Go Much Longer Without a Comment on iSoft.

Since the 1^st of June things have gone from bad to worse for iSoft.

On the 2^nd the company updated the market with what will go down in history as the classic ‘good news, bad news’ press release.

The good news was the ‘go live’ of the core and crucial Hospital Product Lorenzo at the Morcambe Bay NHS Trust.

The bad news, in the same release, was as follows:

“At the same time, political uncertainty in the lead up to the recent UK election and the subsequent change in government, have together led to the deferral of decisions in relation to the English NPfiT program particularly for our partner Computer Sciences Corporation, Inc. For iSOFT, this has affected the timing and conclusion of negotiations surrounding the potential of an agreement with CSC in relation to the market opportunities in England and in particular the Southern cluster of English hospitals, as well as delays in milestone payments. The revenues associated with this agreement had been anticipated in fiscal 2010 and are now anticipated in fiscal 2011. However, as with any commercial negotiation, there is no certainty that revenues will ultimately flow.

Typically the Company earns disproportionately higher revenues in the final quarter of the fiscal year. The factors outlined above, which together with currency impacts as a result of the strong Australian dollar, have resulted in revised revenue, EBITDA and cash flow expectations for the period. Revenue for the 2010 fiscal year is being revised to the range of $440m to $455m. 2010 fiscal year EBITDA is likely to be in the range of $45M - $60M, before exceptional items. 2010 fiscal year operating cash flow has been impacted accordingly.”

----- End Extract.

Sadly for iSoft only a couple of months previously they had guided EBITDA to be around $109M with profit to be above $30M.

You simply do not give surprises to the market on this scale and expect there not to be a pretty severe reaction! There was.

As it was the share price has halved almost instantly and is now only 1/3 of what it was only six months ago.

Since the initial profit warning there have been further releases, (providing some extra explanations and also announcing Board changes) which have seemed to make things worse with the share price as I type being just 25.0 cents.

You can see the later releases and a good deal of other information here:

http://www.abnnewswire.net/companies/en/29476/iSOFT-Group-Limited

There is an article on the topic from the Australian here:

http://www.theaustralian.com.au/business/city-beat/shake-up-for-isoft-group-board/story-fn4xq4zx-1225880115973

From an investor perspective there is no way this is a ‘buying opportunity’, probably until either the share stabilises or someone decides the company is now so cheap it is time to buy it out / take it over. To benefit from the latter you will want to be very sure the share price has bottomed any take a stake the day before the take-over offer is announced!

I wonder is the German e-Health company Compumed sniffing around as they say (they wanted to buy some/all of iSoft as I recall before IBA managed its merger / takeover). See here:

http://www.compumed.de/de/index.php

(If your German is up to it)

Right now all this is much too risky for me and note this is NOT financial advice!

From the e-Health perspective this is all quite sad and I really do hope our only substantial Australian company in the space can regain its footing, sort out the debt issues and move forward. There is clearly now a business that has proven it can deliver a complex e-Health product in Lorenzo and it would be a pity if just as this milestone is reached the company trips for a range of circumstances – some of which (currency value changes, government policy changes with new government in the UK) it clearly could not control.

There is also good news such as this:

http://www.computerworld.com.au/article/350131/isoft_rolls_patient_management_system_tasmania/?eid=-6787

iSOFT rolls out patient management system in Tasmania

Setting the basis for its $4.6 million agreement with the DHHS

• Chloe Herrick (Computerworld)
• 16 June, 2010 10:42

Hot on the heels of an ASX update aimed at reassuring investors about the state of the company, iSOFT (ASX:ISF) has announced it has completed the rollout of its $4.6 millionpatient management system across Tasmania.

The system, which claims to set the foundation for the Tasmanian Department of Health and Human Services' (DHHS) for a shared electronic health record system, was first announced in February 2008.

As reported by Computerworld Australia, the system will integrate patient information across all of Tasmania's public hospitals including the Royal Hobart, Launceston General, and North West Regional Acute Hospitals.

-----

I also believe we need a substantial scale in our e-Health provider participants to assist in keeping NETHA and DoHA practically focussed and it would be a pity if all the major players were from off shore.

I do hope this can all work out as there is a valuable business in the middle of all this temporary mess.

David.

For those with a long memory, some will recall I used to hold some iSoft shares.

These can I say I sold before the present issues arose, while I was still in the black from an investor perspective! I fear it will be a while before the shares recover to their year high of 93 cents or the all time high, near listing of $1.74. The perils of investing in the share-market!

David.

A Colourful Pie Chart From NEHTA That is Really a Huge Misleading Fantasy.

The NEHTA CEO is wandering around popping up a slide extolling the benefits that flow from e-Health as prepared by Booz and Company.

The presentation can be downloaded from here:

http://www.nehta.gov.au/component/docman/doc_download/1018-international-conference-in-healthcare-20-22may-melbourne-peter-fleming

His slide is headed as follows

Economic value of e-health in 2020

TOTAL ANNUAL BENEFIT $7.6bn

Optimal use of pharmaceuticals (including generics) 2.3% ($200m)

Eliminating duplication of effort 8.1% ($600m)

Improved use of infrastructure 8.2% ($600m)

Enhanced workforce productivity 14.7% ($1.1bn)

Reduction of errors 36% ($2.8bn)

Enhanced adherence to best practices 30.6% ($2.3bn)

Source: Booze & Company Global E-Health Investment Model

The details of where this information can from the presentation referenced here:

http://aushealthit.blogspot.com/2010/05/major-study-confirms-value-from-e.html

On the next slide we have the following:

E-health will improve records management

18% of medical errors occur from inadequate patient information

50% of unnecessary acute episodes from lack of knowledge of patient condition

10% of all GP consults are with a patient the doctor has never seen before

25% of doctors’ time spent collecting data

Does anyone else notice the incoherence in all this? Is the NEHTA work plan really going to deliver the benefits cited above? Just where is the explanation of (and evidence for) how much of these 'so-called' will be altered by NEHTA's efforts and the PCEHRs proposed by Government?

The core issue I see in all this is the use of the term ‘e-health’ without really being clear just what is being talked about.

This list from the Booz Report (Page 12) provides some useful clues as to what is the core of e-health

Core E-Health Applications and Capabilities Defined

Connected care enables the electronic transfer of referral information from one provider to another and supports shared care plans where multiple providers are involved with the case treatment of a patient over time.

Decision support provides clinicians with access to guidelines, reminders, and best practices to improve patient outcomes by helping them to make more informed and cost-effective decisions.

Electronic medical records extend a clinical information system with comprehensive patient records, imaging, specialised clinical tools, and interfaces to the local administrative systems within a healthcare organisation.

Identity and access control provides the security infrastructure needed to maintain patient privacy, effectively identify and authenticate providers and patients, and control access to facilities and health information.

Medication management provides clinicians, patients, and dispensing pharmacies with information regarding a patient’s current and past medications, allergies, and basic medication-related decision support in the quest to eliminate medication errors.

Patient self-management provides patients with a portal view for managing their health records and researching health topics. In addition, the capability can provide secure, private patient communications with clinicians, enabling more effective participation in disease management programs and avoiding unnecessary visits to a clinic.

Quality and performance management provides a comprehensive database supporting intelligent performance reporting, monitoring, and the revision and improvement of care guidelines and best practices. It can also support clinical trials and academic research.

Shared summary care records (also referred to as EHRs) provide clinicians with summarized descriptions of the medical events in a patient’s history that may pertain to the current treatment, along with electronic access to detailed procedure, laboratory, and radiology reports.

----- End Extract.

What is obvious, when you take the suggested list of benefits and the core capabilities, is that the strategic and implementation emphasis has to be on provision of ICT support to providers if the majority of the benefits are to be genuinely harvested.

The big ticket benefits come from helping providers do their job better and more safely and all this discussion on Personally Controlled EHR (PCEHR) should be given much less emphasis until we really have nailed provider and hospital support and the communications between these health sector components.

The NEHTA focus on facilitation of messaging applications is correct as far as it goes, but improved GP and Hospital systems are probably even more (and certainly equally) important. These are where the main paydirt (read benefits) exists.

The issue is, of course, that to do this will actually cost some real money and needs to be properly planned, managed and executed. This is something we have not seen all that often recently!

The PCEHR, and its alleged benefits, is a smokescreen and needs to be named as such by those who should know better.

On a slightly different tack is it good to see how the Booz Study points out just how unbalanced the benefits flows and costs are between each of the different elements of the Health Sector (Providers, Consumers, Payers and Government).

David.

I Wonder Is This Planned To Be in Our Future? It Sure Looks Like It!

The following arrived a few days ago.

Health Space launched in Canada

09 Jun 2010

Candian telecoms firm Telus has announced the availability of Telus Health Space, it’s personal health records service based on Microsoft’s HealthVault platform.

The Telus PHR service is the first instance of HealthVault to be licensed internationally outside the US. Telus will market the PHR service to healthcare providers and insurers to offer to their members and patients. The company says 12 Canadian health organizations have signed up to collaborate on embedding applications, medical devices and educational materials.

Powered by Microsoft HealthVault, Telus Health Space will enable individual Canadians will be able to keep all their personal healthcare information – such as lab results and prescription information – in an online database for access over any Internet connection.

Telus says the new consumer health platform can serve as the foundation for building new models of care in Canada helping Canadians take an active role in living healthier lifestyles. Health Space is said to be support a variety of online tools for health and wellbeing and chronic disease management.

The platform is being offered for licensing by healthcare organizations, including provincial governments, health authorities, hospitals, insurers, individual practitioners and employers.

Telus Health Space is the first consumer health platform in Canada to gain Canada Health Infoway pre-implementation certification for providing a secure, interoperable application environment and personal health information platform.

.....

Link

Telus

Jon Hoeksma

Full article here:

http://www.ehealtheurope.net/news/5979/health_space_launched_in_canada

The full release can be read here:

http://about.telus.com/cgi-bin/media_news_viewer.cgi?news_id=1233&mode=2&news_year=2010

It has to be only a matter of time before DoHA sees this as a way to be seen to be actually doing something while NEHTA mucks around with the dream of its Individual EHR which despite multiple attempts has never been seen by COAG or the Government as a great idea worth funding.

It seems to me the risk of fracturing consumer e-Health from the e-Health providing support to consumers gets larger all the time with this fragmented and secretive approach.

This morning Karen Deane published a piece of very interesting reporting in the Australian.

What Labor has to show for e-health spendathon

• Karen Dearne
• From: Australian IT
• June 15, 2010 12:05AM

OPINION: THE Rudd government will spend a whopping $639,315 each and every day on "personally controlled" electronic health records.

That's not a typo.

Five weeks after the federal budget, it remains unclear exactly what Australian taxpayers will receive come June 2012 for their $466.7 million investment in personal e-health records.

Despite hounding the government to be transparent about its plans, we only know that broadly the funds will be spent on "early planning" and "designing" of the new system.

How did the Health Department come up with that sum? Someone had to approve such a hefty investment, only no one is talking.

If those figures shock you, consider that the body set up in July 2005 to deliver a nationwide health IT infrastructure, the National E-Health Transition Authority, has been spending just under $164,000 a day ever since.

And it will keep on spending at that rate until its total current funding of $378m runs out in June 2012.

For more go here:

http://www.theaustralian.com.au/australian-it/opinion/what-labor-has-to-show-for-e-health-spendathon/story-e6frgb0o-1225879672217

I have to say it is a very fair question to ask just how much ‘value for money’ we have had for this!

But the section that really caught my eye was this – direct quote from the Commonwealth Department of Health’s high priced media advisors:

“Last week, I again asked Ms Roxon to advise exactly how the $466.7m announced in the budget will be spent.

This is the reply, attributable to a spokeswoman for the Health Department:

(1) The Australian Government’s investment of $467 million over two years will fund the core national infrastructure, standards and tools to provide all Australians with access to an electronic health record from 2012-13, if they chose to register for one.

Then I asked, what are the priority projects, who is in charge of allocating the funding and what are the expected outcomes?

(2) The Department of Health and Ageing has been allocated the budget funding to implement a personally controlled electronic health record system.

The priority projects for initiating the national system will commence from July 2010.

Initially the focus will be on working with key stakeholders including consumer representatives, health care organisations, providers and states and territories, to identify the requirements for and begin the design of the system. These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include consultation.

The funding will establish a secure system of personally controlled electronic health records that will have:

- Summaries of patients’ health information – including medications, immunisations and medical test results;
- Secure access for patients and approved health care providers to records via the internet regardless of where the record is physically located;
- Rigorous governance and oversight to maintain privacy, accountability and clinical provenance; and
- The national standards, planning and core national infrastructure required to use the national records system.”

Really this is just an outrage in my view. This is the closest thing to double speak one is ever like to hear!

Does anyone reading these answers think they have a clue about what they are saying!

Frankly the only way I can read the 4 points they reveal on how they are going to spend the money is that Microsoft, Google or IBM are very close to being offered an opportunity to solve the ‘political’ e-Health problem for minister Roxon and Mr Rudd.

That doing this won’t really enable and facilitate real health reform seems to have totally escaped them. In tomorrow’s blog I will explain why I think this is the case.

David.

Yet Another Australian Health IT Management Group You Haven’t Heard Of!

NEHTA have left it until a week or so before the so called Health Identifier Service ‘go live’ to release a second version of their Concept of (HI Service) Operations document.

It can be found here:

http://www.nehta.gov.au/component/docman/doc_download/1019-concept-of-operations-v20

Those who follow these things will be aware that there is not going to be anything remotely looking like a ‘go live’.

This was made clear here:

http://aushealthit.blogspot.com/2010/06/hi-service-has-now-moved-to-confession.html

and was indeed confirmed by the NEHTA CEO in late May in a presentation.

Slide 14/22

Implementation Approach.

• Implementation will be a staged approach
• The HI Service is not “big bang” but incremental
• Early adopters will work with NEHTA and they select their vendor partners
• Publication of draft Implementation Plan –www.nehta.gov.au

(Presentation to International Conference in Healthcare – Melbourne – May 20-22, 2010)

The flawed nature of this document (which is not really a Plan, and is even titled ‘an Approach) is reviewed here:

http://aushealthit.blogspot.com/2010/06/degree-of-otherworld-impracticality.html

The document under discussion in this blog is the following:

HI Service - Concept of Operations

Version 2.0— 8 June 2010

Release – Final

Among other things I noticed as I browsed was that the final signoff for this version was provided by something called the IAARG (see page 3).

I wonder what the IAAGR is I thought. Page 10 of the document provides the answer. It is the:

Identification, Authentication and Access Reference Group (IAARG).

As an aside, and back at page 3 we have all sorts of discussions about IAARG ‘Tiger Teams’

Well go here to find out:

http://en.wikipedia.org/wiki/Tiger_Team

“A Tiger team is a specialized group that tests an organization's ability to protect its assets by attempting to circumvent, defeat, or otherwise thwart that organization's internal and external security. The term is also used in other settings, including information technology, aerospace design, and emergency management.

The term originated within the military to describe a team whose purpose is to penetrate security of "friendly" installations to test security measures. It now more generally refers to any team that attacks a problem aggressively.”

More amusingly in the change log for the document we find:

“Updated input from Tiger Team review

References to ‘Responsible Officer’ changed to ‘Responsible Officer’” – What????

But back to the main story.

Regular readers will know I have been curious how security and audit trails are going to be implemented in the HI Service and it seems this obscure Tiger Team is meant to be involved.

On identification and authentication for access to the HI Service we read the following.

First it is important:

“The National E-Health Strategy Summary included identification and authentication as one of the five key national foundations required for e-health:

Identification and authentication - There is a need to design and implement an identification and authentication regime for health information as soon as possible as this work will be absolutely fundamental to the nation’s ability to securely and reliably access and share health information.

Australia should seek, as far as possible, to make the allocation of consumer and care provider national identifiers universal and automatic.”

Second it will have the following security attributes (Page 29)

6.3.5 Information Security

The Security and Access Framework for the HI Service will operate within the context of the overall e-health security and access framework. It covers the principles, policies, processes and tools that are to be used to achieve this aim.

This framework recognises that strong information security will contribute to the success of the HI Service by appropriately safeguarding the personal information required to operate the Service7.

A multi-layered approach will safeguard the HI Service, and accordingly the Security and Access Framework incorporates both technical and non-technical controls. These include:

• Smartcards and PKI certificates to facilitate the accurate identification and authentication of individuals accessing the HI Service

• Robust audit trails, and proactive monitoring of access to the HI Service by both internal and external users

• Role-based access control policies

• Rigorous security testing, to be conducted both prior to and after commencement of operation of the HI Service

• Ensuring users of the HI Service are adequately trained, through provision of educational programs and other training mechanisms

• Requirements that healthcare provider individuals and organisations comply with healthcare identifiers specific legislation

The Security and Access Framework for the HI Service will ensure that the privacy, confidentiality, integrity and availability of information within the HI Service are not compromised.

Security needs to be operationally realistic for stakeholders, meaning that it must support, rather than hinder, the HI Service. As such, security has been designed to be ‘fit for purpose’, and to address policy objectives. Appropriate security controls are therefore being implemented in order to meet the HI Service objectives.

The objective of the Security and Access Framework for the HI Service is to:

• Minimise the risk of unauthorised access to the HI Service and the information it contains

• Enable detection of unauthorised information access or modification, and any other breach of information security (including privacy)

• Facilitate appropriate response to, and investigation of, any such breaches

• Assure the continued availability of the HI Service

• Provide a means to continually improve security protections (including protection of privacy, confidentiality, integrity and availability)

The Security and Access Framework will ensure that the privacy, confidentiality, integrity and availability of information within the HI Service are not compromised. As security needs to be operationally realistic for stakeholders, (meaning that it must support, rather than hinder, the HI Service) it has been designed to be ‘fit for purpose’ and address policy objectives.

----- End Extract

The last little bit of information is here:

6.6.1.4 Authentication Service

The HI Service will use the National Authentication Service for Health (NASH) to provide security credentials for healthcare provider individuals and organisations. These credentials will be used for:

• Accessing the HI Service

• Asserting their identity when participating in e-health

----- End Extract.

The big issue I see here is that, to date, just what NASH is, is planning, and when it will begin delivering whatever it is going to deliver remains severely under wraps. We are also left wondering just where the balance between security and convenience will finally rest in terms of technical implementation – it is mentioned twice in the extract above.

Reading the rest of the Concept of Operations document it is clear that NASH is central to the HI Service’s capacity to deliver what it promises and right now how it will achieve that is vague in the extreme.

Clearly NASH has to be fully operational prior to the commencement of the HI Service if the presently proposed levels of security and access audit are to be delivered. Given the scale of change and training this implies I wonder why we are not hearing a great deal more?

There are going to be a lot of work practices needing to be modified by all this and that will not happen without some very detailed communication with the large number of stakeholders involved.

Oh and by the way the IAARG is really very secure. Not a note, minute or reference anywhere that Google can find!

David.

Weekly Australian Health IT Links – 13 June,2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

General Comment:

The most interesting thing this week was the ongoing discussion of the comments made last week at Senate Estimates as people thought through what it all might actually mean.

I have to say that despite my best efforts I am still to get any clarity about what is meant by the term Personally Controlled EHR (PCEHR), precisely what is intended, and just where it fits with the rest of the alphabet soup of IEHRs, PHRs, SEHRs and so on.

One can only conclude they really don’t know, or if they do, they think we are not entitled to know.

There has now been a month since the Budget (with this detail lacking announcement) was announced and the time for clarity has well and truly arrived.

The other obvious issue is that there has been some apparent change in the popularity of the Government due to the RSPT among other things. The impact of this on present e-Health plans, and all sorts of other things, is clearly under a cloud right now!

-----

http://www.techworld.com.au/article/349738/biogrid_develops_saas_e-health_platform

BioGrid develops SaaS e-health platform

App can be applied to any long-term medical condition

Rodney Gedda (CIO) 11/06/2010 10:16:00

Melbourne-based medical research organisation BioGrid Australia has developed an e-health application which promises to break down information siloes between institutions by offering it as an integrated service.

BioGrid aims to provide an innovative medical research platform that facilitates “privacy protected research” across hospitals and medical research organisations.

BioGrid director Dr Marienne Hibbert said developing the portal provided an interesting example of consumer involvement in an IT project.

“The issue around consumer health is if your information is locked up in a clinic or hospital,” Hibbert said.

“If you have a personal record with important information it needs to be presented in a way people can understand.”

-----

http://www.abc.net.au/news/stories/2010/06/11/2924683.htm

Aboriginal health records get cyber treatment

By Louisa Rebgetz

Posted Fri Jun 11, 2010 12:00pm AEST

The Aboriginal Medical Services Alliance in the Northern Territory has welcomed a $1.5 million funding boost to expand e-health services to remote Indigenous patients.

The service has been trialed over the last four years and enables data detailing people's medical records to be stored at a central location.

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http://www.zdnet.com.au/indigenous-health-sees-4-3-million-it-boost-339303807.htm

Indigenous health sees $4.3 million IT boost

By Jacquelyn Holt, ZDNet.com.au on June 11th, 2010

Indigenous health in Queensland, the Northern Territory, Victoria and South Australia will receive $4.3 million to upgrade IT services.

The Minister for Indigenous Health Minister, Warren Snowdon today announced plans which will see the money distributed across four Aboriginal health organisations to assist over 50 health services in the four states.

The Nganampa Health Council in South Australia will receive almost $2 million for IT systems maintenance and a web-based reporting trial. The Aboriginal Medical Services Association (AMSANT) will see just over $1.5 million for the development of a shared IT arrangement with other Aboriginal medical services and to evaluate the viability of an e-health system in the Northern Territory.

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http://www.theaustralian.com.au/news/health-science/be-careful-of-snake-oil-health-reform/story-e6frg8y6-1225878176921

Be careful of snake oil: health reform

• AT THE COALFACE: Terry Hannan
• From: The Australian
• June 12, 2010 12:00AM

RECENT television advertisements claim: "Under the new health reform, the Australian government is delivering the most significant improvement to our health system since the introduction of Medicare."

The historical e-health reform evidence demonstrated worldwide would counter this claim. The answer is not in providing more hospital beds, training more doctors and nurses, and expanding the number of general practitioner services. This flawed model is essentially a propagation of the present healthcare delivery system, which is based on the costly, inefficient and poor quality widgets model of care.

Present models are no longer affordable, and to ensure success Australia must remove itself from non-data driven recommendations for health care. Real change can be made only with the use of effective health information technology tools. The phrase "electronic health records" is oft-quoted but poorly understood.

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http://www.zdnet.com.au/govt-wants-isps-to-record-browsing-history-339303785.htm

Govt wants ISPs to record browsing history

By Ben Grubb, ZDNet.com.au on June 11th, 2010

Companies who provide customers with a connection to the internet may soon have to retain subscriber's private web browsing history for law enforcement to examine when requested, a move which has been widely criticised by industry insiders.

The Attorney-General's Department yesterday confirmed to ZDNet Australia that it had been in discussions with industry on implementing a data retention regime in Australia. Such a regime would require companies providing internet access to log and retain customer's private web browsing history for a certain period of time for law enforcement to access when needed.

Currently, companies that provide customers with a connection to the internet don't retain or log subscriber's private web browsing history unless they are given an interception warrant by law enforcement, usually approved by a judge. It is only then that companies can legally begin tapping a customer's internet connection.

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http://www.australianageingagenda.com.au/2010/06/08/article/Building-a-case-for-e-health-in-aged-care/NFKJKKFMPI.html

Building a case for e-health in aged care

Published on Tue, 08/06/2010, 11:04:13

The two national aged care peak bodies have joined together under the banner of the Aged Care Industry IT Council (ACIITC) to commission a study into the sector’s IT readiness.

The comprehensive, stratified survey will be conducted by Campbell Research as part of a national project to roll out electronic prescribing and medication management throughout the sector by 2013.

The ACIITC hopes to develop a strategy for implementing a secure repository that GPs, pharmacists and aged care facilities will be able to access.

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http://www.computerworld.com.au/article/349265/healthsmart_roll_e-health_smartcards/?eid=-6787

HealthSMART to roll out e-health smartcards

Part of $360 million Victorian e-health initiative

• Tim Lohman (Computerworld)
• 08 June, 2010 12:02

Victoria's Department of Health will shortly commence implementing an e-health smartcard to manage access to key Victorian public health sector (VPHS) applications via a new single sign-on portal, as part of its whole-of-health ICT strategy, HealthSMART.

The two-factor authentication system will consist of a smartcard management system card printers, contact smartcard readers, a hardware security module, middleware and mini-driver for network authentication, and an application for performing certificate and PIN management functions.

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http://www.computerworld.com.au/article/349141/complete_health_identifier_service_still_months_away/?eid=-255

Complete health identifier service still months away

Software vendors to come online in Q1 2011 as NeHTA rolls out "evolutionary process"

• James Hutchinson (Computerworld)
• 07 June, 2010 16:41

Despite efforts to have the healthcare identifier (HI) service up and running by 1 July, the National eHealth Transition Authority (NeHTA) believes the service could take years to fully implement.

A spokesperson for the authority behind the implementation of the identifier service told Computerworld Australia that the system required additional software vendors, live testing and education for healthcare providers before the system was rolled out nationwide.

Recent amendments made to the Healthcare Identifiers Bill - the legislation that will enable the service to be implemented - has pushed back its reintroduction into Parliament to 17 June, and potentially pushed back the service's starting date back from its original July timeframe.

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http://www.smh.com.au/business/id-theft-threat-largely-ignored-survey-20100607-xpao.html

ID theft threat largely ignored: survey

June 7, 2010 - 1:07PM

Most Australian's aren't protecting themselves against identity theft even though more than half those surveyed had lost a wallet or other personal information over the past three years, according to a debt data firm.

Research by Veda Advantage shows only 30 per cent of people have taken simple measures, such as buying a personal shredder, to protect themselves from ID theft.

The credit/debt data monitor also said 80 per cent of people were worried about identity fraud.

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http://www.theaustralian.com.au/australian-it/google-privacy-probe-toothless/story-e6frgakx-1225876661917

Google privacy probe toothless

• Fran Foo
• From: The Australian
• June 08, 2010 12:00AM

THE Office of the Privacy Commissioner has not set a deadline for its investigation of Google but regardless of the outcome, it has no power to prosecute the internet giant.

Privacy Commissioner Karen Curtis launched a probe into Google on May 17 to determine if people's privacy was breached when its Street View cars captured personal information while inadvertently tapping into unsecure wireless networks.

The possible data breach took place in more than 30 countries and Google is facing at least one civil lawsuit in Oregon, US.

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http://www.nature.com/oby/journal/vaop/ncurrent/abs/oby2010119a.html

Intervention and Prevention

Obesity (2010) doi:10.1038/oby.2010.119

12-Month Outcomes and Process Evaluation of the SHED-IT RCT: An Internet-Based Weight Loss Program Targeting Men

Philip J. Morgan¹, David R. Lubans¹, Clare E. Collins², Janet M. Warren³ and Robin Callister⁴

Abstract

This article reports the 12-month follow-up results and process evaluation of the SHED-IT (Self-Help, Exercise, and Diet using Information Technology) trial, an Internet-based weight loss program exclusively for men. Sixty-five overweight/obese male staff and students at the University of Newcastle (Callaghan, Australia) (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) Information only control group (n = 31). Both received one face-to-face information session and a program booklet. Internet group participants were instructed to use the study website for 3 months. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up for weight, waist circumference, BMI, blood pressure, and resting heart rate. Retention at 3- and 12-months was 85% and 71%, respectively. Intention-to-treat (ITT) analysis using linear mixed models revealed significant and sustained weight loss of −5.3 kg (95% confidence interval (CI): −7.5, −3.0) at 12 months for the Internet group and −3.1 kg (95% CI: −5.4, −0.7) for the control group with no group difference. A significant time effect was found for all outcomes (P < 0.001). Per-protocol analysis revealed a significant group-by-time interaction for weight, waist circumference, BMI, and systolic blood pressure. Internet group compliers (who self-monitored as instructed) maintained greater weight loss at 12 months (−8.8 kg; 95% CI −11.8, −5.9) than noncompliers (−1.9 kg; 95% CI −4.8, 1.0) and controls (−3.0 kg; 95% CI −5.2, −0.9). Qualitative analysis by questionnaire and interview highlighted the acceptability and satisfaction with SHED-IT. Low-dose approaches to weight loss are feasible, acceptable, and can achieve clinically important weight loss in men after 1-year follow-up.

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http://www.abnnewswire.net/press/en/63023/iSOFT_Group_Limited_%28ASX:ISF%29_Releases_Market_Update_On_National_Programme_For_IT.html

iSOFT Group Limited (ASX:ISF) Releases Market Update On National Programme For IT

Sydney, June 7, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) issued a market update on 2 June 2010 partly referring to a deferral of decisions in relation to the National Programme for IT (NPfIT) for our partner CSC (NYSE:CSC) being due to an uncertain political climate in the UK and ensuing election.

In addition, further comments regarding government change were given as a reason for delays in NPfIT procurements in the South of England. Both these statements were iSOFT's opinion and cannot be taken as fact.

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http://www.smh.com.au/world/science/a-brain-but-not-as-we-know-it-20100609-xwyd.html

A brain, but not as we know it

DREW TURNEY

June 10, 2010

We are closer to the ultimate neurology experiment: building a brain, writes Drew Turney.

The 17th-century philosopher Rene Descartes claimed there was a disembodied driver in the brain, a kernel of intelligence that viewed sensory input and wielded consciousness to act upon it.

Though we're no closer to discovering the soul today, we know about dendrites, axons (cell components) and synapses (empty, electro-conductive space).

But what is still a mystery is how even though the brain comprises little more than these simple structures, it has somehow given rise to everything from language to love, from Beethoven to Big Brother.

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http://www.smh.com.au/nsw/cancer-patients-denied-surgery-20100607-xqu1.html

Cancer patients denied surgery

KATE BENSON

June 8, 2010

EXCLUSIVE

HUNDREDS of patients in Sydney, many needing spine and cancer surgery, have been left off hospital waiting lists for up to a year because overworked staff did not file the paperwork.

The mistake, which doctors say has affected more than 800 people, some in acute pain, has forced the health department to order a blitz on the centralised surgery bookings system in western Sydney. But angry surgeons claim some patients have already deteriorated as a result of the fiasco.

The error has also made politically sensitive hospital performance figures - much vaunted by the health department - look better than they are.

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http://www.smh.com.au/technology/technology-news/calls-to-expand-emental-health-20100607-xovs.html

Calls to expand e-mental health

June 7, 2010 - 11:39AM

The internet offers huge potential to bridge the gap between mental health services and those marginalised Australians most in need, experts say.

Professors Helen Christensen and Ian Hickie have joined forces to call for a major expansion of "e-mental health" in Australia.

Web-based mental health services could attain new reach into rural Australia while also placing help only mouse clicks away from the nation's internet savvy teens, they write.

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http://www.misaustralia.com/viewer.aspx?EDP://1275867695548&section=news&xmlSource=/news/feed.xml&title=Experts+call+for+web-based+mental+health+services

Experts call for web-based mental health services

AAP

The internet offers huge potential to bridge the gap between mental health services and those marginalised Australians most in need, experts say.

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http://www.theaustralian.com.au/news/just-16pc-tipped-to-take-up-nbn/story-e6frg6n6-1225876225571

Just 16 per cent tipped to take up NBN

• Matthew Denholm
• From: The Australian
• June 07, 2010 12:00AM

ONLY 16 per cent of homes and businesses passed by national broadband network fibre-optic would choose to connect to it, even after 15 years.

The surprisingly low estimates were prepared by the Tasmanian government and have been released to The Australian under Freedom of Information law, in a ruling by state Ombudsman Simon Allston.

Also released are documents showing Tasmania initially wanted the NBN rolled out mostly via wireless technology - rather than fibre - as a more cost-effective delivery method.

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http://www.smh.com.au/technology/enterprise/seven-free-software-tools-for-top-productivity-20100607-xp8q.html

Seven free software tools for top productivity

DAVID WILSON

June 7, 2010 - 12:51PM

If you're still chained to Internet Explorer, switching to Google's Chrome browser might be the ticket.

The web is a thrifter's paradise. The giant network teems with free applications that tackle everything from spyware to website building.

Yes, free stuff has dodgy associations. You may recall those free but trashy plastic gifts once routinely stuck in cereal packets. The modern equivalent is the spam that promises you a free laptop but only brings more junk mail messages.

Despite free stuff's dubious aura, some tools that you can download at no charge are top-class. That means lean (low on megabytes), stable (rarely liable to crash), plus - above all - effective.

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Enjoy!

David.

AusHealthIT Poll Number 22 – Results – 12 June, 2010.

The question was:

If We are To Have a Shared / Personally Controlled EHR Who Should Deliver and Manage It?

NEHTA

- 1 (2%)

Commonwealth Department of Health

- 7 (18%)

Separate Government Entity

- 13 (34%)

Private Sector via Tender

- 6 (15%)

No One – It’s a Bad Idea

- 3 (7%)

None of the Above

- 8 (21%)

Votes : 38

Comment:

This is a pretty interesting result. It is pretty clear most do not want NEHTA any where near this. It seems a separate government entity gets the cigar – with some support for having DoHA.

I would be curious what those who said None of the Above had in mind. Maybe a comment on those views would be useful?

Again, many thanks to all those who voted

David.