Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, July 16, 2010

Weekly Overseas Health IT Links - 15 July, 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.

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http://www.ama-assn.org/amednews/2010/07/05/bisb0707.htm

Electronic pill bottles might help medication adherence

The bottles send audio and visual alerts when it's time to take medicine. A study showed nearly 100% patient compliance when the devices are used.

By Pamela Lewis Dolan, amednews staff. Posted July 7, 2010.

Pill bottles that electronically alert patients to take their medications show promise for increasing compliance, according to research from the Center for Connected Health, a division of Partners Healthcare in Boston.

A randomized controlled study of patients who used electronic pill bottles wirelessly connected to the Internet found a 27 percentage point higher rate of medication compliance compared with patients who didn't use the electronic bottles.

The bottles, called GlowCaps and produced by Cambridge, Mass.-based Vitality, alert patients with light and sound when it's time to take their medicine. The bottles also generate missed-dose reminder phone calls and refill reminders. Automated progress reports also are sent to the patients' physicians, family or caregivers.

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Healthcare.gov Adds Hospital Comparison Data

The data from the Hospital Compare Tool includes information on how well hospitals care for patients with heart attacks, protect outpatients from surgical infections and use of imaging equipment.

By Nicole Lewis, InformationWeek
July 8, 2010
URL:
http://www.informationweek.com/story/showArticle.jhtml?articleID=225702729

Barely a week after launching HealthCare.gov, the first website to provide a central database of health coverage options and other comparative healthcare statistics, the Department of Health and Human Services announced Wednesday that new information about the quality of care in America's outpatient and emergency departments has been posted to the new website.

The new data, which can be found at the Compare Care Quality link on the front page of HealthCare.gov, includes information on how well hospitals care for patients with heart attacks, compares how hospitals protect outpatients from surgical infections, and examines how efficiently facilities use certain types of imaging equipment among Medicare patients.

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http://healthcareitnews.com/news/hhs-proposes-new-privacy-and-security-rules

HHS proposes new privacy, security rules

July 08, 2010 | Diana Manos, Senior Editor

WASHINGTON – Department of Health and Human Services Secretary KathleenSebelius announced Thursday new proposed privacy and security rules and resources. She said they would strengthen the privacy of health information and help all Americans understand their rights and the resources available to safeguard their personal health data.

Sebelius said the rules are part of an effort led by the Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR) to ensure Americans trust personal health data exchange.

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http://www.gastongazette.com/news/health-48897-keeping-fill.html

Health care providers say keeping electronic records will be good for your health

Daniel Jackson

2010-07-09 09:58:51

Forget all those paper forms you have to fill out every time you go to a new doctor.

One day, we’ll each have one medical file — electronic health records on a National Health Information Network accessible anywhere in the country by any medical provider with authorization to review those files. But just as sure as some readers of The Gazette are viewing this article on newsprint, the conversion to digital medical records has yet to be embraced by all physicians and patients.

North Carolina started an organized effort to create a statewide health care information exchange (HIE) 15 years ago, but doctors offices, hospitals and other providers have been slow to adopt electronic health records (EHR) that could be shared on the HIE for a variety reasons, including financial, technical and privacy concerns.

With the passage of the American Recovery and Reinvestment Act last year, the federal government allocated roughly $36 billion for health information technology, including incentives for medical providers that switch from paper to digital records. And by 2016, medical practices that fail to make the conversion ultimately face penalties that are sure to make health information technology — to use the correct acronym — a HIT.

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http://www.modernhealthcare.com/article/20100708/NEWS/100709943

APSC urges FDA to establish device-ID system

By Shawn Rhea / HITS staff writer

Posted: July 8, 2010 - 1:00 pm ET

The Advancing Patient Safety Coalition, a group of provider, healthcare-quality and patient-advocacy organizations, has sent a letter to Food and Drug Administration Commissioner Margaret Hamburg urging the agency to publish a rule establishing a unique device identification, or UDI, system.

In the letter, the group said the agency was taking "an unreasonable amount of time to publish a proposed rule" for a UDI system, which Congress mandated be developed in 2007 with the passage of that year's FDA Amendments Act. The system would be used to track movement of medical devices from the point of manufacture to their use in patients. Advocates for a UDI system say it would promote a broad range of healthcare system improvements, including patient safety, comparative effectiveness of medical devices and cost reduction through supply-chain efficiencies.

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http://www.modernhealthcare.com/article/20100708/NEWS/100709940

Excellence in IT: St. Luke's Health System

By Deborah Gash

Posted: July 8, 2010 - 1:30 pm ET

In 2007, St. Luke's Health System, Kansas City, Mo., had a physician alignment problem: Its affiliated physicians were unhappy about the amount of paper received from the health system.

Laboratory results, discharge summaries, reports and more were delivered in hard copy. Solving this business problem would strengthen the provider's relationships with its physicians. Also, information technology leadership correctly suspected that the solution would have significant benefits beyond the reduction of paper. St. Luke's launched a health information exchange initiative that allows sharing of clinical data at the community level and beyond.

In an online connectivity solution named St. Luke CareLink, St. Luke's uses a combination of e-health technologies to enable two-way communication: secure messaging, e-prescribing, clinical results delivery and automated personal health records. This e-connectivity is accomplished using a software-as-a-service network platform and supplier-hosted rapid deployment methodology that allows flexibility and extensibility to connect outward. The exchange requires minimal staffing resources and eliminates the need for infrastructure beyond access to the Internet, eliminating large capital outlays.

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http://www.modernhealthcare.com/article/20100708/NEWS/100709949

HHS proposes changes to HIPAA privacy rule

By Joseph Conn / HITS staff writer

Posted: July 8, 2010 - 1:00 pm ET

HHS has proposed a new federal healthcare information privacy rule to amend the Health Insurance Portability and Accountability Act of 1996. Reflecting changes Congress sought last year in the stimulus law, the proposed rule would give patients the right to restrict certain disclosures and ban the sale of patient data without patient consent, according to HHS.

According to an HHS announcement made jointly by David Blumenthal, head of the Office of the National Coordinator for Health Information Technology, and Georgina Verdugo, director of the Office for Civil Rights, the proposed rule would:

-expand individuals' rights to access their information;

-restrict certain disclosures of protected health information to health plans;

-extend the applicability of certain of the HIPAA privacy and security rule requirements to the business associates of covered entities;

-establish new limitations on the use and disclosure of protected health information for marketing and fundraising purposes;

-strengthen and expand OCR's ability to enforce HIPAA's privacy and security provisions.

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http://www.prnewswire.com/news-releases/use-of-health-information-technology-leads-to-improved-care-quality-97969569.html

Use of Health Information Technology Leads to Improved Care Quality

Kaiser Permanente Study Finds Quality of Care Scores Increase as Patients and Physicians Communicate via Secure E-mail

OAKLAND, Calif., July 7 /PRNewswire/ -- Secure patient-physician e-mail messaging improves the effectiveness of care for patients with diabetes and hypertension, according to new research by Kaiser Permanente. The study, published in the July issue of Health Affairs, shows that health information technology improves quality of care scores.

The study observed 35,423 patients with diabetes, hypertension, or both, in Kaiser Permanente's Southern California region, finding that use of secure patient-physician messaging in any two-month period was associated with statistically significant improvements in HEDIS (Healthcare Effectiveness Data and Information Set) care measurements. Results included 2.0 percentage-points to 6.5 percentage- points improvements in glycemic, cholesterol and blood pressure screening and control.

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http://www.fierceemr.com/story/ehealth-initiative-finds-significant-gains-emr-adoption-2007-concerns-about-explaining-value/2

eHealth Initiative finds significant gains in EMR adoption since 2007

July 8, 2010 — 12:00pm ET | By Neil Versel

Health IT adoption is gaining steam, but many have been unable to articulate the value of EMRs within their organizations and, significantly, to the public, a new report suggests. Still, people are optimistic about the future, but worry that the transition to ICD-10 coding and HIPAA 5010 transactions could slow momentum.

The "National Progress Report on eHealth," supported by the Commonwealth Fund and released by the broad-based, nonprofit eHealth Initiative, is an update on a 2007 study meant to identify trends that have emerged since passage of the American Recovery and Reinvestment Act in February 2009. For the report, the eHealth Initiative surveyed more than 100 healthcare professionals in each of five focus areas: aligning incentives; engaging consumers; improving population health; managing privacy, security & confidentiality; and transforming care delivery.

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http://online.wsj.com/article/SB10001424052748704535004575348963511758660.html?mod=dist_smartbrief

Dell Puts Hope in Health-Services Unit

Computer Giant Aims for Higher Margin Areas Using Perot Systems' Technology; H-P, IBM Remain Fierce Competitors

By IAN SHERR

Dell Inc. hopes customers like Methodist Hospital System will help cure what ails it.

Methodist has contracted with Dell's services since December 2009 to help it create and maintain an electronic medical records system. Dell's technicians are also customizing software for Houston-based Methodist's 2,600 doctors so those records can be accessed by staff at any of its four community hospitals.

Dell plans to use Perot to move up the technology food chain. Above: CEO Michael Dell shown in June.

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http://www.informationweek.com/news/healthcare/mobile-wireless/showArticle.jhtml?articleID=225702193

Healthcare Mobile Devices Forecast To Gain 7%

The healthcare industry is among the fastest growing handheld device markets, and should hit $8.8 billion this year, says Kalorama Information.

By Nicole Lewis, InformationWeek

July 2, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225702193

The total market for handheld devices in healthcare is expected to reach $8.8 billion for 2010, a 7% increase from last year when the global market posted $8.2 billion, a new report shows.

The report, titled "Handhelds in Healthcare: The World Market for PDAs, Tablet PCs, Handheld Monitors, & Scanners," was published this week by healthcare market research firm Kalorama Information. Noting that the healthcare industry is considered to be among the largest and fastest growing industry segments worldwide, the document said, "the industry can be classified on the basis of the roles that various entities perform. Hence, the healthcare value chain consists of producers, purchasers, providers, fiscal intermediaries, and payers."

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http://healthcareitnews.com/news/patients-referring-docs-md-anderson-making-good-use-web-portal

Patients, referring docs at MD Anderson making good use of Web portal

July 06, 2010 | Molly Merrill, Associate Editor

HOUSTON – Just one year after its launch, officials at the University of Texas MD Anderson Cancer Center report that 57 percent of patients and 40 percent of referring community physicians are using its Web-based portal for personal health information.

Patients are accessing their medical information an average of 3.3 times per week, while referring physicians are clicking on their patients' records 2.8 times per week, according to MD Anderson Clinical Information Services reports. Officials also noted that new-patient users are being added every week as they register at MD Anderson, return for checkups or hear about the portal.

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http://www.ecommercetimes.com/story/70336.html?wlc=1278556761

Health Information Exchanges, Part 1: Follow That Patient

Successfully establishing the means to link healthcare providers through networks, as impressive as that may be, is just the beginning. "Laying pipe isn't enough," says Jason Hess, general manager of clinical research at KLAS. "You still need some ground rules related to data access, data safety, other legal issues and ease of use."

One of the goals of improved healthcare in the U.S. is to ensure that health insurance is portable. The idea is that people should be able to change jobs, move around the country, and still be enrolled in the same health insurance plan.

Still, when a person from Texas relocates to California and changes physicians, the new doctor may know a more about that person's health insurance than his or her physical condition. To obtain information about the new patient's health usually calls for the doctor to conduct a complete physical exam, perhaps order a few tests, and depend upon the patient's recollections to create a medical history.

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http://www.ehealtheurope.net/news/6058/scottish_practice_goes_live_with_iplato

Scottish practice goes live with iPlato

07 Jul 2010

iPlato Healthcare has implemented iPlato Patient Care Messaging in Scotland for the first time.

The Dunbar Medical Centre in East Lothian has launched the web-based system, which integrates with GP systems and enables fully automated appointment reminders and targeted group messaging.

Its two practices hope to reduce waiting times for GP appointments and to enable GP-led, personalised and timely public health promotion.

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http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2010/07/06/urnidgns852573C40069388000257758003E5DC7.DTL

Secrecy of cloud computing providers raises IT security risks

Ellen Messmer, Network World

Tuesday, July 6, 2010

(07-06) 04:33 PDT -- Despite how attractive cloud computing can sound as an outsourcing option, there's widespread concern that it presents a security and legal minefield for businesses and government. Cloud service providers often cultivate an aura of secrecy about data centers and operations, claiming this stance improves their security even if it leaves everyone else in the dark.

Businesses and industry analysts are getting fed up with this cloud computing version of "don't ask, don't tell," where non-disclosure agreements (NDA) dominate, questions aren't answered, and data center locations and practices are treated like national security secrets. But public cloud service providers argue their penchant for secrecy is appropriate for the cloud model -- and at any rate, everyone's doing it. They often hold out their SAS-70 audit certifications to appease any worry (though some don't have even that)."The business data you store in Google's cloud is safe," said Google product marketing manager Adam Swidler at the recent Gartner security conference held in National Harbor, Md. He emphasized that Google's multi-tenant distributed model entails "splicing data across many hard drives" so that in this "hardened Linux stack" there's a "quick update of all fragments of all files in the hard drives," a process he called "obfuscated files."

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http://www.modernhealthcare.com/article/20100706/NEWS/307079976

HHS sends final meaningful-use rules to OMB for review

By Joseph Conn / HITS staff writer

Posted: July 6, 2010 - 4:15 pm ET

HHS has sent its final meaningful-use rules and certification criteria for electronic health-record system testing to the Office of Management and Budget—typically one of the last bureaucratic hurdles before rules are released. The criteria are called for under the EHR subsidy program established by the American Recovery and Reinvestment Act of 2009.

OMB received a copy of the final rule of the “meaningful use” criteria from the CMS Monday, according to the posting on the website of its Office of Information and Regulatory Affairs.

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http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100707/NEWS/100709958/1029

Excellence in IT: University of Pa. Health System

By Mike Restuccia

Posted: July 7, 2010 - 11:45 am ET

Following is one of the five winners of Modern Healthcare's 2010 IT Case Study Contest.

The University of Pennsylvania Health System includes three acute-care hospitals and two large ambulatory networks that serve Philadelphia, the surrounding five-county area and parts of southern New Jersey. Its physicians see more than 2 million outpatient visits in more than 220 practice locations each year.

The healthcare implementation project for this submission is a comprehensive outpatient electronic medical record. Its features include: clinical documentation, physician ordering, data reporting, outpatient pharmacy, a communications module, myPennMedicine and a referring physicians portal. More than half of Penn Medicine physicians are active users of the ambulatory EMR.

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http://www.miamiherald.com/2010/07/06/1716657/medical-records-go-online-but.html?mitest=A_default

Medical records go online, but at what cost to privacy?

Allison Grisham learns how to navigate her medical records with help from Dr. David Seo, a cardiologist at University of Miami Miller School of Medicine.

You're a South Florida resident on vacation in Boise or Bogotá. You suffer stomach pains and visit a local doctor. You whip out your BlackBerry, punch in your access code and show the doctor a list of your medications, allergies, past illnesses, tests, surgeries and advice from your physician back home.

Electronic medical records, or EMRs, are quickly becoming a reality for doctors and hospitals in South Florida and beyond.

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http://www.healthleadersmedia.com/content/TEC-253370/Large-Patient-Information-Breaches-Passes-Century-Mark

Large Patient Information Breaches Passes Century Mark

Dom Nicastro, for HealthLeaders Media, July 6, 2010

The number of entities reporting breaches of unsecured protected health information (PHI) affecting 500 or more individuals has hit the 100 mark and then some.

As of Friday, July 2, the number of entities reporting the egregious breaches to the government’s HIPAA privacy and security enforcer hit 107. The number of entities—listed on the Office for Civil Rights (OCR) breach notification website—has more than tripled since the enforcer first began posting them in February. The list has grown about 15 per month, or an entity every other day.

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http://www.fiercehealthcare.com/story/missing-beat-cardiovascular-information-systems-lack-functionality/2010-06-30

Missing a beat: Cardiovascular information systems lack functionality

June 30, 2010 — 11:41am ET | By Sandra Yin

Nearly one-third (30 percent) of cardiology IT users say they are considering replacing their cardiovascular information system software (CVIS), because their current vendors don't deliver the performance they expect.

"Client satisfaction continues to trend downward industry-wide as vendors fail to deliver on integration, functionality and service expectations," said Ben Brown, general manager of medical imaging and medical equipment research for KLAS and author of the new CVIS report, Cardiology IT: Has the industry missed a beat?

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http://www.fiercehealthit.com/story/aclu-suit-against-r-i-hie-shows-why-privacy-so-central-health-it/2010-07-05

ACLU suit against Rhode Island HIE shows why privacy is so central to health IT

July 5, 2010 — 9:51pm ET | By Neil Versel

The other shoe has dropped.

Last week, the American Civil Liberties Union sued a state-sanctioned health information exchange in Rhode Island, saying that the pre-operational exchange doesn't have adequate protections for patient privacy. Rules developed by the Rhode Island Department of Health to govern the HIE, called Currentcare, require patients to opt in to the system and control who can access their medical records, but does not allow them to wall off certain data elements, including sensitive information about substance abuse, mental health or HIV status.

The lawsuit, filed June 29 in state court, alleges that the DOH violated the Rhode Island regulatory process by failing to spell out exactly how data sharing will work. "In light of the important privacy and confidentiality issues raised by an EHR system, the legislature clearly envisioned the adoption of detailed regulations through a transparent process of public input," ACLU volunteer attorney Frederic Marzilli told CMIO magazine. "This lawsuit simply seeks to carry out that intent."

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http://www.modernhealthcare.com/article/20100706/NEWS/100709973

Web's sports health information can be way off base

By Maureen McKinney / HITS staff writer

Posted: July 6, 2010 - 12:00 pm ET

The Internet is usually the first stop for people seeking information about common sports injuries such as tennis elbow or a torn rotator cuff. But according to a new study in the July issue of the Journal of Bone and Joint Surgery, the accuracy and quality of that data varies considerably based on the source.

Researchers did Internet searches for 10 of the most common sports medicine diagnoses using Google and Yahoo and then ranked the first 10 websites based on accountability, transparency and content.

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http://www.modernhealthcare.com/article/20100706/NEWS/100709974

Excellence in IT: North Texas Specialty Physicians

By Fowad Choudhry and Thomas Deas Jr.

Posted: July 6, 2010 - 12:00 pm ET

Relevant, quality patient care relies on comprehensive clinical information available at the point of care. To fully transform its paper-based healthcare delivery system into an electronic and integrated care model, North Texas Specialty Physicians, an independent physician association based in Fort Worth, invested more than $10 million into the development of an interoperable health information exchange.

NTSP wanted to gather and use real-time patient information that could be parsed from multiple sources to provide faster, better and safer patient care, enhance physician communication and provide fiscally responsible care within one single sign-on application.

NTSP's HIE collects, communicates and distributes medical data to physicians on disparate electronic health-record applications, providing healthcare providers with real-time parsed clinical data at the point of care. It communicates with certified EHR systems through clinical documents called Continuity of Care Records, or CCRs. The system processes either the ASTM International standard CCR or the Health Level 7-based Clinical Care Document, or CCD, which includes patient demographics, diagnoses, current and past medications, allergies, laboratory results, procedures and a list of patient providers. The interoperable EHR system automatically sends and receives clinical documents prior to the patient's scheduled visit.

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http://www.govhealthit.com/newsitem.aspx?nid=74165

Health IT panel scrutinizes 2013 quality measures

By Mary Mosquera

Friday, July 02, 2010

Even before healthcare providers begin to demonstrate the first set of meaningful use requirements next year, federal health IT policymakers are already working on how high to set the bar for providers to qualify for the next round of financial incentive payments in 2013.

One set of criteria – that providers show the use of health IT to healthcare quality outcomes – will appear in progressively more sophisticated stages. A tenet of meaningful use, quality measures are expected ultimately to help providers both hone their treatment protocols and lower healthcare costs.

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http://www.healthdatamanagement.com/news/breach-maine-mental-health-40597-1.html

Mental Health Data Breached in Maine

HDM Breaking News, July 6, 2010

The University of Maine is notifying 4,585 current and former students after two servers holding information from the school's mental health and support counseling center were breached.

Data on the servers, covering students who sought counseling services between Aug. 8, 2002, and June 21, 2010, includes names, Social Security numbers and clinical information. "Any student or former student who visited the counseling center as a UMaine student since Aug. 8, 2002, should assume that he or she is in the affected database," according to a statement the university has issued.

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http://www.ehiprimarycare.com/news/6054/inps_wants_vision_360_to_be_gp_system

NPS wants Vision 360 to be GP system

06 Jul 2010

INPS is to seek NHS Connecting for Health accreditation for its Vision 360 data hub as a GP system.

The GP systems supplier has been developing Vision 360 for some years and it is already in use as a data repository. It is used or will be used for information sharing in Scotland, Wales and several English health communities.

Max Brighton, INPS managing director, told EHI Primary Care that the eventual aim was to seek CfH accreditation for Vision 360 as a GP system.

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http://www.ehiprimarycare.com/comment_and_analysis/606/ehi_pc_interview:_inps

EHI PC Interview: INPS

06 Jul 2010

EHI Primary Care editor Fiona Barr talks to Max Brighton, managing director of INPS, Russell Blackmore, the company’s product director, and Simon Fanthorpe, its IT director, about the future of the GP system supplier and its Vision 360 data hub.

Add up the column inches devoted to GP system suppliers on EHI Primary Care and elsewhere and you would probably find that they were dominated by two names - EMIS and TPP.

One of these companies is the biggest GP system supplier in the UK and the other has had a high profile entry to the market over the last decade.

Yet over that same period, another company, INPS, has not only maintained its position as the second biggest GP IT supplier in the UK but has also seen its customer base grow every year.

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http://www.ehiprimarycare.com/news/6055/health_guide_gets_first_english_trial

Health Guide gets first English trial

06 Jul 2010

NHS Central Lancashire is using Intel’s Health Guide with COPD patients in Preston so they can monitor their condition from home.

The Health Guide is being used by 40 patients as part of a 12 month pilot in what is the first implementation of the device in England.

The technology, which is provided by GE Healthcare, allows patients to measure their vital signs and respond to questions about their conditions on a regular basis, with all the data being reviewed by a community matron.

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http://www.ihealthbeat.org/features/2010/californias-new-health-information-exchange-hires-ceo.aspx

Tuesday, July 06, 2010

California's New Health Information Exchange Hires CEO

Cal eConnect, the new organization overseeing California's metamorphosis from paper-based to electronic health care, has hired a CEO -- Carladenise Edwards.

Edwards, former health IT coordinator for the state of Georgia and health IT adviser to former Florida Gov. Jeb Bush (R), will oversee the $38.8 million federal grant for health information exchange that California received under the American Recovery and Reinvestment Act of 2009.

"I am delighted to have the opportunity to be part of the largest health information exchange effort in the country," Edwards said. After moving from Atlanta to California, Edwards began managing the start-up organization's business in earnest last month.

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http://medhealth.tmcnet.com/topics/mobile-connected-health/articles/90964-what-does-health-20-mean.htm

July 06, 2010

What Does "Health 2.0" Mean?

The terms "Health 2.0" and "Medicine 2.0" get thrown around quite a bit in e-health circles, but is there any consensus about what they actually mean? The short answer appears to be: no. At least not according to a literature review recently published in the Journal of Medical Internet Research.

To search for unique definitions of Health 2.0 or Medicine 2.0, the authors examined electronic databases such as PubMed, Scopus, and CINAHL, and also searched "gray literature" on the Internet, using Google (News - Alert), Bing, and Yahoo. They found 1937 articles, and common to many definitions were the following themes: Web 2.0/technology; patients; professionals; social networking; health information/content; collaboration and change of health care.

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http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/593

Infoway Certification Services expands to include Diagnostic Imaging, Drug Information Systems

'Infoway Certified' assures products meet pan-Canadian standards

July 5, 2010 (Toronto, ON) – Canada Health Infoway (Infoway) has added diagnostic imaging and drug information systems to its pre-implementation Certification Services. Health information technology vendors can now receive certification for seven classes of technology.

Receiving the 'Infoway Certified' mark gives vendors of health information technology products an advantage in the marketplace by signalling to potential healthcare customers their commitment to pan-Canadian standards and industry best practices, and their leadership in contributing to interoperable health information for Canadians.

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http://walnutcreek.patch.com/articles/medicine-in-the-age-of-twitter

Medicine in the Age of Twitter

Some doctors are embracing the digital revolution and tweeting and using Facebook to give their patients a better understanding of their own health care.

By Ayako Mie | Email the author | 3:13am

When Rahul Parikh arrived at his office on Tuesday morning, the first thing he did was to tweet that the hospital finished construction of the front entrance.

"I thought it was useful information for the community," said the 38-year old Parikh.

Parikh is a pediatrician at Kaiser Permanente Medical Center in Walnut Creek. What makes Parikh different from some other doctors is that he fully embraces Web. 2.0. He tweets about heath care news, in addition to writing medical-related blogs on Salon.com and contributing to the New York Times, the Los Angeles Times, and the San Francisco Chronicle. You can follow the doctor at @parikhmd.

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Enjoy!

David.

Thursday, July 15, 2010

France Takes An Interesting E-Health Path. Any Useful Learnings?

The following appeared a few days ago – and it is interesting the Strategic Path being followed has substantial crossover to what I think should be happening in Australia.

07/07/2010

Voilà! French e-health goes online in 2010

Report: John Brosky

The hosting service has been selected, software standards have been published, and on 11 December 2010 any French citizen will be able to open a file and begin creating a secure, personal electronic health record (EHR). If the agency charged with this ambitious programme meets the deadline, France will suddenly jump to the leading edge of e-health worldwide, rivalling advanced national programmes in Canada, Sweden and Denmark, as well as benchmark regional programmes implemented in Spain and Italy.

Launched with much fanfare in 2004, the dossier medical personalisé (DMP) was promoted as the pièce de résistance for reforming France’s healthcare system, expected to bring over €3.5 billion in cost savings annually for the state health insurance fund.

The July 2007 deadline set by the legislature passed, the programme became a national embarrassment and, in 2008, a joint commission of three government ministries declared the DMP officially dead.

Stubbornly, Health Minister Roselyn Bachelot re-launched the DMP in 2009. The solution may have failed, she said, but the need for patient-centred management and savings for the health insurance fund had not gone away.
Against all odds and in record time, the newly created agency charged with delivering the new DMP moved quickly and convincingly, securing the necessary funding, overcoming legal and technical problems and announcing the ambitious deadline.

During the national Health Information Technology exposition in Paris, European Hospital spoke with Jean-Yves Robin, the head of ASIP Santé (Agence des Systèmes d'Information Partagés de Santé) who is leading the French charge to the frontline of e-health in Europe.

He chafes at the suggestion that France is going to pull a rabbit out of its hat in December, suddenly to become the only country to offer a nationally coordinated healthcare record. ‘This is not a magic trick. This is the fruit of years of work,’ he said during our European Hospital interview. ‘We are not creating something completely new but re-launching the DMP, which is to say we are not re-inventing everything but instead pulling together several years of pilot programmes, development of security systems and tapping into independent efforts such as the medication records and the record of medical acts from the national health insurance agency.’

‘At the moment, yes, France is behind other countries that have launched impressive regional programmes or have focused on specific functions, such as pharmacy or scheduling,’ Jean-Yves Robin conceded. ‘We have had problems with governance and leadership of projects, but those issues are now settled.’ Legal disputes on patient identification and the rights of patients to direct medical records are resolved.

A key strategy, he explained, was to clearly separate the DMP into two different programmes, though both share the same designation in French as DMP.

The dossier médical personnel (DM-Personnel) to be launched in December is an EHR aimed at helping citizens organise health records for consultation with their general practitioner (GP) and other healthcare providers, such as home care providers or emergency caregivers seeking medication histories and a summary of recent surgeries.

The dossier médical patient (DM-Patient), which will be developed progressively over the next few years, is an electronic patient’s record (EPR) that will be shared among healthcare professionals, specialists and clinicians with detailed reports of a patient’s care and will include exam results, e.g. lab reports and medical images.

Lots more here:

http://www.european-hospital.com/en/article/7321-Voil%C3%A0_French_e-health_goes_online_in_2010.html

What the French seem to be doing is creating a patient orientated play-pen where patients can record their health information and have it shareable, if they wish, with their GP.

In parallel they are embarking on a much more complicated and slow process to develop electronic patient records for their health professionals to share with each other.

Yet another county has figured out you actually need to work on both. Hardly voila but pretty sensible!

David.

Wednesday, July 14, 2010

I Wonder Is There a Lunatic Out There Who Would Take This On?

Health and Ageing: Employment Opportunity N.N. 10485856

Department of Health and Ageing Closing date: Monday, 26 July 2010

Executive Division

Job Title: Chief Information and Knowledge Officer

Job Type: Ongoing, Full-time

Location: Canberra | ACT

Classification: Senior Executive Service Band 3

Job Description

Duties

The Department of Health and Ageing is seeking to appoint a Chief Information and Knowledge Officer to assume responsibility for the ongoing transformation of its technology and information capabilities as it proceeds to implement the Government’s recently announced health reform agenda.

Reporting to the Secretary of the Department, and as a key member of the Senior Executive Group, the appointee will have leadership responsibility for information and knowledge management across the portfolio. This will include an organisation-wide focus on data, performance and information to improve health outcomes and to support advances in the development of e-health, including recent Australian Government investment in a personally controlled electronic health record system. The successful candidate will be expected to work closely with a wide range of internal and external stakeholders while developing and coordinating systemic approaches to harnessing information, knowledge, records management and intelligence.

The appointee will have a comprehensive understanding of information and knowledge management and integration processes, preferably from a health perspective, including an understanding of the importance of electronic health solutions. He/she will also have a strong track record in leading and delivering major change programs in large, complex and politically sensitive environments. High level strategic policy advisory skills, outstanding stakeholder management capabilities and the personal capacity to make a major contribution at a strategic level within the portfolio will be required.

The full advertisement is here:

http://www.apsjobs.gov.au/SearchedNoticesView.aspx?Notices=10485856%3A1&mn=SESSearch

The good things about this is that it is at the right level for what needs to be done – reporting directly to the Secretary of the Department and that there is probably enough money to get started (the $446 M over 2 years).

The bad is that it is probably not paid enough – the level goes to about $250,000 p.a. or so – and that there is only 2 years to show any outcomes and that there is currently not a capable delivery organisation to lead in place (meaning it will need to be built).

I have to say taking this on without having some major understandings about governance, discretion and authority – as well as clarity about just where NEHTA fits would be courageous.

My preferred outcome is that this position would actually lead the organisation contemplated in the Deloittes National E-Health Strategy.(See page 66)

Impact on NEHTA

The establishment of a national E-Health Entity will directly impact the role of NEHTA. NEHTA, a collaborative enterprise owned by Australian, State and Territory Governments, was established to identify and jointly develop foundations for E-Health such as the definition of an agreed set of key national E-Health standards and specifications. This constitutes a subset of the functions proposed for the E-Health Entity. NEHTA’s organisational charter expires in June 2009 and hence there is an increasingly urgent need to address the future of the organisation.

In light of the proposal for the establishment of a national E-Health Entity with a significantly broader set of accountabilities and functions than NEHTA in its current form, there are three implementation options that have been considered:

NEHTA to form the basis of the new E-Health Entity with a broader remit

Establish a new legal E-Health Entity and integrate NEHTA’s current execution functions into its structure

Establish a new legal E-Health Entity and allow NEHTA to operate as a separate organisation with accountability for the delivery of core E-Health foundations.

The first option is for NEHTA to form the organisational basis of the new E-Health Entity. This would require the existing NEHTA organisation to extend its accountabilities and functions to allow effective governance of the national E-Health Strategy and the execution of the national components of the three strategic work streams. This option would necessitate changes to NEHTA’s constitutional basis to extend the range of organisational responsibilities and to end the transitional nature of the authority. It would also require changes to the organisation’s brand and operating model.

The advantage of this approach is that the existing NEHTA organisation including legal structure, resources, capabilities, funding and governance arrangements, could be relatively quickly leveraged to support the establishment of the new E-Health Entity. One disadvantage is the extent of work required to restructure, refocus and reskill the organisation. The other is the need to overcome the historic and reasonably widespread perception in parts of the health sector that NEHTA’s progress to date has been too slow and not inclusive enough of the care provider community.

The second option is to establish a new legal E-Health Entity that would integrate NEHTA’s existing execution functions into its structure. The advantage of this option is the establishment of a new national E-Health Entity with a clear set of accountabilities and which is unencumbered by history. The key disadvantage is that the structure and constitutional and legal basis for this organisation must be designed and created from scratch which is likely to be a lengthy exercise and therefore could delay meaningful progress towards national E-Health outcomes.

The third option is to establish a new legal E-Health Entity and allow NEHTA to operate as a separate organisation with accountability for design and execution of national E-Health foundations. In this option, NEHTA would report in to, and seek strategic direction and funding from, the E-Health Entity. This option will minimise impacts to the existing NEHTA work program, but will also create delays associated with the establishment of the new entity. It will also create the significant potential for overlap, duplication and poor coordination between the two organisations, ultimately risking the coordinated delivery of national E-Health outcomes.

----- End Extract.

Option 1 is the go in my view!

Unless all this is sorted this job is a real ‘poison chalice’!

I note in passing that an earlier e-Health head has apparently moved on to the AHIW.

Lisa McGlynn

Australian Institute of Health and Welfare

Bruce | ACT

Senior Executive Service Band 1

No one seems to stay very long in e-Health in DoHA. It might just be that herding cats is just too hard!

David.

The USA Shows How Leadership Really Matters in e-Health.

This appeared overnight – and I would suggest is the most important step for e-Health taken anywhere in the world since the release in the UK of its ‘Information for Health’ Strategy about 8 years ago.

What is described here is the outcome that can be worked towards when some real smarts, some real leadership and some real money are used to address an obvious problem.

Australia compares so poorly in all three areas right now it is really very sad I believe.

The “Meaningful Use” Regulation for Electronic Health Records

Posted by NEJM • July 13th, 2010 • Printer-friendly

David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A.

The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice.

But inevitability does not mean easy transition. We have years of professional agreement and bipartisan consensus regarding the potential value of EHRs. Yet we have not moved significantly to extend the availability of EHRs from a few large institutions to the smaller clinics and practices where most Americans receive their health care.

Last year, Congress and the Obama administration provided the health care community with a transformational opportunity to break through the barriers to progress. The Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs privately and securely to achieve specified improvements in care delivery.

Through HITECH, the federal government will commit unprecedented resources to supporting the adoption and use of EHRs. It will make available incentive payments totaling up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. This funding will provide important support to achieve liftoff for the creation of a nationwide system of EHRs.

Equally important, HITECH’s goal is not adoption alone but “meaningful use” of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes.

HITECH calls on the secretary of health and human services to develop specific “meaningful use” objectives. With the Centers for Medicare and Medicaid Services (CMS) in the lead, the Department of Health and Human Services (DHHS) has used an inclusive and open process to develop these criteria, providing an extensive opportunity for public and professional input. The department published proposed meaningful use requirements on January 16, 2010. The proposal prompted some 2000 comments. This week, the DHHS is releasing a final regulation for the first 2 years (2011 and 2012) of this multiyear incentive program. Subsequent rules will govern later phases.

The full article is here:

http://healthcarereform.nejm.org/?p=3732&query=OF

A .pdf can be downloaded from the bottom of the article. This is worth doing to read the contents of just what is required to receive the $27 Billion in incentive payments.

The Journal has also published an amusing story on one doctor’s trip to the EHR!

Finding My Way to Electronic Health Records

Posted by NEJM • July 13th, 2010 • Printer-friendly

Regina Benjamin, M.D., M.B.A.

The recent oil spill off the Gulf Coast may prove to be one of the great environmental challenges of our lifetime. It is yet another devastating blow to the Gulf region, a place I call home. My heart goes out to the people there who are concerned about how this latest disaster will affect their livelihood and their health. Though the full effects of the spill remain to be seen, already the health needs of Gulf Coast inhabitants are increasing during this time of crisis. Physicians in the area will need to adapt and find innovative ways to efficiently deliver health care for an already underserved population. I recall my experiences as a physician during the crises of Hurricanes Georges and Katrina and try to remember how I adapted.

Full tale here:

http://healthcarereform.nejm.org/?p=3736&query=OF

For another take on all this it is worth reading John Halamka’s blog.

http://geekdoctor.blogspot.com/2010/07/meaningful-use-and-standards-are.html

Tuesday, July 13, 2010

Meaningful Use and the Standards are Finalized

Today at 10am, CMS and ONC released the final rules that will guide electronic health record rollouts for the next 5 years. Key resources include:

New England Journal of Medicine overview. The table provides a detailed list of final meaningful use requirements.

Federal Register publication of the Meaningful Use regulation

Federal Register publication of the Standards regulation

.....

Overall, a very good day for ONC, HHS and stakeholders. The final rule means Meaningful Use will be achievable by many. The Standards and the process to certify their use are sufficiently specific. I'm impressed.

John Halamka

Read and take heart. Good things are possible I believe but lacking the leadership and governance frameworks I am not at all confident they will come to pass.

David.

Tuesday, July 13, 2010

Let’s Get Real With This Silly Patient Controlled EHR Story.

I came upon this great opinion piece the other day.

http://www.fierceemr.com/story/tale-two-phr-models/2010-07-08

Portals see high usage, while untethered PHRs may compromise safety

July 8, 2010 — 1:29pm ET | By Neil Versel

Editor’s Corner

Whenever I get a pitch about personal health records, I immediately ask if the publicist has any evidence that people are using the product in question. I rarely get a response because I know that in most cases, there is no such evidence. The lone exception is a PHR that's "tethered" to a large health system's EMR.

Some such evidence surfaced this week, when the University of Texas M.D. Anderson Cancer Center in Houston reported that 57 percent of patients and a surprisingly strong 40 percent of outside referring physicians are using the center's year-old web portal. And using it often. According to Healthcare IT News, patients have been logging into the portal an average of 3.3 times a week--that's once every other day--and referring physicians are accessing M.D. Anderson patient records 2.8 times weekly.

Not surprisingly, M.D. Anderson's primary EMR vendor is Epic Systems. The company's myChart PHR--called myMDAnderson at the Houston institution--is an integral part of the Epic Care EMR for so many of Epic's customers. The Cleveland Clinic, Kaiser Permanente, NorthShore University HealthSystem in Illinois, the University of Texas Medical Branch and Dean Health Care are among those that have had success with myChart. Partners HealthCare System in Boston, which built its own EMR, also has seen wide acceptance of patient portal.

Why does this model work? Because the EMR automatically populates each patient's PHR, saving people from having to enter all of their own data. Think of personal financial software before online banking became widespread. Who was going to sit down and type the entire contents of a handwritten check register into a Quicken screen? Virtually nobody. But when users gained the ability to download bank statements directly into the software, sales took off.

That's why I am not surprised by the findings in a newly published paper in the Journal of the American Medical Informatics Association. The author, Dr. Donald Simborg, co-founder and board member of Health Level Seven International and a founding member of the American College of Medical Informatics, argues that "untethered" PHRs create "a form of unhealthy consumer populism" by disrupting physician workflow.

Read all the gruesome details here:

http://www.fierceemr.com/story/tale-two-phr-models/2010-07-08

Here is the link to the paper being discussed along with the abstract.

http://jamia.bmj.com/content/17/4/370.abstract

JAMIA 2010;17:370-372 doi:10.1136/jamia.2010.003392

  • Viewpoint paper
Consumer empowerment versus consumer populism in healthcare IT

  1. Donald W Simborg
  1. Correspondence to Dr Donald W Simborg, 407 Old Downieville Hwy, Nevada City, CA 95959, USA; dsimborg@sbcglobal.net
  • Received 19 January 2010
  • Accepted 30 April 2010

Abstract

Institutions, providers, and informaticians now encourage healthcare consumers to take greater control of their own healthcare needs through improved health and wellness activities, internet-based education and support groups, and personal health records. The author believes that “untethering” all of these activities from provider-based record systems has introduced a form of unhealthy consumer populism. Conversely, integrating these activities in a coordinated manner can sustain both consumer empowerment and consumer well-being.

----- End Abstract.

The one line summary is pretty simple – unless you have links between professional data sources and a patient held record they won’t be used and if they are they are likely to be potentially dangerous.

The only way the crazy plans from the Department of Health and NEHTA can work is if GPs, specialists, lab information providers and the like contribute information to the patient held record.

If you think this is going to happen without very substantial incentives and assistance being put in place – for which at present, as far as we know, there is no budget, you are dreaming!

This is the second shoe to fall in my view. First we know the evidence for the value and effectiveness of PHRs vs EMRs is absent and second we now know the apparent plans from DoHA will do nothing to remedy this issue.

Of course we have also yet to hear just how the issue of the ‘digital divide’ is to be addressed – i.e. how is a PHR going to help those without regular internet access? (This is a good fraction of the target audience as I understand it.)

All this needs to go back to a fundamental and open-minded review. Right now what we know suggests some pretty bad mistakes are being planned.

Maybe after the election!

David.

Monday, July 12, 2010

We Are Heading Towards A Major Fiasco In Australian E-Health. Total Fragmentation and Dysfunctional Unplanned Directions.

I was prompted to start thinking about the messy direction we seem to be hurtling down in e-Health by a couple of things that have appeared over the last few weeks

First we have had the Telstra / RACGP announcement.

Telstra, GPs in e-health agreement

Telstra plays a card in the e-health game, signs MOU with the Royal Australian College of General Practitioners

  • AAP (Computerworld)
  • 09 July, 2010 07:49

The nation's GPs and Telstra have reached an agreement on the roll-out of "critical first step" e-health reforms.

The Royal Australian College of General Practitioners (RACGP) has signed a memorandum of understanding with the telco giant, outlining a range of hi-tech services to be brought online from next year.

The first would allow the nation's 17,200 GPs to access health care applications, diagnostic tools and an array of other clinical and administrative software programs using a "single log-on" web service.

"A web-hosted service will make GPs lives easier (allowing them to) access applications from anywhere - from their practises, homes, hospitals or aged care facilities," RACGP president Dr Chris Mitchell said in a statement on Thursday.

"GPs are busy and the implementation of a national e-health strategy might seem daunting, however ... this collaboration will make it easy for general practise to take advantage of the new technology we now have available."

The web service, to be operating from July next year, would also end the current need for clinics to each purchase their own copy of the software used by their GPs.

More here:

http://www.computerworld.com.au/article/352600/telstra_gps_e-health_agreement/?eid=-255

The same issue is also covered here:

Telstra to provide e-health cloud to GPs

By Suzanne Tindal, ZDNet.com.au on July 8th, 2010

The Royal Australian College of General Practitioners and Telstra have this week signed a memorandum of understanding that will hopefully see the telco provide software as a service to the college's members.

Over the next few months, the college will hold working groups with members and stakeholders to decide on specialist medical systems it would like Telstra to provide via the cloud.

These could include clinical software programs, decision support tools for diagnosis and management, care plans, referral tools, e-prescribing tools, as well as a range of online training and other administrative and clinical services.

Once systems have been decided on, Telstra will provide access to them using a T-Suite-backed single sign-on platform, according to Dr Chris Mitchell, president of the Royal Australian College of General Practitioners. The College has 17,200 GP members.

"GPs are busy and the implementation of a national e-health strategy might seem daunting. However, staying up-to-date and making sense of the latest technology is important," Mitchell said. "A web-hosted service will make GPs' lives easier. A web-based solution means GPs can access applications from anywhere; from their practices, homes, hospitals or aged care facilities."

No money has changed hands and no contracts have been signed, with Mitchell saying that the arrangement was very much at the beginning of its journey.

Mitchell thought that some of the general applications already on T-Suite could now benefit the college's members, but hoped that more medical-specific software would make its way onto the Telstra cloud platform within the next three to six months. Certainly he hoped to see software made available before July next year.

"We're really keen to get started on this very quickly," he said.

Telstra sounded more cautious. Telstra spokesperson Rod Bruem said that existing desktop software apps would move across to the platform by mid next year with beta testing to be carried out later this year.

More here:

http://www.zdnet.com.au/telstra-to-provide-e-health-cloud-to-gps-339304407.htm?omnRef=NULL

When examined a little more closely what this announcement is really all about is moving the GPs who sign up to an application suite, delivered over broadband, using Software as a Service techniques.

The software available at present from this service includes anti-virus, financial, HR management and CRM applications. According to the Telstra website the actual GP or clinical software is exactly zero, as far as I can tell.

See here:

http://www.telstrabusiness.com/business/portal/online/site/productsservices/businesssoftware.11003

I just note in passing the recent articles on cloud computing security. For Health Information we really want near total security.

http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2010/07/06/urnidgns852573C40069388000257758003E5DC7.DTL

Secrecy of cloud computing providers raises IT security risks

(07-06) 04:33 PDT -- Despite how attractive cloud computing can sound as an outsourcing option, there's widespread concern that it presents a security and legal minefield for businesses and government. Cloud service providers often cultivate an aura of secrecy about data centers and operations, claiming this stance improves their security even if it leaves everyone else in the dark.

Businesses and industry analysts are getting fed up with this cloud computing version of "don't ask, don't tell," where non-disclosure agreements (NDA) dominate, questions aren't answered, and data center locations and practices are treated like national security secrets. But public cloud service providers argue their penchant for secrecy is appropriate for the cloud model -- and at any rate, everyone's doing it. They often hold out their SAS-70 audit certifications to appease any worry (though some don't have even that)."The business data you store in Google's cloud is safe," said Google product marketing manager Adam Swidler at the recent Gartner security conference held in National Harbor, Md. He emphasized that Google's multi-tenant distributed model entails "splicing data across many hard drives" so that in this "hardened Linux stack" there's a "quick update of all fragments of all files in the hard drives," a process he called "obfuscated files."

Swidler acknowledged there has been some secrecy about where things are located because "we think it's a security risk." Nonetheless, "Google is trying to open up a little transparency in what we do," he said.

-----

Not satisfied with all this in recent times we have had all the fruits of the NEHTA sponsorship of the RACGP with announcements on such areas as:

Mental Health:

http://aushealthit.blogspot.com/2010/04/more-magical-thinking-from-racgp-on.html

to say nothing of RACGP involvement in Medisecure and all the paid enthusiastic spruiking of the Health Identifiers.

There must be a very keen business development person at the College casting around for e-Health press release opportunities!

Read more on this here:

http://aushealthit.blogspot.com/2010/04/it-seems-someone-is-running-e-health.html

and here:

http://aushealthit.blogspot.com/2010/01/nehta-spin-machine-pops-gasket-and.html

Additionally we have had announcements from the Commonwealth Government about Patient Controlled EHR and an implementation plan that makes little if any sense. See here:

http://aushealthit.blogspot.com/2010/07/we-have-utter-madness-afoot-at-doha.html

In the background we still have only patchy progress on e-prescribing with Standards as yet un-delivered and un-adopted.

Step back for a moment and consider this:

In a presentation in August 2009 Adam Powick of Deloittes, who developed the agreed but still unfunded Nation E-Health Strategy, said on his slide 10 and 11.

Conclusion –the next 12 months are key

•Initial set of national eHealth foundations will be delivered

•Government’s response to reform commission report will be communicated

•Significant eHealth progress planned across all State/Territory jurisdictions and key parts of the private sector

•Beginning of meaningful on the ground collaboration in areas such referrals and discharge summaries

•A number of personal health record solutions will become available to Australian consumers

•Delivery of a national ePrescription capability

Conclusion –the need to work together

We are poised for significant progress but still could easily fragment the national agenda into 1000 moving parts.

What is needed is:

Clarity, Focus, Pragmatism, Leverage, Collaboration.

---- End Slides.

I would add we also need leadership and relevant competent governance. We are not getting any of this and Adam’s prediction get closer by the day I fear. I would also note a lot of what Adam thought would happen has not actually happened yet.

There is a lot of un-coordinated Brownian Motion happening right now and the risk it will all implode and waste heaps of money rises daily!

David.

AusHealthIT Poll Number 26 – Results – 12 July, 2010.

The question was:

How Satisfied Are You With the Leadership and Governance of Australian E-Health?

Thrilled

- 1 (3%)

Pretty Much

- 4 (12%)

Just Above 50%

- 2 (6%)

Not Satisfied

- 7 (21%)

Extremely Unhappy

- 18 (56%)

Votes: 34

This is hardly unexpected. 77% are not impressed. DoHA and NEHTA should take notice!

Again, many thanks to all those who voted

David.