Privacy Based Control of Personal Health Information – Are We Organised on All This? I Doubt It!

In the last few weeks there has been a considerable amount of work being undertaken in thinking about what is needed to protect individual privacy of health information in the US. There are some issues worth considering for Australia as well.

First we have this:

HHS panel mulls patient control over select data

By Mary Mosquera
Wednesday, August 04, 2010

The Privacy and Security Tiger Team yesterday began exploring how current technologies can help patients make decisions on consent and access to their electronic health records when more sensitive patient data is involved.

The team, composed of government and private sector healthcare privacy experts, teed up questions related to how to accommodate patients who might want to exercise highly-selective levels of control over electronic versions of their personal health information or portions of that data.

Although the direct exchange of patient data between providers for treatment purposes does not require patient consent beyond what is covered in existing law and fair information practices, some patients may want to exercise more choice in consultation with their providers about how their sensitive data is handled, the experts noted.

“We want to honor patient preferences from the policy perspective and determine if technology supports it,” said Deven McGraw, the chair of the tiger team, who is also director of the Health Privacy Project at the Center for Democracy and Technology, at the Aug. 3 meeting.

The group’s general mission is to come up with solutions to thorny privacy and security challenges related to health information exchange and make recommendations to the Office of the National Coordinator for Health IT.

More useful material here:

http://www.govhealthit.com/newsitem.aspx?nid=74366

The same issues are also covered here:

Tiger team revisits direct exchange of health info

By Joseph Conn / HITS staff writer

Posted: August 5, 2010 - 12:45 pm ET

A federal advisory panel stepped back on a proposed recommendation that patients have the opportunity to control the direct exchange of their sensitive personal health information absent federal or state laws mandating patient consent.

The proposed federal health information technology policy recommendation came Tuesday during a meeting of the privacy and security tiger team of the federally charted Health IT Policy Committee.

The tiger team has been meeting as often as twice a week since June to try to quickly develop healthcare IT privacy and security policy recommendations in the run-up to the implementation of a massive federal subsidy program for health IT under the American Recovery and Reinvestment Act of 2009. The first "payment year" of the federal IT subsidy program starts Oct. 1 for hospitals and Jan. 1, 2011, for office-based physicians.

One of the subsidy program's eligibility requirements is that healthcare providers be able to demonstrate that they're successfully using health IT to exchange patient information. The tiger team has focused its deliberations on policies governing such "meaningful-use" information exchanges.

In 2000, in the waning days of the Clinton administration, HHS issued its first HIPAA privacy rule, which mandated that healthcare providers and other so-called covered entities obtain patient consent before exchanging protected healthcare information for treatment, payment and specific list of "other" healthcare operations. In 2003, however, the Bush administration amended the HIPAA privacy rule and gave "regulatory permission" for covered entities to disclose the same sort of patient information for treatment, payment and other healthcare operations without a patient's consent. Consent, or the lack thereof, has remained a thorny issue in health IT ever since.

Previously, the tiger team reported to the Health IT Policy Committee a recommendation that patient consent not be required for what it called "directed exchange"—transactions limited to the exchange of information between providers for treatment of a specific patient. Based on this recommendation, patient consent would not be required in the event of a primary-care physician sharing patient information with a specialist as part of a referral, for example.

But the tiger team also suggested that there be six specific "trigger" conditions in which HHS might want to use its influence to require consent before patient information was exchanged. These trigger conditions were presented to the HIT Policy Committee in a progress report on the tiger team's activities during a committee meeting July 21.

According to the tiger team's original recommendations, one of the six specific conditions that should trigger a patient-consent requirement is the exchange of information "that is often perceived to be more sensitive than other types of information"—behavioral-health and substance-abuse information, for example, as the National Committee on Vital and Health Statistics defines these and other types of information as sensitive.

The tiger-team recommendations were accepted by the Health IT Policy Committee with the provision that they could be changed when a full set of recommendations is resubmitted to the committee by the tiger team in a month or so. Created under the American Recovery and Reinvestment Act of 2009, the Health IT Policy Committee makes recommendations to the Office of the National Coordinator for Health Information Technology at HHS.

It was the trigger for “more sensitive” information that was stepped back by the tiger team on Tuesday as members sought to answer this question: “For directed exchange, is the presence of sensitive data in the information being exchanged a trigger for requiring consent?”

The new answer they came up with is no.

Tiger team Co-chair Deven McGraw said members based their discussions and ultimate recommendation on a straw proposal (PowerPoint) that was not “word for word” but “close” to the content of an e-mail drafted last week by tiger team member Wes Rishel. McGraw is the director of the Health Privacy Project at Center for Democracy and Technology, a Washington-based think tank. Rishel is a vice president and distinguished analyst in the healthcare provider research practice of Gartner, an IT market research firm.

According to the straw proposal:

• All health information is sensitive, and what patients deem to be sensitive is likely to be dependent on their own circumstances.
• However, some federal and state laws recognize some categories of data as being more sensitive than others.
• Unless otherwise required by law, with respect to direct exchange for treatment, the presence of sensitive data in the information being exchanged does not trigger a requirement to obtain the patient's consent in the course of treating a patient.

The straw proposal, however, carried its own caveat: that the policy recommendation "does not change the patient-provider relationship," which the tiger team suggests must provide a foundation of trust for the patient as a prerequisite for health information technology use to be successful.

"When information is transmitted by a provider as a direct exchange for a specific treatment purpose, clinicians should take into account and honor, to the extent possible, patients' expressed or likely concerns for privacy and also ensure the patient understands the information the receiving clinician will likely need in order to provide safe, effective care," according to the proposal.

Lots more discussion here:

http://www.modernhealthcare.com/article/20100805/NEWS/100809976

We also have this commentary;

Privacy--Get Over It?

Rob Tholemeier

Health Data Management Blogs, July 23, 2010

You have zero privacy anyway. Get over it.” I'm not defending this quip by the master quipster, founder and former CEO of Sun Microsystem, Scott McNealy, but is this the de facto consequence of the mad dash to implement EHRs and HIEs?

Lately, my e-mail inbox is full of stories about hospitals fined for what looks like minor breaches of patient privacy. In one case, a California hospital was dinged $25,000 for two employees accessing three patients’ health information. Fines for more “egregious” breaches have been higher.

Really, how in the world can a medical facility ensure that there will be no unauthorized viewing of health information given the state of EHR’s internal data privacy, and given the fact that much of this information is now being more widely distributed via HIEs? Clearly, busting employers on a HIPAA beef is not working to prevent employees from accessing or leaking out personal health information.

I suppose the first question is: Do patients really care about keeping their health information private? One would think so based on the way the public reacts to stories about the information that they voluntarily post on Facebook getting out. But on the other hand, physicians, HIE advocates, and the government would like to have all information about the patient readily available to assist in diagnosis and treatment.

So who decides how much information is open to whom?

And is it possible to provide a more granular access to patient information and restrict just what information goes to which interested party and controlled pretty much completely by the patient?

The answer to the second question is, of course.

We do this every day with our financial information. We gladly hand over our credit card to a waitress anywhere in the world in order get an authorization to charge the restaurant bill to the card. When we lease or finance a car, we permit a one-time access of our credit history and credit score for the dealer. My county property tax records are online. Anyone can easily see out how much property tax I pay each year, but not what I had for dinner or how I paid the taxman (check, credit card, or cash). We do not permit the real estate agent, car salesman, or waitress to roam about in our financial records freely.

There is a well-defined set of discrete transactional access paths to our financial information and we restrict the access to these paths to certain individuals and institutions for a specific time period for a specific use.

Why can’t we do the same thing with our health information?

We might be OK with pretty much everyone knowing what we are allergic to. We certainly want the health insurance company to get sufficient information to pay the claim (most of the time). We might want to restrict information about our orthopedic work to our primary care doc and the orthopedist who did the work, but not share it with a clerk at a different orthopedist office who may be in the same HIE. A patient may want to restrict mental health records to only the psychiatrist who treats them and no one else.

There is a solution. There is a considerable amount of standards work, reference models, demonstration products, and a handful of software companies with technology for sale that enable patient controlled consent over just what health information gets out and where it goes.

For those specifically interested in healthcare consumer privacy and consent management the May and June presentations to the Privacy and Security Workgroup are enlightening.

The May meeting lays out the consent management model in detail. Click here for the PowerPoint document that explains the model. The June meeting shows an example implementation at the Veterans Administration (click here). And for those interested in all the gritty details I would point you to the HL7 collaborative care model page as a starting point.

More indeed here:

http://www.healthdatamanagement.com/blogs/HDM_blog_Tholemeier_security-40664-1.html

There is no real way to summarise all this. It is clear some serious thought is being given as to how best provide patient confidence in the protection of their sensitive information (as they perceive it) while making sure providers have reasonable access to the information needed for care.

If the Personally Controlled EHR is to be anything more than spin some people at DoHA and NEHTA are going to similarly have to work to address these issues in ways at everyone is happy with.

The presentations linked in the text will give those interested a flavour of just how complex this may very well turn out to be. They are well worth a read!

David.

A Few Comments on the ABC Health Report Monday August 9, 2010 on E-Health.

The basics:

Links to the show with audio and a full transcript are found here:

http://www.abc.net.au/rn/healthreport/

The contents of the show was described as follows.

E-health

listen | download (10.9MB)

Daniel Keogh investigates the future of Australia's pursuit of electronic health records; a venture that has already taken a considerable amount of time and money with little to show for it.

Among the major contributors were:

Ms Sally Crossing – Frustrated Patient

Dr Mukesh Haikerwal - NEHTA

Dr Terry Hannan – Formerly President of the Australian College of Health Informatics

Ms Lisa Pettigrew – CSC Health Practice

Ms Carol Bennett – Consumer Health Forum

Dr Ashish Jha - Associate Professor of Health Policy and Management, Harvard School of Public Health

My first comment is that this was a good effort and really needs a listen!

If I had to summarise my feelings about the 23 minute or so discussion I would have to say that I found the discussion a little naive and insular from the Australian speakers and maybe a slightly pessimistic view from the American ‘expert’.

As with so much we seem to see and read in e-Health these days there was a lack of clarity about just what it was that was being spoken about and just how applicable it is to the larger Australian community. An EMR system that works well in Kenya or the NT may just not be the right fit for metropolitan Sydney or Melbourne for example.

There was a lot that was good among what was said like the recognition that the days of paper records should be over and that younger clinicians were amazed at the lack of automation in the health sector.

Sadly what was missing was any clarity, again, around just what the path from where we are now to what the desired end state might be. It is really extremely simplistic to keep saying e-health and electronic health records are good and not really putting together a clear picture of what is a sensible path forward – as we were actually given by the National E-Health Strategy.

I remain very concerned that we have not had any real explanation of just what NEHTA / DoHA are cooking up in the backroom with various consultants who may, or may not, have some vested interests in the outcomes of the consultation. Until we see what is suggested and the strength of the option analysis and business case provided how can we even begin to form a view? All this is a multi-year billion dollar endeavour that should not be being undertaken without proper public and technical scrutiny!

On the basis of overseas experience creating a half baked summary record of questionable provenance, completeness and quality for which there is no real benefits case for is probably the wrong way to be going until we have got the basics of EMRs and Secure Messaging in place.

I am also still of the view the Health Information Exchange route as being followed in the US - as provided by people like Axolotl and others - needs to be looked at very closely in terms of cost, benefits and practicality before we lock ourselves into any specific directional approach. To go to a large scale Shared EHR without careful review of alternatives could be very, very stupid.

I also was a trifle surprised to have an American expert comment on how hard and difficult all this is – and it is – without pointing out there are some exceptional examples of success in the US. (Think Kaiser Permanente’s Health Connect and the Systems at Partners in Boston and at Intermountain Health.)

The bottom line is that this is important and needs leadership, transparency, expertise, appropriate funding and serious long term political commitment. I leave it as an exercise for the reader to work out how many of those we have in place!

David.

If E-Health Will Change Your Vote The Choice Just Got Easier – But Only Slightly!

The following appeared today.

Coalition vows to postpone e-health spending until the budget is back in surplus

• Karen Dearne
• From: The Australian
• August 10, 2010 12:00AM

AN Abbott government will defer spending on electronic health records until the budget is back in surplus.

"We are certainly committed to e-health; we think it will lead to many improvements in patient safety," opposition e-health spokesman Andrew Southcott said.

"But $5 billion has been spent on e-health over the past 10 years and the experience is that a lot of money can be wasted."

In fact, as health minister in the Howard government, Tony Abbott presided over much of this expenditure. In 2005, Mr Abbott pulled the plug on the Coalition's former HealthConnect sharable e-health records program, and created the National E-Health Transition Authority, which has been spending about $165,000 a day ever since.

While the Coalition has vowed to scrap Labor's $467 million personally controlled e-health record program as a saving measure, "that's not to say individual records can't be revisited" when a budget surplus was achieved, Dr Southcott said.

"In government, the important (e-health) priority will be the successful introduction of healthcare identifiers," he said. "Funding has already been set aside for that through the Council of Australian Governments."

All the reported reaction is here:

http://www.theaustralian.com.au/australian-it/coalition-vows-to-postpone-e-health-spending-until-the-budget-is-back-in-surplus/story-e6frgakx-1225903153090

If ever there was a plan you have when you don’t have a plan this is it. As for the plan to go ahead with the Health Identifier Service, when a good deal of the reason for creating the service was to enable reliable clinical information exchange, this seems to be having a bit of a ‘bob each way’.

Similarly there is no comment on just what a Coalition Government would do about NEHTA and what aspects would proceed and what may not.

I guess it all boils down to whether you believe Labor will deliver something useful with its 2 year $467M plan, and you believe you understand just what will be delivered and why, or you think a great deal more clarity is required from both sides – a point made by Dr Fernando further on in the article.

I have to say I am still in the latter camp – but I guess one has to say something is better than nothing and that seems to really be what the Coalition is offering.

I also have to say I think Labor is guilty of what I call ‘magical thinking’ if they believe the money they plan to spend will make any real difference without a major reform of leadership and governance in the area.

Despite the new information I still somehow think other matters should determine your vote – but if e-Health is it, Labor by a whisker and with some prayer!

David.

AusHealthIT Poll Number 30 – Results – 09 August, 2010.

The question was:

Which State Public Health System is Doing Best in E-Health?

Australian Capital Territory

- 0 (0%)

New South Wales

- 3 (6%)

Northern Territory

- 9 (18%)

Queensland

- 3 (6%)

South Australia

- 26 (54%)

Tasmania

- 0 (0%)

Victoria

- 4 (8%)

Western Australia

- 3 (6%)

Votes 48

Looks like a clear win for the team in South Australia.

On a population basis the NT also seems to be doing pretty well.

I hope there was not any voting sneakiness!

Again, many thanks to all those who voted!

David.

Weekly Australian Health IT Links – 09 August, 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:

I commented on the election and e-Health yesterday, so I will hit on a couple of internet related issues that at least need a passing thought as one tries to work out if one will cast a formal vote or something less clear!

The issues I see as relevant as the Internet is a key enabler of virtually any substantial e-Health initiative.

Clearly the National Broadband Network (NBN) is conceptually a great idea and I have to say I love the idea of ubiquitous fast broadband wherever people want and need it. As covered in the articles cited below the worry is are we actually going to get value for money for the $43 Billion it will cost, could it be done more cheaply and what are the risks of creating a Government Monopoly as the NBN Co will clearly become. For myself I would like more assurance than is presently out there that the current plan is optimal from a business, technical and governance standpoint.

The second issue is Senator Conroy’s Internet Filter. With Mr Hockey saying they oppose it and the Greens opposing it – I think it is dead and buried and I have to say I think that is a very good thing. It is stupid both in technical and policy terms in my view! There are better ways for parents to look after their children than to trust a filter that is easily bypassed – and I would rather the adult population be treated as adults – able to decide for themselves what they want to use the internet for.

This makes it clear just how easy it is to bypass.

http://www.crikey.com.au/2010/08/05/dodgingthefilter/

Now let’s go back to e-Health proper!

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http://www.computerworld.com.au/article/355781/why_do_nbn_better_cheaper_faster_/?eid=-255

Why not do the NBN better, cheaper, faster?

It would be a national and economic tragedy to dismiss the strong elements in the NBN plan just for the sake of short-term political expedience

• Trevor Clarke (Computerworld)
• 04 August, 2010 17:03

When you are faced with an opponent that has a great game, sometimes the best offence is to just do what they are doing, but better.

Take the best parts of that game and build on them to make a better proposition. Most smart sporting teams and individuals, armed forces, corporations, organisations and governments do it all the time.

It really makes no sense to re-invent the wheel when you can take great components or concepts and advance them to higher levels with additions, amendments and cost savings.

It’s an easy to grasp approach and one that has held generations of engineers, entrepreneurs, inventors, scientists, academics, policy makers, organisations and even families and individuals in very good stead.

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http://www.smh.com.au/opinion/politics/pity-the-pm-didnt-hold-broadband-to-the-light-then-oppose-it-20100801-111c5.html

Pity the PM didn't hold broadband to the light, then oppose it

August 2, 2010

Why did Gillard let through $50 billion to be wasted on the broadband network?

Julia Gillard is right. The story about her cabinet comments on parental leave and age pension increases costing some $50 billion is a beat-up. The real question is why she didn't apply the same critical approach to the cabinet decision to approve the $50 billion (including the government payment to Telstra) rollout of the national broadband network, which went to cabinet the night before it was announced on April 7, 2009.

It was approved without any cost-benefit analysis or even a rudimentary business case to support it.

The plan was based on conversations between Communications Minister Stephen Conroy and the then prime minister, Kevin Rudd, over a couple of days flying between Canberra, Melbourne and Brisbane.

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http://www.theaustralian.com.au/national-affairs/nbn-to-cover-93-per-cent-of-nation-more-than-originally-thought-says-alp/story-fn59niix-1225899098990

NBN to cover 93 per cent of nation - more than originally thought, says ALP

• From: AAP
• July 30, 2010 3:39PM

LABOR says its national broadband network will deliver super-fast fibre optic cable internet access to 300,000 more premises than first thought.

Julia Gillard, campaigning in Perth, said the $43 billion network was being rolled out on time and on budget.

About half of households and businesses in the only three Tasmanian towns connected to the network have been accessing the service - a faster rate of uptake than many expected.

The NBN is a major point of difference between Labor and the Coalition in a campaign featuring “me-tooism” on key issues.

Ms Gillard was keen to emphasise that difference today when she and Communications Minister Stephen Conroy released maps showing the network's coverage had expanded to 93 per cent of the nation.

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http://www.theaustralian.com.au/australian-it/minority-of-paying-users-could-kickstart-e-health-market/story-e6frgakx-1225900248005

Minority of paying users could kickstart e-health market

• Karen Dearne
• From: The Australian
• August 03, 2010 12:00AM

MOST potential users say they will not pay for personal electronic health records, but the few prepared to pay could kickstart the market.

CSC health director Lisa Pettigrew says an independent report it released last week showed only 43 per cent of respondents had heard of proposals for e-health records, but 26 would be prepared to pay for the service.

An overwhelming 70 per cent were not willing to pay a fee for their own records, with 88 per cent saying state and federal governments should foot the bill.

"But 6 per cent of the population represents more than 1 million people prepared to pay at least $100 -- that's actually a healthy start," Ms Pettigrew said. "That demand could sustain a couple of companies."

There was a clear community view that government should provide the core e-health platform, along with a record service as "a provider of last resort", she said.

"As part of a modern health system, at a minimum, patient data needs to be available electronically, and the government needs to provide that social infrastructure," she said.

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http://www.computerworld.com.au/article/356007/liberals_slash_net_filter/?eid=-255

Liberals to slash net filter

Liberal party finally plays what could be a winning card in opposing the highly controversial Internet filter plan

• Computerworld Staff (Computerworld)
• 06 August, 2010 08:1

The Federal Opposition has moved to trash the Government's highly controversial mandatory ISP-level Internet Filter.

In July, communications minister, Senator Stephen Conroy, announced a deal between Telstra, Optus, iPrimus and the Federal Government, that would see up to 70 per cent of Australians have filtered Internet access, while a plan to implement a mandatory filter would be delayed for a year.

Under the deal, the Internet Service Providers (ISPs) will impose web content filtering for their customers and the Federal Attorney-General‘s office will also review the filter blacklist - or refused classification content - to be administered by the Australian Communications and Media Authority (ACMA).

But last night after months of staying mum on the net filter, Shadow Treasurer Joe Hockey revealed the Coalition would block Labor's mandatory internet filtering policy in parliament, in a move that will signal the death of the controversial project if the Greens control the balance of power in the Federal Senate after the election.

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http://www.smh.com.au/technology/technology-news/coalition-to-dump-flawed-internet-filter-20100805-11kmv.html

Coalition to dump 'flawed' internet filter

August 6, 2010 - 8:44AM

The Coalition has announced it will scrap controversial plans for an internet filter if it wins the August 21 election.

Federal Labor's controversial plan to filter the internet could be dead in the water after the Coalition announced it opposed the policy.

Opposition treasury spokesman Joe Hockey said on Thursday a Coalition government would abandon Labor's "flawed" filter policy.

Instead, a Tony Abbott-led government would encourage parents to take more responsibility for monitoring their children's use of the web.

Communications Minister Stephen Conroy's office says Labor will be pushing ahead with its plan despite the latest setback.

"We believe the internet filter will not work," Mr Hockey told ABC Radio's Triple J

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http://www.nehta.gov.au/media-centre/nehta-news/676-ade-mhc

Take a multi-media tour of e-health in action in Adelaide

6 August 2010. NEHTA is pleased to announce the Model Healthcare Community (MHC), a demonstration of how the new national Healthcare Identifiers Service (HI Service) works, will be on display at the Royal Australian College of General Practitioners (RACGP) offices in Adelaide from Wednesday 11 August.

The MHC display is part of e-health Futures, the RACGP’s interactive e-health display demonstrating how e-health information will work among healthcare professional and between healthcare settings.

The HI Service commenced operation on 1 July 2010. It has been developed as a foundation service for e-health initiatives in Australia recognising that a requirement for a safe and secure e-health system is the ability to uniquely identify everyone involved in a single healthcare transaction. Medicare Australia is the operator of the HI Service.

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http://www.computerworld.com.au/article/355736/wa_health_flags_infrastructure_overhaul/?eid=-6787

WA Health flags infrastructure overhaul

Data Centre renewal part of six major ICT renewal projects

• Tim Lohman (Computerworld)
• 04 August, 2010 11:42

Western Australia Health is to shortly go to market for the procurement of managed central computing services.

The procurement will see WA Health source primary and secondary data centres, servers, storage, appliances, firewalls, and a data network.

It will also feature a strong services component including data centre management services, disaster recovery services, project services and relocation services to help facilitate the move to the new provider.

The massive undertaking will commence in late November, with the primary data centre slated to be fully operational at the end of April 2011, while the second data centre will be up and running by early June 2011.

The primary data centre will be located in WA, offer Tier 3 certification and will have a minimum capacity of 125 square metres. The contract for the new data centres will be for a period of up to eight years. WA Health’s existing data centres are located in the Perth metropolitan area. The primary centre hosts Health’s business critical production applications and the secondary centre is the disaster recovery site.

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http://www.e-health-insider.com/news/6126/isoft_launches_stand_alone_eprescribing

ISoft launches stand alone ePrescribing

03 Aug 2010

Clinical software supplier, iSoft, has launched a web-based ePrescribing and medications administration system for the NHS.

The company says that the system is already being used at ten hospitals in Australia and across six district health boards in New Zealand and that a number of NHS trusts are close to becoming early adopters.

The software, which will be showcased at E-Health Insider Live 2010 in November, provides a drug formulary and decision support rules engine to prevent drugs being wrongly prescribed.

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http://www.abnnewswire.net/press/en/63472/iSOFT_Group_Limited_%28ASX:ISF%29_Launches_Proven_Web_Based_E_Prescribing_Solution_For_The_NHS.html

iSOFT Group Limited (ASX:ISF) Launches Proven Web-Based E-Prescribing Solution For The NHS

Sydney, Aug 4, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) has today launched a new e-prescribing and medication administration (ePMA) solution in the UK and is close to finalising deals with a number of NHS trusts to become early adopters.

The solution is already used at ten hospitals in Australia and across six district health boards in New Zealand for safer and more efficient medicines management. Users report sharp falls in incidents due to drugs being wrongly prescribed or doses being missed. And incidents due to illegible scripts are a thing of the past.

Working with First DataBank, a leading provider of drug databases and active clinical decision support, iSOFT has adapted the solution for the UK market. It offers a drug formulary and decision support rules engine to stop drugs being wrongly prescribed and so shorten hospital stays. It will also streamline processes such as discharge, reduce re-admission rates, and cut costs.
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http://ehealtheurope.net/news/6140/isoft_partners_with_irish_ipath_on_patho

iSoft partners with Irish iPath on pathology

06 Aug 2010

ISoft has announced that it will partner will I-Path Diagnostics, a Belfast based provider of web-based pathology systems to boost its presence in the UK pathology market.

The company will add I-Path’s web based platform, PathXL which enables glass slides used by pathologists to be converted into digital files and then accessed and distributed via the N3 network or internet, to its existing laboratory suite.

ISoft will provide the system under software as a service model to provide customers with access to information when they need it or as a scalable system to trusts across the UK.

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http://www.i2p.com.au/article/guild%E2%80%99s-erx-clarification-camouflages-facts-why-hide-truth

Guild’s eRx clarification camouflages the facts!! Why hide the truth?

James Ellerson

The thought that first struck me after reading ‘the clarification’ about the eRx Script Exchange on the editorial page of the May Issue of the Pulse+IT magazine was - Why is this clarification so necessary?

On the surface it seemed like a reasonable statement to make.

It read: “Clarification - in the March 2010 edition of Pulse+IT it was reported that the electronic prescribing service operated by eRx Script Exchange had received 7.5 million scripts "sent to the eRx script hub by prescribers" as of the middle of January.

Omitted from the article was reference to a workflow that allows pharmacists to send repeat prescriptions to the hub for later retrieval by any pharmacist connected to the eRx system.

The volume of transactions quoted in the March 2010 article included such scripts, in addition to scripts sent to the hub directly by prescribers.”

I found the clarification intriguing; particularly the comment “Omitted from the article was reference to a workflow that allows pharmacists to send repeat prescriptions to the hub for later retrieval …. “.

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http://www.theaustralian.com.au/australian-it/government/queensland-health-payroll-improving-lucas/story-fn4htb9o-1225900715860

Queensland Health payroll system improving: Lucas

• From: AAP
• August 03, 2010 5:01PM

QUEENSLAND Health's pay system is improving following a move to regionalise it, says Health Minister Paul Lucas.

An auditor-general's report released in June was highly critical of the new payroll system's introduction.

Those in charge of implementing QH's new system - under which staff have been underpaid, overpaid and not paid at all - had rushed its introduction before proper testing and the provision of fail-safes, the report said.

Seven recommendations to prevent future problems were all adopted.

Following its release, the government announced it would implement a localised payroll system by the end of September, modelled on the federal government's local area networks.

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http://www.computerworld.com.au/article/355627/qld_govt_implements_new_payroll_system/?eid=-255

Qld Govt implements new payroll system

Follows Auditor General's report on bungled Queensland Health payroll system

• Chloe Herrick (Computerworld)
• 03 August, 2010 17:0

The Queensland Government is implementing a new payroll model in response to the Auditor General’s report, handed down on the June 29, on the Queensland Health payroll fiasco.

The key recommendation of the report was for Queensland Health to reconsider its business model to determine the most "effective and efficient strategy" to deliver payroll services.

In responding to the report, the Government claimed it had adopted all of its recommendations, and would additionally implement a dedicated pay hub to service every hospital by 30 September.

Commenting on the announcement, Deputy Premier and Minister for Health, Paul Lucas, said the Government was looking at the payroll applications closely to ensure the appropriate software had been chosen for Queensland Health’s needs.

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http://www.theaustralian.com.au/news/world/depression-more-likely-in-teenagers-addicted-to-the-internet-study/story-e6frg6so-1225900420201

Depression more likely in teenagers addicted to the internet: study

• From: AFP
• August 03, 2010 9:44AM

TEENAGERS "addicted" to the internet are more than twice as likely to become depressed than those who use it in a more controlled manner.

A study published in the Archives of Pediatric and Adolescent Medicine questioned 1041 teens from Guangzhou in southeastern China to try to identify whether they used the internet in a pathological way, and were assessed for anxiety and depression.

The vast majority of the teens - more than 940 - used the internet normally, but 6.2 per cent were classified as being moderately pathological internet users and 0.2 per cent were “severely pathological” users.

Nine months later, the teenagers' psychological states were reassessed, and the researchers found students who used the internet uncontrollably or unreasonably were around two-and-a-half times as likely as normal web users to develop depression.

-----

http://computerworld.co.nz/news.nsf/telecommunications/91-per-cent-of-australians-in-favour-of-e-health-records

91 per cent of Australians in favour of e-health records

Expectation is that government and insurers will pay

By Lisa Banks, Sydney | Wednesday, 4 August, 2010

Australian's are overwhelmingly in favour of having e-health records but are not willing to pay for the privilege, according to a survey from CSC.

According to the survey results, 91 per cent of Australian's surveyed want all their healthcare data stored in the one place and 27 per cent are willing to pay $50 annually for it to happen. However, 70 per cent are unwilling to pay anything for the right.

Director of health services for CSC, Lisa Pettigrew, said the survey, A rising tide of expectations, showed Australian's expections in regards to e-health services access.

-----

http://www.computerworld.com.au/article/355318/ipads_go_under_knife_victorian_hospitals/?eid=-255

iPads go under the knife at Victorian hospitals

Victorian State Government commits to purchasing 500 iPads for experimentation in public hospitals

• Renai LeMay (Computerworld)
• 02 August, 2010 08:53

The Victorian State Government has unveiled a program where 500 iPads will be delivered to a number of hospitals in the state, as the Brumby Labor government continues to show a great deal of interest in the Apple platform.

The rollout will cost about $500,000, according to a statement issued yesterday by state health minister Daniel Andrews, and would see the iPads used by graduate doctors, nurse practitioners and advanced practice nurses to use while treating patients.

The trial will take place from January next year, although Andrews did not disclose which hospitals would get the technology.

-----

http://www.computerworld.com.au/article/355345/optus_flicks_switch_docsis_3_0_cable_users/?eid=-255

Optus flicks switch on DOCSIS 3.0 for cable users

New hybrid fibre coaxial (HFC) upgrade will bring broadband speeds to an average of around 80 megabits per second

• Renai LeMay (Computerworld)
• 02 August, 2010 13:31

Optus has completed a substantial upgrade of its HFC cable network in Brisbane, Melbourne and Sydney that will allow residents in supported areas access to speeds up ranging up to around 80 megabits per second (Mbps) or more, using the improved DOCSIS 3 standard.

Speeds on the network have historically maxed out at around 20Mbps - similar to the top speeds on rival ADSL2+ networks. However, most customers could only receive slower speeds - for example, up to 10Mbps.

Optus general manager of fixed network strategy Michael Wagg said the telco had tested around 6,000 customer connections and had come up with an average of just under 75Mbps download speeds - although the median was 81Mbps. In general the speeds will represent a four-fold improvement on the previous access.

-----

Enjoy!

David.

E-Health on the ABC This Morning

Don't forget ABC Radio National 8.30am - E-Health on the Health Report.

Audio and Transcripts here later today.

http://www.abc.net.au/rn/healthreport/

David.

Less Than Two Weeks to the Election - Are We Adequately Informed Yet?

The following appeared a day or so ago

E-health missing from Abbott plan

• Karen Dearne
• From: Australian IT
• August 06, 2010 12:19PM

E-HEALTH supporters are disappointed the coalition has overlooked health IT as a key reform objective in its election policy.

Opposition leader Tony Abbott did not make any commitment to future e-health programs, despite his former advocacy as health minister in the Howard government.

Australian Medical Association president Andrew Pesce said the absence was "a major concern because, without e-health, we cannot make the best use of existing health care services and avoid errors, duplication and waste."

Dr Pesce has previously pointed to the potential for the national broadband network to give Australians in rural areas access to improved medical services through tele-consultations, high-quality diagnostic imaging and fast access to electronic health records.

But the AMA remains uncertain what benefits will accrue from Labor's $467 million personally-controlled e-health records scheme funded in the recent budget, as details are yet to be revealed.

.....

The Royal Australian College of General Practitioners welcomed the coalition's commitment to GP services and infrastructure-building, but is also pursuing a broader e-health agenda.

RACGP president Chris Mitchell said governments must recognise that the greatest benefit to patients and the most effective healthcare occurs in the community setting.

In particular, GPs are seeking a shift in focus from hospitals to community care, prevention, supported teamwork, greater access to diagnostic tools and investment in e-health.

The RACGP has recently signed an agreement with Telstra to deliver web-hosted services to its membership, providing GPs with secure access to healthcare applications such as decision-support, care planning, electronic referrals and prescribing, plus online training and administrative services.

“Staying up-to-date is important," Dr Mitchell said. "This partnership will make it easy for GPs to take advantage of technology that is now available.

Using the web means doctors can access applications from anywhere; from their practices, homes, hospitals or aged care facilities.”

More here:

http://www.theaustralian.com.au/australian-it/government/e-health-missing-from-abbott-plan/story-fn4htb9o-1225902070935

All I can say is that this is getting all too hard. Here are the basics of what they say.

Here is the relevant page from the ALP.

http://www.alp.org.au/agenda/health-reform/

The key policy platform is this:

From July 1 this year, the Gillard Labor Government began delivering $7.3 billion in investments over the next five years to provide:

• 1,300 new sub-acute hospital beds
• Emergency department waiting times capped at four hours;
• Elective surgery delivered in clinically recommended times for 95 per cent of Australians;
• Training for 6,000 more doctors, including doubling the number of GPs trained every year;
• Better support for nurses working in GP and primary care, aged care and mental health;
• A national after hours GP service – with a 24 hour hotline that provides GP advice and can arrange a follow-up visit in your local community;
• Support to upgrade around 425 GP practices and health clinics across the country – so that GPs can expand their facilities and locate more services in a single community location.
• Support for 2,500 additional aged care beds;
• A personally controlled electronic health record for every Australian that wants one;
• new investments in prevention, including tough new action to tackle smoking; and
• new investments in mental health services, with 20,000 extra young people per year to get assistance.

From the Coalition we have the following link.

http://www.liberal.org.au/Issues/Health.aspx

As best I can tell there is no recent information on e-health there.

However ZDNet has published the following:

http://www.zdnet.com.au/coalition-e-health-black-hole-worries-ama-339305054.htm?omnRef=NULL

Coalition e-health black hole worries AMA

By Josh Taylor, ZDNet.com.au on August 6th, 2010

update Australia's peak medical body, the Australian Medical Association (AMA), has expressed concern over the Coalition's seeming lack of e-health policy.

Ahead of the 21 August election day, the Coalition this week announced some of its health policies, should it win government. While the AMA welcomed various health initiatives from the party including money for general practitioners and extra hospital beds, it noted there was a distinct absence of any policy in relation to e-health.

"We also note that there is no commitment from the Coalition yet on e-health," said AMA president Dr Andrew Pesce in a statement.

.....

In a statement, Shadow Health Minister Peter Dutton said that the Coalition was "absolutely" committed to e-health.

"We are committed to e-health into the future. We do strongly support a roll-out of e-health and the funding is there until 2012."

"We don't trust Labor with money; we don't trust them because they have wasted it in every other area," he said. "We will review why Labor has gone nowhere on e-health in three years and whether or not the money is being most efficiently spent."

Updated at 3:00pm, 6 August 2010: comment included from Peter Dutton.

This position was put a month a so before the election:

http://www.openaustralia.org/debates/?id=2010-06-22.33.2&s=speaker%3A10188#g42.1

Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

by leave—It is widely recognised and acknowledged that the introduction of a unique individual healthcare identifier is one of the important pieces of architecture in e-health in our country. The opposition understands this. We support e-health. We supported it in government. For example, the widespread computerisation of general practice was an initiative of the Howard government almost a decade ago. We support the introduction of a unique individual healthcare identifier; however, as many submissions to the Senate inquiry identified, the healthcare identifier legislation is too broad. That is why the opposition has drafted a number of sensible amendments to prevent function creep and to see that there is greater parliamentary scrutiny of the laws that will underpin the healthcare identifying service.

----- End Extract.

Joe Hockey has also spoken on this:

http://www.joehockey.com/mediahub/transcriptDetail.aspx?prID=977

You can read his comments close to the end of the transcript.

At the end of the day I fear we are not all that much further ahead. At least both sides, in generality, support e-Health. The details are vague – so I suspect you decision on voting preference should be based on other issues – sadly!

David.

Look Who Turns Up When A Big Bucket of Money is On Offer!

This appeared a day or so ago.

August 5, 2010, 11:00 am

I.B.M.’s Strategy in Electronic Health Records

By STEVE LOHR

I.B.M. has been quietly saying for months that it planned to enter the market for electronic health records, a business being primed with hefty government subsidies.

The only question has been how Big Blue, a company geared to deal with big corporations, would cater to the messy, fragmented market of physicians.

I.B.M. provided its answer Thursday morning. It’s not going in alone, but as a technology partner. The offering will be a Web-based subscription service, but enhanced by I.B.M. data-mining technology and tweaked by the scientists in its research labs. And I.B.M. is going into electronic health records selectively, and not yet marketing to small practices with just a few doctors.

I.B.M.’s partner is a subsidiary of the insurer Aetna, ActiveHealth Management, which makes disease management software and personal health records. ActiveHealth will provide the user record and decision support technology, while I.B.M. provides the cloud computing services and data-intelligence technology.

The offering will tap I.B.M. researchers for advanced features like matching patients to specialists with the best measured record of results for similar patients.

Physicians will not have to install new software in their offices. It will run on computers in I.B.M. data centers and be accessed by doctors with a Web browser on personal computers. They will pay monthly fees for the service, from several hundred dollars to nearly $1,000 per doctor, I.B.M. says, depending on the number of physicians in a medical group and on what features they use.

“This is our first software-as-service play in clinical health care,” said Robert Merkel, vice president for health care in I.B.M.’s global business services unit.

Full story here:

http://bits.blogs.nytimes.com/2010/08/05/i-b-m-s-strategy-in-electronic-health-records/

This is the downstream effect of having a funded, sensible e-Health strategy. The private sector will work to provide attractive offerings and roll them out pronto.

Enough said!

David.