Weekly Overseas Health IT Links - 27 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 subscription payment.

-----

http://www.cmio.net/index.php?option=com_articles&view=article&id=23404

Beyond Alerts: Linking CDS to Evidence-Based Medicine

Alliance of Chicago’s dashboards can track performance at a glance, including Type II Diabetes quality measures. Screenshot courtesy of Chicago Alliance of Community Health Centers

Connecting clinical decision support (CDS) to evidence-based medicine can mean assembling or linking to knowledge bases, having reliable access to the latest research and practice-based evidence, and figuring out who pays and how. And those decision support systems better be workflow-sensitive. But organizations that take the CDS-evidence-based medicine plunge have a lot to gain, as do their patients.

In a recent review of 70 controlled trials, researchers from Duke University Medical Center and Old Dominion University’s College of Health Sciences found that CDS systems significantly improved clinical practice in more than two-thirds of trials. The research identified four CDS features that are predictors of improved clinical practice:

• Automatic provision of decision support as part of clinician workflow
• Provision of recommendations, rather than assessments only
• Provision of decision support at the time location of decision making
• Computer-based decision support

Of 32 systems possessing all four features, 30 (94 percent) significantly improved clinical practice, according to the researchers.

In the scope of meaningful use, the Department of Health and Human Services (HHS) defines CDS systems or tools as those that provide practitioners with “general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.”

-----

http://www.healthleadersmedia.com/print/LED-254873/Top-10-Most-Costly-Frequent-Medical-Errors

Top 10 Most Costly, Frequent Medical Errors

Cheryl Clark, for HealthLeaders Media, August 11, 2010

Avoidable medical errors added $19.5 billion to the nation's healthcare bill in 2008, according to a claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries (SOA). The report lists the 10 most expensive errors in healthcare settings.

Most of that amount, $17 billion, was the cost of providing inpatient, outpatient and prescription drug services to individuals affected by medical errors, says Jim Toole, chairman of SOA. "While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Pressure ulcers—the most frequent type of expensive error—were most often preventable, the authors wrote.

The other nine errors include postoperative infections and problems related to devices and prosthetics, among other complications.

-----

http://www.ehiprimarycare.com/comment_and_analysis/617/my_verdict_on_emis_web

My verdict on EMIS Web

10 Aug 2010

I went to the EMIS Web event at the Reebok stadium last week and was impressed. EMIS Web is the company’s ‘next generation’ system and it looks ready.

Some may say ‘about time’, but apparently EMIS is going through accreditation. EMIS Web is already running it in four practices, with the hope of 100 more this year and a couple of thousand next year.

Demand may be huge, though, and this will need to be managed by EMIS and by primary care trusts (at least until they are abolished and replaced by commissioning consortia).

-----

http://www.ehealtheurope.net/comment_and_analysis/615/expert_view:_david_akka

Expert view: David Akka

04 Aug 2010

The European head of Magic Software surveys progress on HL7 – and the integration approaches that can be taken to using it.

On 28 August 2005, Hurricane Katrina hit the southern coast of the US with devastating effect. More than 1,800 people lost their lives, and the total destruction of homes and property was estimated to top out at more than $81 billion.

In the resulting cleanup operation, the Health Level 7 (HL7) capabilities of the Houston-Harris County Immunization Registry enabled a total of 38,360 vaccination records to be searched in rapid time. The net result was 13,377 matches that saved more than $1.5m in needless vaccinations.

-----

http://www.modernhealthcare.com/article/20100818/NEWS/100819918

Health IT testing procedures issued

By Joseph Conn / HITS staff writer

Posted: August 18, 2010 - 12:15 pm ET

The federally supported National Institute of Standards and Technology has published a set of procedures for testing health information technology as part of a certification program that will determine healthcare providers' eligibility for government subsidies for the purchase of electronic health-record systems.

The NIST procedures are to be used by testing and certification organizations recognized by the Office of the National Coordinator for Health Information Technology. Providers must use a certified EHR in a "meaningful manner" to qualify for federal IT incentive payments provided under the Medicare and Medicaid programs and authorized by the American Recovery and Reinvestment Act of 2009.

The 45 test procedures "evaluate components of electronic health records such as their encryption, how they plot and display growth charts, and how they control access so that only authorized users can access their information," according to a statement from the NIST.

Read more.

-----

http://www.azcentral.com/arizonarepublic/business/articles/2010/08/20/20100820digital-hospital-records-more-efficient.html

Digital hospital records tied to higher efficiency

by Ken Alltucker - Aug. 20, 2010 12:00 AM
The Arizona Republic

Patients treated at hospital emergency rooms that use all-digital-records systems are more likely to have shorter stays than at hospitals with paper or basic digital-records systems, according to a study by an Arizona State University professor.

The findings come at a time when several Arizona hospital systems and physicians seek to bolster their use of electronic health records while the federal government prepares to provide up to $27 billion to compel hospitals and doctors to adopt digital-records systems.

-----

http://www.fierceemr.com/story/report-epic-likely-get-massive-contract-replace-dods-ahlta-ehr/2010-08-19

Report: Epic likely to get massive contract to replace DoD's AHLTA EHR

August 19, 2010 — 9:44am ET | By Neil Versel

A week ago, FierceEMR reported that the man who would be top doc at the Pentagon--Dr. Jonathan Woodson, President Obama's nominee for assistant secretary of defense for health affairs--wants the development of an advanced EHR to be among his top priorities, should he be confirmed for the job. As it turns out, some of the gears already are turning.

-----

http://www.modernhealthcare.com/article/20100819/NEWS/100819896

CHIME publishes EHR guide for CIOs

By Andis Robeznieks / HITS staff writer

Posted: August 19, 2010 - 12:45 pm ET

The College of Healthcare Information Management Executives has just published The CIO's Guide to Implementing EHRs in the HITECH Era, an 80-page booklet aimed at assisting chief information officers and other IT executives in electronic health-record implementation and meeting the meaningful-use requirements to qualify for federal health IT subsidies provided for under the American Recovery and Reinvestment Act of 2009.

CHIME, an Ann Arbor, Mich.-based organization with some 1,400 members, noted that its latest guide evolved out of a similar publication, the Health Care Leader Action Guide on Implementation of Electronic Health Records (PDF), that it released this past July with the American Hospital Association.

-----

http://www.nytimes.com/2010/08/16/technology/16drill.html?_r=2&ref=health

Less Web Access Among Chronically Ill

By TEDDY WAYNE

Although the number of “cyberchondriacs” — people who research health information online — is at an all-time high, those who are afflicted with chronic conditions are less likely to have Internet access, according to data from Pew.

A Harris poll also found that, while Internet access has remained stable in the last five years, the percentage of frequent health information searchers leaped in the past year. The mean number of monthly searches for health information is 6.0, with 17 percent looking 10 or more times in the last month.

-----

http://healthcareitnews.com/news/patients-concern-about-access-medical-records-paramount-says-survey

Patients' concern about access to medical records is paramount, says survey

August 17, 2010 | Molly Merrill, Associate Editor

SAN FRANCISCO – Patients worry about not being able to access their paper medical records when they need them the most, placing that above concerns about whether their records contain inaccuracies or are stolen, according to a new survey.

The survey, which polled 500 female adults and 500 male adults on their paper medical records, was conducted by GfK Roper for Practice Fusion, a San Francisco-based EHR company.

According to the survey, inability to access medical records remained consistent as the top concern (26.7 percent) across all patient income levels, genders and regions.

-----

http://fcw.com/articles/2010/08/13/hhs-new-strategic-plan-emphasizes-health-it.aspx

HHS' new strategic plan emphasizes health IT

Draft plan sets goals for 2010 to 2015

• By Alice Lipowicz
• Aug 13, 2010

The Health and Human Services Department is emphasizing adoption of health information technology and the fostering of innovation among its objectives for its new Draft Strategic Plan for Fiscal Years 2010-2015.

The strategy outlines three major goals: transforming the health care system, advancing knowledge and improving health. Within each goal, there are several objectives and specific projects.

-----

http://govhealthit.com/newsitem.aspx?nid=74469

Tiger team clarifies consent rules for HIEs

By Mary Mosquera

Tuesday, August 17, 2010

The federal privacy and security tiger team said health information exchanges cannot share sensitive patient information beyond a simple point-to-point exchange without first obtaining a patient’s consent.

The panel, which advises the Health Policy Committee, clarified the matter at an Aug. 16 meeting of the team. Its previous guidance was unclear about the privacy obligations of health information exchange organizations, according to panel members.

More specific language was required because some health information exchanges (HIEs) provide both multipoint exchange services among a provider community but also handle direct point-to-point exchange services.

-----

http://www.modernhealthcare.com/article/20100820/NEWS/100819894

Panel suggests some patient consent is needed

By Joseph Conn / HITS staff writer

Posted: August 20, 2010 - 12:00 pm ET

The federally chartered Health IT Policy Committee accepted a number of recommendations from its various work groups Thursday, including its Privacy & Security Tiger Team, but from the latter, acceptance came not without some controversy.

The tiger team presented its final list of proposed policy guidelines approved by the group last week. The group's recommendations targeted the exchanges of health information needed for providers to meet the meaningful-use requirements of the electronic health-record system subsidy program provided for under the American Recovery and Reinvestment Act of 2009.

-----

http://www.modernhealthcare.com/article/20100818/NEWS/100819920

Schwarzenegger: Telehealth the 'future of medicine'

By Joseph Conn / HITS staff writer

Posted: August 18, 2010 - 11:45 am ET

Gov. Arnold Schwarzenegger officially launched the California Telehealth Network on Tuesday at the UC Davis Cancer Center in Sacramento.

In a news briefing, Schwarzenegger lumped the telecommunications network's development in with construction of bridges, highways and other concrete-and-steel projects included in his administration's $60 billion infrastructure development program, but he also pointed to the special role information technology plays in saving lives and improving public health.

"Here, we're talking about the digital highway, broadband, that is also part of the infrastructure," Schwarzenegger told briefing attendees, including U.S. Chief Technology Officer Aneesh Chopra and state and local health IT officials. "A lot of people are not aware of that, but there are a thousand people a year dying in California of just someone misreading a prescription or not having the total medical records and so on, so this is inexcusable." With the launch of the California Telehealth Network, he said, "We are changing that, and reducing errors, and saving money at the same time."

-----

http://www.fiercehealthcare.com/story/california-debuts-telehealth-network-will-link-850-facilities-2012/2010-08-19

California debuts telehealth network that will link 850 facilities by 2012

August 19, 2010 — 1:04pm ET | By Sandra Yin

Telehealth, which can shrink the distance between patients and specialists and cut costs while improving patient outcomes, got a big boost when California Gov. Arnold Schwarzenegger launched what will become the largest telehealth system in the country Tuesday, the Los Angeles Times reports.

The California Telehealth Network is a peer-to-peer network that allows providers to share X-rays and other diagnostic test results instantaneously, and view treatments and procedures from remote emergency rooms or surgical centers in real time, according to InformationWeek. The network consists of a broadband stream that will be dedicated to healthcare information only and kept separate from the mainstream information highway, the Times reports.

-----

EHRs Can't Measure Stage 1 Meaningful Use

Two-thirds of the quality reporting requirements aren't captured in current hospital electronic health record systems, finds CSC study.

By Nicole Lewis, InformationWeek

Aug. 16, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226700296

As hospitals gear up to meet Stage 1 of the meaningful use requirements under the federal government's electronic health record (EHR) incentives program, a new report concludes that EHRs will only be able to provide about a third of the data requirements for Stage 1 quality measures outlined in the final rule.

Not only is time working against putting in place the necessary technology to meet the requirements for computerized physician order entry (CPOE), problem list, and so forth, but the quality reporting requirement adds to the duties. In short, hospitals, doctors, and other clinicians have their work cut out for them.

-----

http://www.ehiprimarycare.com/news/6162/docobo_offers_oz_client_management

Docobo offers Oz client management

16 Aug 2010

UK telehealth firm Docobo Ltd has announced an exclusive deal to distribute ComCare, an Australian community care client management system.

The ComCare product has been developed, and is widely used by, Silver Chain - a Western Australia-based, not for profit, charity that provides district nursing and care services to 40,000 clients annually.

ComCare is a client management application designed for community and residential health care organisations.

The system covers both staff and patient management system, and is designed to run on mobile devices, enabling case co-ordination and the support and management of community based staff.

-----

http://www.ehiprimarycare.com/news/6158/cochrane_backs_remote_monitoring

Cochrane backs remote monitoring

13 Aug 2010

Remote monitoring of patients with heart failure can reduce deaths and hospital admissions, according to a research review.

A Cochrane Database Systematic Review found those patients whose condition was being monitored remotely were 34% less likely to die than those without access to technology.

Among people taking part in a programme to remotely monitor heart failure, there were 102 deaths per 1,000 patients compared with 154 deaths per 1,000 patients who did not receive remote monitoring.

The review, which looked at 245 studies covering 9,500 patients with chronic failure and 2,710 undergoing monitoring, found a difference between remote monitoring involving digital or wireless transmission of data to a clinician and telephone support in which patients reported their own data over the telephone.

The report found that deaths were lower among patients offered telephone support, although the difference was less marked.

-----

http://www.ehiprimarycare.com/news/6161/microsoft_healthvault_

Microsoft HealthVault "stands ready”

13 Aug 2010

Microsoft’s international business development lead has told E-Health Insider that the company “stands ready” to work with the government on personal health records.

Should the coalition want to move forward with plans to introduce PHRs, Microsoft says it would hope to support them with its HealthVault platform.

EHI TV asked whether Microsoft is disappointed by the lack of action by the coalition government in developing PHRs, as suggested in last year’s Independent Review of NHS IT commissioned by the Conservatives.

In response, Mark Johnston said: “We stand ready to help support the ambition of the leaders in the government as well as the NHS.

-----

http://www.ihealthbeat.org/features/2010/storeandforward-telemedicine-eyed-for-mental-health-care.aspx

Tuesday, August 17, 2010

Store-and-Forward Telemedicine Eyed for Mental Health Care

by Kate Ackerman, iHealthBeat Senior Editor

As of September 2008, 77 million residents lived in the country's 3,059 mental health professional shortage areas, or HPSAs, according to the Kaiser Family Foundation. The foundation reported that it would take an additional 5,145 mental health care providers to meet a population to practitioner ratio of 10,000 to 1.

Telemedicine often is cited as a potential solution to the country's mental health provider shortage. However, synchronous telemedicine -- which involves live, two-way interactive video -- presents its own scheduling and technological challenges.

Peter Yellowlees -- professor of psychiatry and director of the health informatics graduate program at University of California-Davis -- noted that a large barrier to live telemedicine consultations is the difficulty of coordinating "five or six people to meet together at one time in two locations."

-----

http://govhealthit.com/newsitem.aspx?nid=74432

ONC sets up NHIN ‘governance’ workgroup

By Mary Mosquera

Friday, August 13, 2010

The Office of the National Coordinator (ONC) has created a new workgroup to make recommendations on establishing a set of high-level rules-of-the-road for organizations participating in the nationwide health information network (NHIN).

With creation of the “governance” panel, ONC wants to host discussions from the health IT community on what to include in a formal rulemaking on the issue planned for early next year.

-----

http://www.healthdatamanagement.com/news/health-care-technology-news-open-source-interoperability-40853-1.html

Emdeon Tests Open Source Clinical App

HDM Breaking News, August 13, 2010

Electronic data interchange vendor Emdeon Inc. is testing open source software to facilitate the exchange of clinical data.

The Nashville, Tenn.-based company is piloting the hData application developed by The MITRE Corp., McLean, Va. Emdeon sells revenue cycle management software and operates the nation's largest claims clearinghouse. It also electronically transmits lab orders/results and electronic prescriptions via its EDI network.

-----

http://www.ama-assn.org/amednews/2010/08/16/bica0816.htm

EMR purchase poses dilemma for doctors near retirement

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted Aug. 16, 2010.

Investing in an electronic medical records system was not something many physicians late in their careers were probably thinking about a few years ago. But the introduction of incentive pay for adopting an EMR -- and the penalties for not adopting -- have older physicians wondering if such an investment is worthwhile.

Starting in 2011, physicians will have the opportunity to earn up to $44,000 over five years in Medicare incentives, or $64,000 in Medicaid incentives, for "meaningful use" of an EMR as defined by the federal government. But if a physician plans to stay in practice more than five years and does not adopt an EMR, he or she can expect Medicare reimbursement to start declining in 2015, leading to a 5% total cut by 2019.

Todd Sherman, lead partner of the Sherman Sobin Group, a Mount Laurel, N.J.-based financial consulting group that specializes in physician retirement planning, said meaningful use is a hot topic for those deciding whether to invest in technology this late in a career.

-----

http://healthcareitnews.com/news/orlando-health-rolls-out-decision-support-tool-2000-docs

Orlando Health rolls out decision support tool for 2,000 docs

August 13, 2010 | Bernie Monegain, Editor

ORLANDO, FL – Orlando Health will implement a Web-based decision support checklist tool to assist physicians with diagnosis decisions.

The $1.7 billion not-for-profit healthcare organization with a community-based network of hospitals, tapped Isabel Healthcare for an automated system that it will make available to more than 2,000 physicians.

Orlando Health executives say the initiative is part of Orlando's commitment to quality and patient safety.

While most diagnoses are reached through the experience and knowledge of the physician, in 10 to 15 percent of cases they are more difficult to determine, according to industry reports. Isabel assists by accelerating the process for determining the diagnosis of a patient in those situations where there is some question.

----

http://www.healthdatamanagement.com/news/health-care-technology-news-medications-medical-home-guidance-40857-1.html

Guide Covers Medications, Medical Home

HDM Breaking News, August 16, 2010

The Patient-Centered Primary Care Collaborative has released a guide describing the features and benefits of comprehensive medication management under the medical home model of care.

The Washington-based collaborative represents 600 employer, insurer, provider and consumer member organizations promoting the medical home model. The guide outlines the rationale for comprehensive medication management and the necessary steps to promote best practices and improve quality.

.....

The medication guide is available at pcpcc.net/files/medmanagement.pdf.

--Joseph Goedert

-----

http://www.modernhealthcare.com/article/20100816/NEWS/100819954

Reporter's notebook: Tracking at a crossroads

By Shawn Rhea / HITS staff writer

Posted: August 16, 2010 - 11:45 am ET

For the third year running, the supply-chain standards organization GS1 Healthcare US held a small roundtable discussion dinner for media, healthcare supply-chain professionals and suppliers during the annual Association for Healthcare Resource & Materials Management conference. This year's event occurred on the second evening of AHRMM's four-day conference, held this month in Denver.

The discussion had me thinking about the ongoing effort to implement a universal tracking system. GS1 has been politicking for several years to become top dog in the medical-products tracking standards arena, but healthcare reform has created a new sense of urgency to close the deal among proponents of the standards. Additionally, more than a few of the proponents are concerned that federal regulators aren't moving fast enough to develop rules and guidance that will ensure that standards for tracking the use of medical devices and products are appropriately linked to electronic health-record systems and useful to healthcare providers and patients.

-----

http://www.modernhealthcare.com/article/20100817/NEWS/100819934

Ingenix: A stimulated appetite for acquisitions

By Vince Galloro / HITS staff writer

Posted: August 17, 2010 - 11:00 am ET

Ingenix's voracious appetite for acquisitions is fueled in part by federal subsidies for electronic health-record systems under the American Recovery and Reinvestment Act of 2009.

In two of its three deals announced in the last month, Ingenix, an Eden Prairie, Minn.-based division of insurer UnitedHealth Group, has pointed to the stimulus law as a driving factor.

Ingenix's most recent deal is a definitive agreement to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen. The stimulus act provides $783 million in near-term direct funding for the implementation of statewide and regional health information exchanges, in addition to the $36.5 billion it provides in incentives for hospitals and physicians to make meaningful use of EHRs, Ingenix noted in its news release announcing the deal.

-----

http://www.modernhealthcare.com/article/20100816/NEWS/308169970

Ingenix to acquire Axolotl Corp.

By Vince Galloro / HITS staff writer

Posted: August 16, 2010 - 4:30 pm ET

Ingenix, Eden Prairie, Minn., said it has a definitive agreement in place to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen

-----

http://www.fiercehealthit.com/story/get-prescription-online-without-ever-seeing-doc/2010-08-16

Get a prescription online without ever seeing a doc

August 16, 2010 — 1:24pm ET | By Neil Versel

Editor’s Corner

A recent article in Forbes reports how patients in Britain are able to go to least a dozen websites for online consultations with doctors they've never met and have physicians prescribe medications. The sites are completely legal and regulated by an agency called the Care Quality Commission.

"The British websites are definitely an exception, but they are the start of a trend we will soon see everywhere," Norwegian telemedicine expert Dr. Steinar Pedersen told the business magazine. Pedersen was unable to name any other countries that allow physicians to prescribe medication remotely for patients they've never seen in person.

In countries including Canada, Denmark, Norway, Germany, and France, doctors are only allowed to treat patients online if they have previously seen them in person," Forbes reports. "In the United States, several companies offer online medicine," the article says, "but patients must typically speak to a doctor on the telephone or set up a videoconference for a live, face-to-face chat."

-----

http://www.govhealthit.com/newsitem.aspx?nid=74427

VA, DOD agree on single lifetime personal identifier

By Mary Mosquera

Wednesday, August 11, 2010

The Veterans Affairs and the Defense departments have agreed on a single common personal identifier, one of the keys to its efforts to build an electronic record that can be follow military service members throughout their lifetimes.

The agreement is a significant step toward making the complex Virtual Lifetime Electronic Record (VLER) project a reality because it will identify a service member whether they are seeking healthcare services or payment benefits and on active duty or retired, according to a senior VA official.

-----

Enjoy!

David.

A New Health IT Blog For Australia

Have just had an e-mail from Dr Eric Browne who has established a new Australian Blog on Health IT.

It is found here:

http://blog.healthbase.info/

Now Eric is way smarter than the average bear and will be well worth reading - not that I have any real idea just where he stands on all the issues I try to address. I am pretty sure his views will be solid, worthwhile and well considered.

David.

This Discussion on Privacy Is Worth Following Closely. It Has Implications for OZ.

The following appeared a little while ago.

Health IT group drafts privacy recommendations

By Joseph Conn / HITS staff writer

Posted: August 19, 2010 - 12:30 pm ET

A federally chartered advisory work group charged in June with devising recommendations on privacy and security policies to support the government's electronic health-record system subsidy program presented today its near-final list of guidelines to the Health Information Technology Policy Committee.

The work group, known as the privacy and security tiger team, met Monday and released what amounts to a consensus report on its recommendations, said Deven McGraw, co-chair of the tiger team and director of the Health Privacy Project at the Center for Democracy and Technology, a Washington think tank. The Health IT Policy Committee advises the Office of the National Coordinator for Health Information Technology at HHS.

According to the tiger team's draft document posted on the HIT Policy Committee's website, the team's recommendations are based on "fair information practices," a now globally accepted set of privacy policy guidelines that stems from a 1973 report by the U.S. Department of Health, Education and Welfare.

"All entities involved in health information exchange—including providers and third-party service providers like Health Information Organizations (HIOs) and intermediaries—follow the full complement of fair information practices when handling personally identifiable health information," according to the tiger team proposal.

One fair-information practice incorporated by the tiger team in its recommendations is the requirement that there should be "openness and transparency about policies, procedures and technologies that directly affect individuals and/or their individually identifiable health information."

Another fair-information practice cited in the tiger team recommendations involves individual choice: Individuals, it notes, "should be provided a reasonable opportunity and capability to make informed decisions about the collection, use and disclosure of their individually identifiable health information." (This is commonly referred to as the individual's right to identifiable health information exchange.)

But the tiger team, while pronouncing that patients should have a choice, also made recommendations that either did not support or limited patient choice under an array of common healthcare scenarios.

For example, the tiger team recommended that healthcare providers—as they do now with paper records—bear the responsibility of maintaining the privacy and security of EHRs. Providers that exchange identifiable patient information "should be required to comply with applicable state and federal privacy and security rules," the team wrote. But for what the tiger team members define as "direct exchange" between a patient's treating providers, the tiger team recommended that patient consent not be required, just as it is no longer required under the privacy rule pursuant to the Health Insurance Portability and Accountability Act of 1996.

Nor should a patient consent requirement be triggered by the direct exchange of particularly sensitive healthcare information.

Lots more here:

http://www.modernhealthcare.com/article/20100819/NEWS/100819905/1029

Now consider what we have from NEHTA – From their 2009 Privacy Fact Sheet.

Six privacy tenets for e-health

1. Commitment to privacy

A commitment to privacy is the starting point for NEHTA initiatives involving the collection and handling of personal/health information.

NEHTA recognises that:

• Privacy is an integral component of a secure and interoperable e-health environment;

• It must be embedded in the design process;

• It must comply with all legal requirements; and

• It should promote privacy-positive approaches.

2. Health-specific focus

All NEHTA initiatives involving the collection and handling of personal/health information are focused on obtaining measurable benefits for individual health consumers and health providers as well as ensuring the improvement of public health outcomes.

3. Individual participation

All relevant NEHTA initiatives will seek to maximise the degree of control individuals may exercise over the collection and handling of their personal/health information.

4. Clarity & transparency of purpose

All NEHTA initiatives involving the collection and handling of personal/health information will seek to articulate their intended purposes transparently and clearly.

5. Data quality, audit & security

All NEHTA initiatives involving the collection and handling of personal/health information will ensure that robust data quality, audit and security measures are put in place.

6. Governance arrangements

All NEHTA initiatives involving the collection and handling of personal/health information will be subject to appropriate governance arrangements designed to ensure, amongst other things, that these privacy tenets are supported and progressed into, and beyond, the implementation phase of each initiative.

----- End Extract.

I don’t know about you but there seems to be a lot of ‘will seek to’, focusing on’ and ‘subject to appropriate’ rather that hard edged precision about what is actually going to be done.

In the past NEHTA has argued that it might just be a bit ‘too hard’ to provide the degree of control over their personal information at least a substantial minority of the population really want.

Just what will be done and how it will work needs to be fully clarified and properly consulted before any technical designs are developed or tenders issued.

David.

Is This A Credible Study or a Bit of Spin? You Be the Judge.

We had an interesting release appear just before the election.

Wednesday, August 18, 2010

Another study boosting broadband

Actually it doesn't even mention the NBN, but that's the impression you are meant to get..

Minister for Broadband, communications and the digital economy

TELEHEALTH BENEFITS BETWEEN $2BN - $4BN PER YEAR

Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy said a new report by Access Economics estimated the benefits of telehealth to Australia could be between $2 billion and $4 billion a year.

The report, Financial and externality impacts of high speed broadband for telehealth, found telehealth offers the potential for significant benefits to Australia’s population, especially for people who are elderly or who live in rural or remote communities.

“Telehealth including online consultations, electronic health records, in-home care, and online health education will not only open up new possibilities in health care delivery, but will have significant savings on the health budget,” said Senator Conroy.

The report found one of the reasons telehealth in Australia has been held back is the lack of high-speed broadband, particularly in rural areas.

The report noted that even where high-speed broadband was available, it often had slow upload speeds and reliability could be patchy.

“The National Broadband Network will fix these issues once and for all,” Senator Conroy said...

More here (including a neat display of the 30 page report)

http://petermartin.blogspot.com/2010/08/anther-study-boosting-broadband.html

Nice one Peter Martin!

The report is headed as follows:

Financial and externality impacts of high-speed broadband for telehealth

June 2010

The Executive Summary makes for some very interesting reading.

Executive Summary

The Department of Broadband, Communications and the Digital Economy (DBCDE) requested Access Economics to report on the financial and externality impacts of ubiquitous high-speed broadband in relation to health and aged care costs, in particular the impacts that would result from increased use of:

• tele-medicine for remote consultations;
• remote home-based monitoring of chronic-disease patients and the aged; and
• remote training of medical professionals (using haptics); while
• excluding the benefits of personalised electronic health records (EHRs).

The report was required to:

• identify and articulate the nature of the impacts;
• determine a methodology to estimate these impacts, both on a net present value (NPV) and an annualised cash basis; and
• provide high-level estimates of the impacts.

Tele-health offers the potential for significant gains to Australia’s population, especially for people who are elderly or who live in rural or remote communities. Unfortunately, however, despite a myriad of tele-health studies, it is difficult to measure such benefits. Tele-health studies to date have been constrained by poor economic and health data and methods.

Most studies have, however, shown that tele-health is cheaper and faster (and at least equally effective) compared to transporting patients or health care providers over large distances.

Thus, it should be possible to estimate time and money savings at a national level, if not health gains.

• There does not appear to be sufficient data to estimate the benefits of online training for rural / remote medical professionals.

Using a combination of a national level United States (US) study into one aspect of tele-health (tele-consulting) and a national level Australian study that was mostly based on EHRs but had tele-health components, Access Economics estimates that steady state benefits to Australia from wide scale implementation of tele-health may be in the vicinity of $2 billion to $4 billion dollars per annum.

----- End Extract

It would have to be said that this is one of the most vague, assumption laden and non coherent pieces of work I have ever seen. Access Economics themselves admit that, and make it clear without a lot more work, their rather vague set of figures should be treated as ‘guesstimates’, if that.

A close reading makes on think this is little more than a proposal to do a lot more detailed modelling while admitting that comparable useable information from Australia is essentially non-existent and only slightly better in the US.

It is also clear that even if the benefits were accurately assessed, which they clearly can’t be on the basis of what is offered in this report, then the impact of more or less bandwidth being available is utterly unknown and totally unpredictable.

For Senator Conroy to claim the proposed National Broadband Network (NBN) is an answer to all the issues identified here and to claim these findings in anyway justify the $43B investment in the NBN is clearly, in my view, laughable. It is this type of nonsense generalised political claim that undermines the case to sensible e-health implementations which have a strong supportive evidence base – including aspects of much that is mentioned in this report as well as EHRs.

Of course, one also wonders why a report completed in June, 2010 suddenly appears a day or so before an election?

Telehealth can be wonderful, for example there is little doubt tele-psychiatry, referring doctor to specialist telemedicine and remote home monitoring are valuable useful technologies! However none are cost free and all need to have serious investment and planning to succeed,

I really wish there was more rigour in the debate in the e-Health space.

David.

This Looks Like Desperate Pre-Election Promising To Me! How Credible Is It?

The following leapt out just before we all went to the polls

First places in Australia to get E-Health

Nicola Roxon posted Tuesday, 17 August 2010

Brisbane, the Hunter Valley and Melbourne’s eastern suburbs will be at the cutting edge of cyber health advances as the first areas in Australia to use electronic health records.

These three sites will lead Australia as the Gillard Labor Government takes the health system into the 21st Century by building an electronic health record system that improves patient care and the safety and efficiency of the health system.

“This is an important step forward in allowing online access to health records for each Australian that chooses to,” Minister for Health Nicola Roxon said.

“Patients will control what goes onto their record and who can access their information.

“Brisbane, Melbourne and Hunter Valley residents who agree to participate at one of these sites will be at the forefront of this exciting new initiative.”

“This builds on the Prime Minister’s announcement yesterday that Medicare rebates will be provided for online consultations across a range of specialities for the first time,” Ms Roxon said.

Each of the e-health sites announced today – GPpartners (QLD), GP Access (NSW) and Melbourne East GP Network (Victoria) – was chosen because they already have strong e-health capability and support within their communities.

In addition to e-health records, these three sites will use health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.

These sites will help lead the way in developing and informing future planning of the system, improving technology and identifying what works well and what could work better. The two year investment in the three sites will be up to $12.5 million in total.

The state governments of the three states will also join this partnership to drive e-health forward in these communities. The Queensland Government has committed $1.2 million of in-kind support to GP Partners. The NSW Government has also committed $1.2 million to support the initiative and will work with the National E-Health Transition Authority to integrate their Healthelink pilot program with the national rollout.

If re-elected, the Gillard Labor Government will call for expressions of interest to identify further lead implementation sites in the near future, and significant funding will be available to support this process.

The e-health system will also benefit from the roll out of the National Broadband Network.

More here:

http://alp.org.au/federal-government/news/first-places-in-australia-to-get-e-health/

There is coverage here:

Online trial of e-health records has begun

• Karen Dearne
• From: The Australian
• August 17, 2010 12:00AM

HEALTH Minister Nicola Roxon is preparing to announce the first sites for her $466.7 million personally controlled e-health records program.

"The government will soon make an announcement on where in Australia patients will be first to have access to PCEHRs," she said yesterday.

"This is an exciting next step as the Gillard Labor government builds the health system we need for the future."

The Australian can reveal the Health Department signed contracts with three GP divisions -- Hunter Urban in NSW, Melbourne East in Victoria and GP Partners in Brisbane -- to "develop lead implementation site" proposals in mid-July.

These divisions all have expertise in health IT, and each received $100,000 for the work.

The National E-Health Transition Authority has a $300,000 one-year contract to co-ordinate the project.

More here:

http://www.theaustralian.com.au/australian-it/online-trial-of-e-health-records-has-begun/story-e6frgakx-1225906056802

and here:

Labor launches e-health records

$12.5 million of funding provided over two years to three GP communities in Queensland, NSW and Victoria

• James Hutchinson (Computerworld)
• 17 August, 2010 12:15

Sites in Brisbane, the Hunter Valley and Melbourne's eastern suburbs will receive $12.5 million over two years as the starting point for the Labor party’s proposed $466.7 million e-health records policy.

Three general practitioner networks - GPpartners in Brisbane, GP Access in the Hunter Valley and the Melbourne East GP Network - will receive the funding to implement both the e-health records and unique health care identifiers for patients, providers and hospitals, as well as electronic discharge summary and referrals systems.

Funding for the e-health project was earmarked in the 2010/2011 Federal Budget, but thus far no details have been released as to how that money would be spent, or what standards would be adopted for inter-compatibility of e-health record systems, confusing industry groups and healthcare providers. The government organisation charged with implementing the systems, the National eHealth Transition Authority (NeHTA) has largely remained silent on the topic.

Health minister, Nicola Roxon, has suggested that under Labor’s plan, Medicare Australia may be considered to host the e-health record data in addition to the unique identifiers it has already implemented and assigned to 97 per cent of Australians.

It is also known that the e-health records will be voluntary and personally controlled by the patient, allowing them to determine what information is visible to healthcare providers, and which providers have access to the record. The records are also likely to tie into a new $392.3 million initiative that would see the Government issue Medicare rebates for medical consultations conducted online over the National Broadband Network (NBN).

Of the three clinics chosen, the Brisbane-based GPpartners has been the most active in the e-health arena, implementing its Health Record eXchange (HRX) in 400 providers including Queensland’s Metro North Health Service District over the last five years. As at February this year, the implementation had seen a 26 per cent reduction in the cost of administering patients, with 1320 patients having been registered on the system by June 2008.

In a letter to local newspaper, Northside Chronicle, GPpartners chair, Dr Henry Brian, dismissed the privacy concerns that have dogged the rollout of e-health records nationally, saying that a system would simply save lives.

GP Access in the Hunter Valley provides internal administrative services to general practitioners in its network. The Melbourne East GP Network currently runs an e-health Practice Incentives Program (PIP) using the NeHTA-compliant Argus secure messaging protocol.

In addition to the $12.5 provided by the Federal Government, the Queensland and NSW State Governments will each commit $1.2 million to support their respective GP communities, with NSW pledged to integrate its Healthelink pilot program with the national rollout through NeHTA.

More here:

http://www.computerworld.com.au/article/357235/labor_launches_e-health_records/

and here:

Labor announces first e-health record sites

By Josh Taylor, ZDNet.com.au on August 17th, 2010

Residents of Brisbane, Melbourne and the Hunter Valley will be the very first to get electronic health records, Health Minister Nicola Roxon has announced today.

"This is an important step forward in allowing online access to health records for each Australian that chooses to," Roxon said in a statement. "Patients will control what goes onto their record and who can access their information."

"This builds on the Prime Minister's announcement yesterday that Medicare rebates will be provided for online consultations across a range of specialities for the first time," she added.

According to Roxon, GPpartners in Queensland, GP Access in New South Wales, and Melbourne East GP Network in Victoria were chosen for the roll-out, as they already had e-health technology available.

The government has outlined $12.5 million in funding for the three sites, which comes from the $466.7 million investment the Federal Government outlined in this year's budget.

The Queensland Government has also committed to providing GPpartners with $1.2 million in funding, while the New South Wales Government has promised to chip in $1.2 million to the roll-out. NSW will work to integrate its Healthelink pilot program with the National E-Health Transition Authority's national roll-out.

More here:

http://www.zdnet.com.au/labor-announces-first-e-health-record-sites-339305266.htm

as well as here:

E-Health records become a reality

Three sites across Australia to take part in GP network trial

• Renai LeMay (CIO)
• 17 August, 2010 17:51

The Federal Government's $466.7 million e-health records scheme will shortly start to surface in patients’ lives in the real world, with Health Minister Nicola Roxon announcing three trial general practitioner networks that will start to implement the technology.

Labor allocated the money in the last Federal Budget after years of the health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients' records and achieve clinical outcomes.

The Opposition, however, has pledged to cancel the scheme.

The three GP networks will be GPpartners in Brisbane, GP Access in the Hunter Vally in New South Wales and the Melbourne East GP Network in Victoria.

"This is an important step forward in allowing online access to health records for each Australian that chooses to," said Roxon in a statement, noting the networks were chosen because they already have strong e-health capability within their communities.

More here:

http://www.cio.com.au/article/357267/e-health_records_become_reality/?eid=-601

and last here:

Labor unveils e-health records trial sites

• Karen Dearne
• From: Australian IT
• August 17, 2010 4:27PM

LABOR will rely on a Howard government e-health project to kickstart its $467 million personally controlled e-health records strategy.

Health Minister Nicola Roxon has confirmed GP Partners in Brisbane, GP Access in the NSW Hunter Valley and Melbourne East will receive $12.5 million in total funding to act as pilot sites over the next two years.

The Australian today revealed the three GP divisions had been selected as lead implementation sites, under a project led by the National E-Health Transition Authority.

Ms Roxon said the three lead sites "will be at the cutting edge of cyber-health advances".

They will also trial the new healthcare identifiers regime, and will be first to electronically send hospital discharge summaries and referrals using national specifications, she said.

The Queensland government has already committed $1.2m in in-kind support to GP Partners, while NSW will commit the same amount for the Hunter trial.

More here:

http://www.theaustralian.com.au/australian-it/government/labor-launches-e-health-records-trials/story-fn4htb9o-1225906463440

So suddenly by giving $100,000 to 3 divisions and having NEHTA co-ordinate for $300,000 we can have e-health records up and being piloted!

I am sure there are all fully standardised, data and content interoperable implementations that have just suddenly sprung into existence fully functional, fully privacy complaint and so on!

If only it was so easy, why was it not done years ago?

I look forward to the independent evaluations of what has been obtained for the total $12.5M and the matching State contributions. I would be willing to bet they never reach the public domain, just like the evaluation reports of most of the HealthConnect expenditure – and yes I do know there was an obfuscatory summary report released ages ago!

From this report it hardly looks like we have a co-ordinated strategic set of projects. Much more like an emergency political fix to me!

E-health measures progress as minority government looms

Announced funding for e-health trial sites will yield a proposal by the end of September, though the fate of the program remains uncertain

• James Hutchinson (Computerworld)
• 24 August, 2010 08:0

Election analysts predict that it could take as much as two weeks to decide the fate of the Australian Government, but planned e-health measures are expected to progress in as little as a month.

The $12.5 million provided by the Labor party during the election campaign to three pilot sites in Queensland, Victoria, New South Wales, is expected to yield a proposal for the implementation of voluntary, personally controlled e-health records on a national scale by the end of September.

NSW and Queensland state governments each committed a further $1.2 million in funding to the program, amounting to $14.9 million for the implementation of records.

The three sites - GPpartners in Brisbane, GP Access in the Hunter Valley and the Melbourne East GP Network - are in the process of collaborating on the proposal, which will see each provide specialised technologies and technical support to stakeholders.

GPpartners in Brisbane, for example, has been trialing its Health Record eXchange (HRX) software in 400 providers over the last five years, putting it in the best place to provide the software itself as well as the web-based interface required by both clinicians and patients to control the records.

GP Access, which provides services to 400 clinics on NSW’s Central Coast, has rolled out generic secure messaging software to 98 per cent of clinics in the area, allowing different systems to communicate and send referrals between practitioners and specialists. The GP network was a finalist in the Australian Telecommunications User Group’s (ATUG) national awards in 2006 for the proliferation of managed broadband services to GP clinics across the region and has aided some clinics in going completely paperless.

The Melbourne East GP Network has also facilitated the roll out of a secure messaging system based on Argus, as well as a shared referrals and health records system.

GP Access IT team leader, Jason Ruminek, told Computerworld Australia that the organisation was in a “holding pattern at this stage” over the funding, but that the project was still progressing.

Lots more here:

http://www.computerworld.com.au/article/358036/e-health_measures_progress_minority_government_looms/?eid=-255

Is anyone else surprised that the flagship Shared EHR in the Northern Territory did not get some funds?

David.

NEHTA’s Blueprint – Do We Learn Anything New or Useful?

The following appeared on the RSS feed a few days ago

NEHTA Blueprint

The NEHTA Blueprint is a reference document intended to familiarise readers with major e-health capabilities that NEHTA is promoting for national adoption.

The Blueprint brings together and summarises the key design documents from across the NEHTA work program into a single document, explains how they fit together and how they fit within the broader strategic direction.

The Blueprint covers a range of capabilities including identifiers for individuals, providers and organisations, authentication, secure messaging, clinical terminologies, supply chain, pathology requests and reports, diagnostic imaging requests and reports, medication management, referrals and discharge summaries. The Blueprint is a living document and will be periodically updated as the NEHTA work program evolves.

This Blueprint is intended for an audience that is actively working in e-health. Potential readers include executives, policy officers, clinicians and technical staff.

If you have any comments or questions about the Blueprint, please direct your questions or feedback to: architecture@nehta.gov.au This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Blueprint

Download here: NEHTA Blueprint (20.87 MB)

Blueprint Sections

The Blueprint is a large document. Readers who wish to download the document in separate parts, a set of links have been provided

• Blueprint Part 1 (3 MB) (Chapters 1 and 2 - Introduction and Blueprint Overview)
• Blueprint Part 2 (6.81 MB) (Chapter 3 - Foundations)
• Blueprint Part 3 (8.26 MB) (Chapter 4 - Solutions)
• Blueprint Part 4 (3.34 MB) (Chapter 5, 6, 7, 8 - Future Capabilities, Architecture, Change and Adoption, Risks and Challenges)

Frequently Asked Questions

A set of frequently asked questions can be found here: Blueprint FAQs (63.98 kB).

The announcement is here:

http://www.nehta.gov.au/about-us/nehta-blueprint

As you would expect the there has been an enthusiastic welcome from at least one quarter!

NEHTA Blueprint online

by Charles Wright on August 20, 2010

Not quite sure what’s happening with ehealth? NEHTA has just published its Blueprint - “a reference document intended to familiarise readers with major ehealth capabilities NEHTA is promoting for national adoption”.

.....

Recommended for people writing in The Australian in particular!

More enthusiasm and excitement here!

http://www.ehealthcentral.com.au/2010/08/nehta-blueprint-online/

Well where does this all get us?

First we need to be clear that this document is first a listing of the “major ehealth capabilities NEHTA is promoting for national adoption”. It is not a list of current outcomes it is what is being promoted!

Second there are some interesting comments in the draft Frequently Asked Questions (FAQ).

Examples are:

“Q: Who should read the Blueprint?

A: This document is intended for an audience that is actively working in the e-health area within Australia. It is designed to be a reference document used to promote understanding of all elements making up the current NEHTA e-health work program, and provide guidance to more detailed documentation. Potential readers include executives, policy officers, clinicians, reference group members and technical staff.”

It is a big stretch to imagine any executives digesting a 200+ page document – despite all the pictures

“Q: When will the e-health products in the Blueprint be rolled out?

A: NEHTA is currently collaborating with all States, Territories, the Federal government and the private sector to find opportunities for early adoption of ehealth capabilities that align both the national strategy and with local priorities and programs of work.

In these collaborations, ownership and priorities for implementation always remains in control of the local project sponsor(s). NEHTA’s role is to work with local project teams and facilitate access to specialist knowledge about NEHTA specifications and national infrastructure.

The majority of change and adoption activities will be undertaken and managed at local and regional levels across the Australian health system. There is a need, however, for national strategies to accelerate the adoption of e-health in Australia to a tipping point as quickly as possible. Once a tipping point level of participation has been successfully achieved, other mechanisms will be considered to sustain continued growth in participation by healthcare providers.”

Translation – we are looking around for local areas of activity we can help with but don’t actually have money etc to contribute.

Also we need national adoption strategies but we are not doing it ourselves and need to consider mechanisms to have this happen!

“Q: What about personally controlled electronic health records?

A: As part of the 2010/11 federal budget, in May 2010, the current government announced a $466.7 million investment over two years in to a Personally Controlled Electronic Health Record system to support the National Health and Hospitals Network. Personally Controlled Electronic Health Records (PCEHR) are discussed briefly in the Blueprint and the section will be updated once more information is available.”

We know little more than we read in the NHHRC Reports and the press about this. Amazing the most lavishly funded e-Health initiative ever seen in Australia and NEHTA is not really seriously engaged or involved months after the announcements. One might a hoped DoHA and NEHTA might be actually talking from the get-go on all this. Seems not!

I don’t plan to comment on the whole document – but this section really stood out (Page 8 of consolidated document)

“The implementation of this strategy (The NHHRC Strategy) will require:

• Making sure the appropriate drivers are in place to support widespread adoption of e-health. This includes setting up a trusted approach to governance to deliver a shared vision based on a common strategy, thus ensuring that the benefits and outcomes are aligned with a mix of policy and regulatory drivers, such as claims and incentives and accreditation requirements;

• Collaboration with a wide range of primary/community based care organisations, acute/post acute care organisations, and other bodies that promote better self managed care of individuals;

• Development of national infrastructure services to support healthcare identifiers, security, location and other services (e.g. supply chain), as well as standards and solutions for key healthcare processes in care coordination, medications management and diagnostic services;

• Collaboration with a range of IT vendors who support healthcare; and

• Collaboration with government and privately operated online service providers, such as messaging solution providers, prescribing solution providers and imaging services.”

From where I sit and what I am told from all sides each of these points could do with a very substantial greater effort!

There also seem to be no clear dates for achievement of anything – just vague discussions of tipping points for adoption.

A classic example of this is the National Authentication Service for Health (NASH) Here we are told we are up to the design phase – and then, after a few pages – told no more information is available! What is going on here we can only wonder?

Overall, reading through I am left with two major impressions. First because of a lack of clear national leadership and governance of e-Health, NEHTA actually has no clear idea of how the get there (their future states) from here (the present states).

Second this document is much more a list of ‘gunna’s rather than actual blue-prints for steady progress. There is still so much in this document that is ‘will deliver.’ The classic is here (Page 15).

“Over the next three years, the National E-Health Transition Authority (NEHTA) will deliver key components of the National E-Health Strategy, endorsed by Australian Health Ministers in late 2008.”

Is it another 3 years we have to wait for delivery?

I do note in passing this is meant to be a ‘Draft for Consultation’ but that no date is given to get back to them. Additionally it surprising just how slow the development of the document was (took over a year – see page 7). Does NEHTA have no urgency for any of this?

David.

Note many of the comments on this post – and the post itself also bear directly on this document.

See here:

http://aushealthit.blogspot.com/2010/08/dr-andrew-mcintyre-blogs-on-future-for.html

D.

Dr Andrew McIntyre Blogs on The Future For NEHTA in A New Political World.

This has just been posted on the Medical Objects Web Site:

e-Health in Australia – Time to actually move forward!

Well we have had the election and there is no clear winner but it appears that the Rudd/Gillard government is the loser. eHealth is up for some reassessment and it certainly needs some.

From all reports $5 Billion of taxpayers money has been spent over the last 10 years and we have little to show for it. 10 years is long enough for any reasonable plan to bear fruit and there is clearly some fundamental flaw in the methodology.

The decision to purchase a SNOMED-CT license, and a Certificate Authority is the only positive I can find. We do have a Secure messaging standard, but it is flawed by the fact that it really depends on Nehta “NASH” service for suitable certificates rather than working with the existing Medicare certificates. (and NASH is vapour ware) Virtually every general practice has Medicare certificates as part of the PIP program and the reason that the secure messaging standard was not designed to work with them lies with the dysfunctional relationship between Nehta and Medicare.

Dysfunctional organisations seem to be at the heart of the matter. We have not had one organisation for 10 years, but about 4 or 5 each of which has been rebadged and restarted only to repeat the same mistakes. That mistake, or the core of it is the idea that they have to “solve” the problem and produce software. Government is hopeless at doing this, indeed most large organisations are hopeless at producing software and large projects tend to fail. What we need is government to provide governance to move the industry forward rather than trying to do the heavy lifting. After 10 years the things that were working at the start are still working and all the things that are working are based on consensus standards. What we need is governance to comply with those standards and progress the standards in an incremental way. Currently we see much talk of Nehta inventing standards and despite some very capable people inside Nehta this is doomed to failure. Standards have to be created by consensus, as then the industry will engage with the painful standards process in order to prevent silly ideas becoming a standard and to fix errors where they occur. They will only engage when they know they have a duty to comply with the standards and this is where the lack of governance is failing us.

The standards process has become orphaned because Nehta have said they will be dictating the path, and they have failed to produce any clear path. More recently they have tried to steam roll standards and this is also likely to fail as without adequate review the standards will be poor.

Out there is the real world, which is the world that Medical-Objects inhabits, we see significant advances in communication with the number one obstacle being poor standards compliance. Because of a lack of governance large vendors feel that they can flout the standard and dictate the formats though sheer market size. Because of a lack of compliance anything that does work is fragile because it is never quite right, but has to be wrong in exactly the right way in order for it to work.

The dreams of the connected health landscape are often formulated by people with no knowledge of the importance of the lower levels. We can connect to the whole world of internet services because of compliance with the invisible things like tcp/ip and http standards and not because some middle manager dreamed of the internet. The dreams of a connected eHealth world rely on applications supporting the creation and consumption of high quality, standards compliant messages and not on the glossy pdfs produced by Nehta.

I don’t think we need Nehta, the states are not the eHealth leaders in this country and Nehta was setup as an uneasy alliance of the states, many of whom ignore Nehta anyway. What we need is good governance and a focus of standards compliance of all the applications that make up the landscape. There does need to be funding of the standards process and there needs to be a mechanism for providers of healthcare to pay to buy standards compliant software, which is built properly will be more expensive than they are paying now. However, the money they are saving is working against the big picture of a connected landscape and this is where governance and some well directed funding could make a huge difference. If every health application was required to be standards compliant we would see an enormous spike in interest in the standards process and the consensus process could be resuscitated for its premature death and we could start moving forward one level at a time.

The big bang process has failed, as it was bound to do and we need a return to proven paths. The cost would be a fraction of what was planned and the results, though slow would be much more solid. The tortoise is still in the race, it’s time to stop trying to follow the scatterbrain hare!

The blog is found here and is cross posted with permisson:

http://blog.medical-objects.com.au/?p=65

It will be fun to watch the apoplexy over on the NEHTA Sponsored blog!

Enjoy.

David.