The View From the Top on Health IT in the USA. It’s Getting Pretty Exciting!

The following commentary appeared a few days ago.

The New Momentum Behind Electronic Health Records

Secretary Kathleen Sebelius

Department of Health and Human Services

Aug 26, 2010

A funny thing happened on the way to a 21st century health care system.

Many different groups representing vastly different interests across health care recently came together around an issue that seemed like a roadblock to building a healthier America a short time ago.

At a press conference earlier this month sponsored by the medical journal Health Affairs and Brandeis University’s Health Industry Forum, major insurance companies, provider groups, doctors, hospitals, and patients announced that they will team up to support so-called “meaningful use” regulations – guidelines that doctors and hospitals will have to follow to earn incentives for moving from paper to electronic medical files.

In doing so, they cleared a major hurdle to a health information technology revolution that will cut health care costs, reduce paperwork, improve outcomes and empower patients.

Today, in almost every other sector besides health, electronic information exchange is the way we do business. A cashier scans a bar code to add up our grocery bill. We check our bank balance and take out cash with a debit card that works in any ATM machine.

But despite the clear benefits of health IT, only two in ten doctors and one in ten hospitals use even a basic electronic record system.

That means patients spend too much time filling out the same form over and over. And doctors spend too much time writing down medical histories, tracking down x-rays and repeating expensive tests.

Health care providers may agree with the benefits of electronic health records. But they’ve also believed that adopting them was too difficult and expensive.

As the event earlier this month demonstrated, that’s changing – in large part due to an ambitious investment we made in the Recovery Act to reduce many of the obstacles that limited the spread of electronic health records in the past.

As part of that investment, we’ve created health IT Regional Extension Centers across the country where providers can go to find out which health record system fits their needs.

We’re training thousands of new health IT professionals who can help providers make the switch from paper to digital records.

And we’re providing grants to states for health information exchange, which will ensure that information can be shared across provider and hospital networks, while maintaining our strong commitment to patient privacy.

In the past, some providers also had financial concerns. For smaller practices and clinics in particular, the promise of greater efficiency and long-term savings was often overshadowed by the up-front costs of putting in an electronic health record system and the staff to administer it.

That’s why, under the Recovery Act, providers will be able to earn substantial bonus payments if they adopt electronic records: up to $44,000 in Medicare or almost $64,000 in Medicaid for individual providers, and millions of dollars for hospitals.

To earn these incentives, providers will have to meet “meaningful use” standards which require that electronic health records are, in fact, used to improve the quality of care – to collect essential health data, support better clinical decisions, and give patients electronic access to their own medical records, so they can be full partners in their care. These systems must be able to encrypt information and automatically logoff users, among other safeguards.

Previously, some provider groups had expressed skepticism about these standards, worrying that they were too burdensome. But this month’s press conference underscored an emerging consensus that the benefits of electronic health records far outweigh the costs – and that the time for action is now.

In fact, the most promising sign for the future of our health care system is not what stakeholders were saying, but what they’re already doing.

At that same press conference, major insurers like Aetna, United and WellPoint announced their own provider loan and training programs for electronic health records.

Full Article here:

http://www.kaiserhealthnews.org/Columns/2010/August/082610Sebelius.aspx

There are a few points that arise from this column.

First it is clear that the US Health Secretary really has a plan that has full Government backing to more into the future and has attached very substantial funds to bring that outcome about.

Second a holist approach is being adopted to address educational needs, funding, and the various regulatory, safety and standards issues and so on.

Thirdly Government is providing seed funding in areas where it seems useful to demonstrate the practicality and workability of the various strategies and directions so they can be adopted with confidence.

Fourth, where appropriate, the private sector is being engaged in delivery of the seeding and demonstration programs and the work products that have been developed have been placed in the public domain for use by all.

Last there is clear, goal orientated strategic leadership coming from the very top of Government, with the support of the President, and, in dramatic contrast to the Australian situation we see all the policy and strategic direction setting happening with very high levels of transparency and openness.

The combination of sensible private / public co-operation, transparency, smart investments via applying the concept of ‘meaningful use’, a holistic approach and senior leadership seems to have the US moving very quickly to make up what may have been seen 2-3 years ago as a substantial gap.

There is clearly stuff we can learn from all this in my view.

David.

More Evidence Electronic Reminders Can Help Improve Care.

The following appeared a few days ago.

Tracking system can improve follow-up after abnormal Pap test

August 20, 2010 | Bernie Monegain, Editor

BOSTON – Physicians who use an automated, electronic medical record tracking system to follow up on patients with an abnormal Pap test could increase the number of women who achieve diagnostic resolution and do so in less time than using traditional methods, according to new research.

Researchers from Boston University School of Medicine (BUSM) reported their findings in the Journal of General Internal Medicine.

Screening for cervical cancer with a Pap test is only as successful as the follow-up rate for an abnormal result, the researchers said. If a patient has a Pap test, yet does not receive appropriate follow-up for an abnormal result, then the opportunity to prevent or treat pre-cancerous lesions or cervical cancer is missed and the Pap test is ineffective.

The advent of tracking systems provides great potential to address inadequate follow-up on a systemic level, researchers found.

"We developed a tracking system for our internal EMR, and evaluated this tracking system as an intervention to improve adequate follow-up of abnormal Pap tests," said lead author Elizabeth Dupuis, MD, from the Section of General Internal Medicine in the Department of Medicine, and the Women's Health Interdisciplinary Research Center at BUSM.

The BUSM researchers compared abnormal Pap test follow-up rates for the 24 months prior to implementing the tracking system with rates 12 months after its implementation. The evaluation monitored all subjects for 12 months from the date of their abnormal Pap test through diagnostic resolution. Controlling for type of abnormality and practice location, the adjusted time to resolution decreased significantly from 108 days prior to implementing the tracking system to 86 days after implementation.

More here:

http://healthcareitnews.com/news/tracking-system-can-improve-follow-after-abnormal-pap-test

This seems to be a very good outcome, ensuring there is no unreasonable delay between a identification of a suspicious result and definitive resolution being achieved in terms of completed follow-up and treatment if needed.

Of course the front end of this is also important – where the EMR identifies patients who need various screening interventions and makes sure they are done – and then – when abnormalities are identified – makes sure the issue is properly and safely resolved.

Another brick in the evidence wall!

David.

This Is Pretty Exciting News - I Wonder Will Australian Users Get Access At Some Point?

The following blog post appeared a few days ago.

Tuesday, August 24, 2010

Evidence-Based Medicine’s Giant Leap

Cerner and the British Medical Journal (BMJ) have teamed to provide evidence-based medicine (EBM) embedded in the electronic medical record in a manner that is as exciting and encouraging a development in healthcare IT as anything I’ve ever seen — I repeat, as exciting as anything I’ve ever seen. Coming from a noted cynic and critic of healthcare IT, this flash of optimism is a significant change in the wind.

I was attracted to healthcare by the huge greenfield opportunity to apply the lessons I learned in military command centers (the Universe loves irony) about embedded computerized decision support. I’ve been searching for a sustainable piece of grass in that green field ever since.

One of the factoids I enjoy throwing around is the length of time that elapsed before US healthcare providers widely adopted and routinely practiced EBM for the treatment of community-acquired pneumonia —17 years. The Mean Time To Improvement (MTTI) in healthcare is abysmal, but not because clinicians are unwilling to change, rather because the clinicians don’t always know how to change or whether they should change at all.

The BMJ methodology provides clinicians with a trustworthy and convincing source of evidence upon which to justify a change in clinical behavior; and the integration of the BMJ knowledge into Cerner’s EMR gives clinicians an easy avenue for practicing that change in a fashion that can drive the MTTI in healthcare from decades to days. That’s not a dramatic overstatement — this collaborative effort between Cerner and BMJ, and what I hope will be similar efforts in the future, can radically lower the MTTI in healthcare.

As I mentioned in previous blogs, one of my major challenges in this relatively new position as CIO is to squeeze more value — measurable and perceived — from the Cayman Islands’ substantial investment in Cerner’s products. At the same time, we are undertaking a new care delivery model here that looks and feels very similar to the concepts evolving in the United States under an Accountable Care Organization (ACO) and Medical Home.

Among other commitments, our new model (known as CayHealth) is contractually committed to practice and measure EBM. The challenge, of course, is to enable EBM, that is, make it as easy as possible for clinicians to practice true EBM and then measure that practice somehow. This marriage of BMJ’s EBM content with Cerner’s Millennium application suite is an opportunity to do both — derive more value from the Cayman Islands’ Cerner investment, as well as support the imperatives of CayHealth.

Historically, there have been several barriers that were too high for EBM to hurdle:

· Governing the definition and content of EBM

· Updating, maintaining, and disseminating EBM to clinicians in a timely fashion

· Efficiently integrating EBM into the clinicians’ workflow

· Achieving all the above while making EBM affordable

The Cerner-BMJ collaboration knocks every one of these hurdles to the ground.

Read the details here:

http://callitanything.blogspot.com/2010/08/evidence-based-medicines-giant-leap.html

The blog is written by Dale Sanders, CIO of the Cayman Islands National Health System.

For those who are curious go here:

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

It seems there are only 60,000 or so people living there but that it has a huge economy, built apparently on being a rather major tax haven!

A little more research came up with this site:

http://group.bmj.com/products/evidence-centre/cerner/

BMJ Evidence Centre

Action Sets and Cerner Millennium

We have worked closely with Cerner to develop our Action Sets within the CareDesigner tool, which effortlessly pre-validates them for integration directly into the Millennium PowerChart.

Customised for your specific needs

Cerner Millennium’s PowerChart centralises patient information management and supports comprehensive care planning and coordination. Care plans and orders are created specifically for each region, and reviewed by local expert reviewers. They can be individualised based on the patient information entered during admission and ongoing treatment.

Giving you control

Cerner’s Care Designer tool enables customers to customise Action Sets for use within their organisation, for example, by incorporating national, regional or local guidelines. You can change, add to or remove Action Sets in line with changing guidelines and local best practice. Local Cerner teams work closely with all customers to support successful implementation.

The Action Sets package includes links to Evidence Summaries, which present relevant content from Best Practice, Clinical Evidence, performance measures, and links to Cochrane and national and international guidelines. The package also includes full web access to Clinical Evidence and Best Practice allowing for both to be used as referential tools outside of the clinical workflow.

----- End Page.

Pleasingly it seems the core information is available in standardised form for integration into a range of clinical systems.

See here:

http://group.bmj.com/products/evidence-centre/systems-integration

Systems integration

There is considerable diversity in the electronic health systems being used by hospitals, and no single solution for integrated healthcare.

Accordingly, the BMJ Evidence Centre supports multiple delivery channels for its authoritative healthcare information. We store our content in an industry-standard structured format and can provide access to it via a web API. This enables clinicians to access our authoritative evidence, expert opinion and guidelines within the tools they already use.

Standards:
Our approach is to develop support for whatever standards, contexts and vocabularies your system requires. We already support the following for structuring and querying our clinical information:

• HL7 Infobutton, REST, or other messaging standards (e.g SOAP)
• Multiple query contexts covering treatment and diagnosis
• Clinical vocabularies including ICD 9 / 10, SNOMED-CT and free text
• Results in a range of formats including XHTML, XML, ASCII, Atom/RSS

----- End Extract.

Maybe NEHTA or DoHA could investigate and possibly fund some form of national program to have this information made available to Australian practitioners.

Dream on I guess!

David.

It Looks Like It Will be a While Before iSoft Recovers from This Mess!

iSoft released its annual 2010 Full Year results just on market open today.

You can read the gruesome details here:

http://media.corporate-ir.net/media_files/irol/16/161325/investorpack.pdf

and for the real details here:

http://media.corporate-ir.net/media_files/irol/16/161325/4e.pdf

The result has already be covered here:

iSoft CEO steps down after poor result

• Michael Bennet
• From: The Australian
• August 31, 2010 12:06PM

ISOFT Group chief Gary Cohen has stepped down as part of a review after a horror full-year result.

Shares in the Sydney health information technology company slumped more than 20 per cent to 12.5 cents, after it reported a $382.9 million loss, following $34.7m profit last year.

The company's shares have now fallen about 83 per cent this year.

The result included a $341m one-off impairment charge, primarily related to goodwill. Total revenue fell 20 per cent to $431 million and earnings before interest tax depreciation and amortisation tumbled 77 per cent to $30m.

Chairman Robert Moran, who described the result as "disappointing", said iSOFT's board has commenced an in-depth review of the company's business operations.

A number of aspects of the review are already being implemented, including the departure of Mr Cohen who will remain with the company to assist with its transition and strategic development.

iSOFT has engaged an executive search firm to assist in finding a new CEO, with chief operating officer Andrea Fiumicelli to serve as acting chief.

The company has also commenced a "board renewal" process to identify candidates from both Britain and Australia to join the board.

On the result, Mr Moran said: "A difficult economic environment, adverse currency impact, delays to the implementation of the National Program for IT in the UK and an increased cost structure all contributed to this result."

iSOFT changed its name back to iSOFT last year after IBA Health acquired the group in 2007.

Mr Moran said the review has already targeted annualised operational cost savings of $50m by end of June 2011, with more than half of this to come through headcount reductions.

More here:

http://www.theaustralian.com.au/business/city-beat/isoft-ceo-steps-down-after-poor-result/story-fn4xq4zx-1225912302486

There is also some additional information here:

STOCKS ON THE MOVE

* Health information company iSoft (ISF.AX)

ISOFT

31 August,2010

ISF.AX, (0.135, -0.030, -18.180%), the market's most active stock, lost a quarter of its value to hit a 6-½ year low of A$0.125 after it reported a loss of A$383 million due to a hefty writedown of goodwill.

It said it needed to restructure its senior debt facilities, review its capital structure and was considering asset sales. Its chief executive stepped aside to work with the board on strategic options for the company.

Full article is here:

http://money.ninemsn.com.au/article.aspx?id=7953645

Clearly all this is pretty bad news for iSoft investors – to say nothing about how the ex-CEO (Gary Cohen) must feel to essentially lose his job.

While it is hard to be sure it does seem we are in part seeing in the figures the effects of the takeover transaction from a year or so ago impacting – as well as all the issues around the UK National Program for Health IT which have harmed cash flow and the need to recognise that there has been a major reduction in the value of the company’s intangible assets.

The 2009 annual report reveals there was over a billion dollars of intangible assets on the company and with the write down in these results this amount has been essentially halved but it is still a rather large $480 million.

Given that the company has a very substantial amount of ongoing legacy and maintenance revenue and many customers all over the world as well as a very newly developed and apparently quite good product in Lorenzo we can only hope the steps planned will turn the ship around!

For all concerned it would be sad if this can’t be achieved, but I doubt it will be quick!

David.

Weekly Australian Health IT Links – 29 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.

General Comment:

Well, it seems we remain in political limbo, with uncertainty surrounding all sorts of policy directions.

It has been pleasing to see health and general and e-Health seems firmly back on the agenda.

As an example we see here:

http://www.smh.com.au/federal-election/rural-services-now-in-spotlight-20100823-13in1.html

Rural services now in spotlight

Mark Metherell

August 24, 2010

Country people are more likely to die from cancer, may wait four weeks to see a doctor and get a lower share of Medicare spending.

Despite their plight, their needs failed to draw national attention during the election campaign.

That changed dramatically on Saturday night, says rural health spokesman Gordon Gregory. He said yesterday he had heard more about rural health as a political issue in the preceding 40 hours than in the previous 40 weeks.

That is thanks to the elevation of three country independent MPs who have bemoaned the lack of rural health services and who may now choose the next prime minister.

----- end quote.

The risk, in these rather fraught times, is that we will see less than considered policy emerge. I suggest we be alert to that outcome – but not be alarmed just yet!

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http://www.theaustralian.com.au/australian-it/greens-back-e-health-with-strong-data-security-and-privacy/story-e6frgakx-1225909093831

Greens back e-health, with strong data security and privacy

• Karen Dearne
• From: The Australian
• August 24, 2010 12:00AM

THE Greens will support government initiatives on e-health, as long as strong data security and privacy protections are in place.

"If you talk to people in aged care, in Aboriginal and regional health, they are very strongly supportive of e-health," WA Greens Senator Rachel Siewert said yesterday.

"So are we. But we do want to make sure that sensitive medical information is protected, and that individuals have control over decision-making (about access).

"We will work with whoever's in government on e-health, to ensure those safeguards are there. And that's very definitely about negotiation, not obstruction."

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http://www.computerworld.com.au/article/358524/politicians_bad_each_other_e-health_/?eid=-255

Politicians as bad as each other on e-health

Round table event hears there is too much focus on the technology, and not enough on healthcare

• Mahesh Sharma (Computerworld)
• 27 August, 2010 07:09

THE e-health capabilities of the major political parties are “as bad as each other” according to the former chief of the South Australian department of health.

The comments were made at the health informatics conference on Tuesday, when ABC's Tony Jones moderated a roundtable of industry veterans, who discussed a number of issues about e-health including the qualities required to lead a successful project implementation.

The panel comprised of the head of the National e-health transition authority, Peter Fleming, Ernst &Young health and human services lead (former CEO South Australia Department of Health) Jim Birch, author of the independent evaluation report of the NHS summary care record, UK professor Trish Greenhalgh, health informatics society of Australia president professor Michael Legg and technology vendor Intersystems's CEO Professor Stan Capp.

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http://blog.healthbase.info/?p=67

evolution, revolution and NEHTA

2010-August-26 | 08:19 By: eric Filed in: policy and politics

There is a wide spectrum of opinion in Australia regarding how e-health should be progressed. At one end of this spectrum we have the proponents of national-scale, top-down architected and developed infrastructure, such as exemplified by HealthConnect and by the NEHTA work program. At the other end, we have those who believe that such national-scale, government-run projects are doomed to fail, have been shown to fail around the world, take forever, and cost an order (or several orders) of magnitude more than organically evolving, bottom-up, industry-led alternatives. Where does the truth lie?

Many cite “the internet”, as an example of a successful, complex, evolving ecosystem that was not designed top-down by a government. However, some parts of it were. What is clear, is that the internet’s success is based on many soundly engineered components. These components are based on standards, modularity, clear separation of concerns, ease of implementability, relatively simple conformance requirements, and well tested implementations. This notion of soundly engineered components is one that is poorly understood or acknowledged in e-health, but one that needs to be if substantial progress is to be made.

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http://www.ehealtheurope.net/news/6183/orion_health_launches_rhapsody_4

Orion Health launches Rhapsody 4

24 Aug 2010

New Zealand's Orion Health has announced the launch of the latest version of its integration engine, Rhapsody 4.

Orion says the latest version of Rhapsody focuses on providing greater support for the latest industry trends, technologies and standards, including secure web services, already adopted by groups such as HL7 and Integrating the Healthcare Enterprise.

Paul de Bazin, Rhapsody product manager said the solution now provides greater support and features for organisations using service oriented architecture (SOA) to solve their integration challenges.

“Healthcare institutions are recognising the value of using integration tools to provide simple, reusable components – but they also require those components to be healthcare specific.”

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http://www.medicalobserver.com.au/news/online-consults-cautious-welcome

Online consults: cautious welcome

24th Aug 2010

Caroline Brettingham-Moore

DOCTORS say appropriate guidelines and rebate amounts for online consultations are crucial if Labor’s promised $392 million e-consults investment is to avoid creating perverse incentives for GPs.

Under its pre-election pledge, Labor would provide rebates of up to $100 for GPs treating rural and regional patients via online consultations and video-­conferencing, according to News Ltd reports. This is almost three times the current $34.30 rebate for a level B consult.

However, Labor had not confirmed these rebate amounts as MO went to press.

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http://www.theaustralian.com.au/news/health-science/low-tech-road-to-crisis-e-health-reform/story-e6frg8y6-1225910648546

Low-tech road to crisis: e-health reform

• AT THE COALFACE: Terry J. Hannan
• From: The Australian
• August 28, 2010 12:00AM

CRITICAL e-health reform is being interrupted by the Coalition.

The rest of the world has confirmed that healthcare technologies are essential for reform work.

The Coalition's anti-National Broadband Network stance indicates lack of comprehension of the capability of modern technologies to improve care delivery. And Labor is in an impossible situation caused by technological limitations to its e-health projects. Add to this the non-election. It all brings to mind the 1977 Tenerife air disaster in which two airliners collided on a runway. Investigators found that loss of cognitive efficiency, high autonomic arousal and loss of communication accuracy led to multiple small errors, culminating in the disaster.

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http://www.medicalobserver.com.au/news/concerns-held-for-funding-of-ehealth-trials

Concerns held for funding of e-health trials

24th Aug 2010

Caroline Brettingham-Moore

A QUEENSLAND division charged with trialling national standards for electronic health records in collaboration with NEHTA has expressed fears the funding could dry up before development work is complete.

Brisbane-based GPpartners – one of three divisions last week charged with trialling the standards – originally established a Health Records Exchange (HRX) system funded by the Howard government’s Cooperative Research Centres program in 2005.

But its deputy chief executive Brett Silvester said he “lives in fear” of short-sighted approaches, having previously seen federal funding for the development of the HRX axed in 2007.

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http://www.computerworld.com.au/article/358577/nbn_speeds_necessary_healthcare_identifier_service/?eid=-6787\

NBN speeds not necessary for healthcare identifier service

But healthcare experts say a more reliable infrastructure would help fast-track healthcare applications

• Mahesh Sharma (Computerworld)
• 27 August, 2010 11:07

The Labor government's proposed $43 billion national broadband network (NBN) isn't necessary for the rollout of the health record identifiers, according to the head of the National eHealth Transition Authority (NEHTA).

The comments were made at the health informatics conference on Tuesday, when ABC's Tony Jones moderated an e-health discussion with five industry representatives.

When Jones quizzed the panel about the need for the NBN, NEHTA CEO Peter Fleming said a reliable internet connection – not faster speeds - was the most significant requirement for the implementation of the healthcare identifier service (a system where a unique 16-digit number will be used to electronically link a patient's health records).

In this context, he said it didn't matter whether the reliability was delivered as part of the Labor government's proposed NBN or another project.

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http://www.theaustralian.com.au/australian-it/queenslands-mater-hospital-leads-way-on-e-health/story-e6frgakx-1225910776754

Queensland's Mater Hospital leads way on e-health

• From: AAP
• August 27, 2010 9:47AM

A PAPERLESS computer monitoring system will help doctors care for premature babies at a Brisbane hospital, in an Australian first.

The Mater Hospital's Neonatal Critical Care Unit has introduced the new BadgerNet system to give medical staff real time access to health records.

It is the first Australian neonatal clinic to use the technology. Director of neonatology Dr David Knight said the system will save time and lives. "Staff have access to electronic prescribing and drug administration systems,'' he said.

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http://www.medicalobserver.com.au/news/independents-push-ehealth-centre-stage

Independents push e-health centre stage

27th Aug 2010

Caroline Brettingham-Moore

THE rollout of the National Broadband Network (NBN) and e-health now lie at the heart of negotiations between three Independent MPs, Labor and the Coalition as the two parties jostle to form a minority Government.

As MO went to press the Coalition had won 73 seats, while Labor was just behind on 72 seats – however an additional seat is looking likely for Labor after Greens MP Adam Bandt said he would be inclined to support the party in a hung parliament.

And WA National MP Tony Crook has not yet pledged his support for the Coalition.

Independent MPs Tony Windsor, Rob Oakeshott and Bob Katter last week continued negotiations with the two major parties as they worked to broker a deal that would benefit their rural and regional constituents.

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http://www.healthinvestor.co.uk/%28X%281%29A%288nbGQtd6ywEkAAAAZmM1NzdiYWMtZjU3NC00NTg2LThhMzAtZTZiNTEwYjhmZTA0rgPYG4SxbZPw6cPcxsTWo9DJb9s1%29S%283f3qwi55ywwj1nyr1irgd145%29%29/ShowArticle.aspx?ID=1278

iSoft targets telehealth market

NHS software supplier iSoft has won a place on the telehealth assistive technologies framework agreement, which should allow the firm to expand its fledgling telehealth division.

The framework agreement is with Buying Solutions, the national procurement organisation for all UK public services, and will facilitate the buying of a wide range of products for public sector contracting authorities.

The agreement is for two years, with the option of two further one-year extensions, and will cover the areas of telecare, telehealth and telecoaching.

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http://www.hospitaliteurope.com/default.asp?title=iSOFTawardednationaltelehealthsupplieragreement&page=article.display&article.id=22777

iSOFT awarded national telehealth supplier agreement

Wednesday 25th August 2010

The framework agreements facilitate the buying process across a broad range of services and products for UK public sector contracting authorities, saving time, resources and avoiding duplication of effort.

The Telecare, Telehealth and Telecoaching framework agreement is for two years (with the option of two further one year extensions) and covers the purchase, installation, maintenance, monitoring and coaching of telecare and telehealth solutions.

iSOFT entered for tender applications in the areas of telehealth products, telehealth services, telecoaching products and services, and managed services – and the company was successful in all four areas. iSOFT has partnered with Bupa Health Dialog for the category of telecoaching.

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http://www.computerworld.com.au/article/358082/qld_health_adopts_warehouse_management_system/?eid=-255

Qld Health adopts warehouse management system

New system expected to result in less goods returns and decreased potential for delays to patient care

• Tim Lohman (Computerworld)
• 24 August, 2010 13:57

Queensland Health (QH) is to implement a new warehouse management system at its Central Pharmacy (CP) business unit to improve the efficiency of delivering pharmaceuticals and dental products to all QH hospitals and clinics.

The agency currently uses the enterprise-wide pharmacy software system iPharmacy, supplied and maintained by iSoft to connect all QH pharmacy departments with CP.

According to Queensland Health, all processes within the CP warehouse are completely paper-based where automation ends at the release of a picking list. Dental products also rely on the Pronto application for managing stock order processes.

QH’s Shared Services Partner (SSP) agency, which supplies clinical consumables and as part of QH’s Supply Chain Management Integration Strategy (SCMIS) Project, will also benefit from the new system.

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http://www.theaustralian.com.au/australian-it/trial-for-stroke-victims-telemedical-services/story-e6frgakx-1225909043923

Trial for stroke victims: telemedical services

• Karen Dearne
• From: The Australian
• August 24, 2010 12:00AM

Stroke patients will be next to benefit from the expansion of acute telemedical services in a Victorian trial.

The plan is to give doctors in Bendigo Hospital immediate access to Melbourne-based neurologists using wireless videoconferencing, so patients who would benefit from a life-saving drug can be identified quickly.

Project leader and head of neurology for Eastern Health Christopher Bladin says stroke victims in rural and regional hospitals who need the blood-clot buster tPA generally miss out.

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http://www.theaustralian.com.au/australian-it/net-value-adds-to-medical-education-surgery-over-the-web/story-e6frgakx-1225909046325

Net value adds to medical education: surgery over the web

• Karen Dearne
• From: The Australian
• August 24, 2010 12:00AM

A SIMPLE idea to broadcast surgery live over the internet has sparked a medical education revolution.

It will benefit specialists conducting rare or complex operations as well as under-resourced doctors in remote locations.

Surgeon and internet entrepreneur Andrew Renaut says his videosurgery live and on-demand webcasts, accessible to medical professionals only via a secure site, are just the start.

"For the first time, surgeons and surgical trainees can watch a whole range of rare or advanced procedures," he says.

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http://www.computerworld.com.au/article/357876/opinion_filter_dead_it_ll_back/?eid=-6787

Opinion: The Filter is dead, but it'll be back

National security imperatives will ensure some kind of net filter will be on the agenda in future

• Trevor Clarke (Computerworld)
• 23 August, 2010 10:56

The Greens' success over the weekend in cementing their hold on the balance of power in the Senate has sounded the death knell for the government’s controversial ISP-level internet content filter.

While the plan had been delayed in July with the Federal Attorney-General‘s office to review the filter blacklist - or refused classification content - to be administered by the Australian Communications and Media Authority (ACMA), the weekend’s election result means for the next few years the filter will not get legislative approval as the Greens have committed to blocking it.

The drowning of the much-hated filter could be cemented further should the Coalition be able to form a minority government with the gang of five independents.

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http://www.theaustralian.com.au/australian-it/opinion/a-rolls-royce-nbn-is-simply-not-commercially-viable/story-e6frgb0o-1225909068539

A Rolls-Royce NBN is simply not commercially viable

• Dave Stevens
• From: The Australian
• August 24, 2010 12:00AM

THE national broadband network will be a revolutionary piece of infrastructure with enormous benefits.

It will deliver 1GB high-speed internet to 93 per cent of Australians.

But there would also be speed and safety benefits to giving every Australian a Rolls-Royce, and the government doesn't do that because it would be ridiculously expensive, with many rarely leaving the garage.

So too the NBN.

The price we've been quoted is $43 billion, but that's only for the initial build.

Factor in the year-on-year running costs and the NBN rests somewhere between a losing investment and a financial black hole, guaranteed never to break even, let alone to turn a profit.

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http://www.theaustralian.com.au/australian-it/nbn-important-to-regions-but-you-cant-eat-it/story-e6frgakx-1225909090898

NBN important to regions 'but you can't eat it'

• Andrew Colley, Mitchell Bingemann
• From: The Australian
• August 24, 2010 12:00AM

LABOR may be quietly rejoicing that regional telecommunications is shaping as a key bargaining chip in the battle to form government.

The party is armed with its $43 billion National Broadband Network, but regional backing for it to form government is far from certain.

Signs for Labor were positive when all three independents, Rob Oakeshott, Tony Windsor and Bob Katter, whose support is shaping as necessary to forming government, indicated broadband would crown their list of demands to take to the major parties.

As it became clear on Saturday night the election would lead to a hung parliament, Mr Oakeshott told ABC TV: "You don't need to be an Einstein to work out that telecommunications is one of the issues we will be talking about."

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http://www.theaustralian.com.au/australian-it/government/nbn-under-scrutiny-by-country-mps-windsor-katter-and-oakeshott/story-fn4htb9o-1225909874574

NBN under scrutiny by country MPs

• UPDATED: Fran Foo
• From: Australian IT
• August 26, 2010 10:52AM

INDEPENDENT MP Tony Windsor has questioned the $43 billion National Broadband Network price tag, describing it as a "fictitious number".

Mr Windsor is one of three country MPs at the centre of power-sharing negotiations, including Rob Oakeshott and Bob Katter, who want access to Treasury secretary Ken Henry and Finance department secretary David Tune as they prepare a "roadmap" before entering into talks with Julia Gillard and Tony Abbott.

They've issued a "call for information'' on seven key areas, including access to the costings on all election commitments. As a result Labor could finally be forced to reveal how the $43bn figure was derived.

Mr Windsor described the request as "a test to the parties in terms of their promises going into the election" and questioned the veracity of the NBN funds.

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http://www.theaustralian.com.au/national-affairs/dick-smith-questions-nbn-benefits/story-fn59niix-1225909103250

Dick Smith questions NBN benefits

• Annabel Hepworth
• From: The Australian
• August 24, 2010 12:00AM

ENTREPRENEUR Dick Smith has fired a salvo against Labor's National Broadband Network.

He said he was concerned about the lack of a cost-benefit study and questioned the benefits for the bush.

Mr Smith said he was against the $43 billion plan "because it's never been properly costed".

Labor's plan was released without such an analysis to measure the claimed benefits in areas like e-health.

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http://www.theaustralian.com.au/business/telstra-in-limbo-with-broadband-on-the-line/story-e6frg8zx-1225908600813

Telstra in limbo with broadband on the line

• Mitchell Bingemann
• From: The Australian
• August 23, 2010 12:00AM

A SHIFTING customer landscape and poor financial results had prepared Telstra to adapt to the advent of the National Broadband Network.

However, the election outcome has left the telco in uncertain territory.

Before Saturday, Telstra chief executive David Thodey knew the election would shape the giant telco's future.

A Labor win would mean the $43 billion NBN would go ahead -- and Telstra would be guaranteed a major role -- at the cost of dismantling its vertically integrated business.

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http://www.theaustralian.com.au/national-affairs/regional-internet-service-to-fore/story-fn59niix-1225908603884

Regional internet service to fore

• Mitchell Bingemann
• From: The Australian
• August 23, 2010 12:00AM

BROADBAND is shaping up to be the key bargaining chip in the battle to form government.

This is occurring as Labor and the Coalition try to woo a clutch of independents from electorates starved of adequate telecommunications services.

Three independents emerged from the weekend's unresolved election with the power to bring either Labor or the Coalition to power in a minority government.

The three members -- Bob Katter from Kennedy in north Queensland, Rob Oakeshott from Lyne on the NSW mid-north coast and Tony Windsor from neighbouring New England -- all hail from electorates where access to high-speed broadband is rare and service is patchy, and where mobile networks do not reach towns with fewer than 100 people.

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http://www.theaustralian.com.au/national-affairs/abbott-set-to-shift-policy-ground-in-negotiations-with-independents/story-fn59niix-1225908602365

Abbott set to shift policy ground in negotiations with independents

• Patricia Karvelas, Political correspondent
• From: The Australian
• August 23, 2010 12:00AM

TONY Abbott has revealed he is prepared to alter his election promises -- including on his proposed broadband network.

His move is an attempt to win over the crucial independent MPs who are weighing up their support for him.

Mr Abbott said yesterday that within the "broad" policy parameters he established during the campaign, he had every intention of negotiating on the themes the independents would raise with him.

"Obviously, I accept that broadband is important because I put forward a very good broadband policy. I don't want to pre-empt the discussions that I expect will be had over the next few days, just to say that I intend to be very pragmatic, but within the broad policy parameters which we discussed during the election," Mr Abbott said.

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http://www.commsday.com/commsday/?p=1432

COMMENT: Does the NBN have a mandate?

Posted on August 22nd, 2010 | 155 post views

One of the interesting conclusions to draw from Saturday night’s Australian election—where neither side gained a majority of seats and both sides scored a statistical dead heat in terms of two-party preferred vote—is that there was no clear verdict from the Australian people as to whether the next government has a mandate to either continue with or cancel the proposed NBN.

Three weeks into the campaign, with Labor riding on an NBN high with the publication of its proposed fibre maps and the Coalition wilting in the assault of a hostile media on its apparent lack of broadband smarts, it would have been safe to say that a potential Coalition win would have been in spite of its broadband policy, not because of it. It would have been quite legitimate for NBN advocates to continue to argue their case for a change in Coalition broadband policy no matter the result.

But the last two weeks of the campaign and the election results themselves muddy the waters.

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http://www.theaustralian.com.au/australian-it/exec-tech/tv-cables-as-quick-as-nbn-national-broadband-network/story-e6frgazf-1225909053431

TV cables as quick as NBN

• UPDATED: Stuart Kennedy
• From: The Australian
• August 24, 2010 11:01AM

IF the national broadband network ever gets built, it promises network speeds of 100 megabits per second.

There will be more in the future as the technology gets upgraded.

But you can get close to NBN speeds, at least in terms of download capacity, right now due to upgrades on the hybrid fibre cable networks laid down by the telcos back in the 90s to carry pay TV.

These have long offered internet access as well as pay TV and the latest DOCSIS 3.0 upgrade to the Optus HFC network pushes download bandwidth from 20Mbps right up to 100Mbps.

Note: This really works. A small pity the upload rate is only about 2Mb/Sec.

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Enjoy!

David.

There is a Small Window For Sanity in E-Health as We Get a New Government. Maybe We Can Exploit It?

With the not entirely unexpected outcome of the recent federal election providing us with a moment or two of reflection time, it seemed to me there was a window open to maybe define a way forward that would work for all sides of politics.

If I were one of these, now rather important independents or Greens, (as both can’t govern in their own right) what would I be looking for?

First I would want to obtain acceptance that a transition to an e-Health enabled and improved health system will be neither quick and easy nor will be cost or pain free.

The evidence that we can improve the quality, safety and efficiency of our health system as well as making it more sustainable, through a planned, pragmatic, coherent deployment of e-Heath is in I believe.

Second I believe that we cannot endlessly put off serious commitment to making this transition for the whole health system, rather than just for those parts of the system that are controlled by the State health systems.

This inevitably means we need to move to a more inclusive, pragmatic form of national e-Health governance and leadership of which NEHTA is only a part.

From the blogs referenced in this post:

http://aushealthit.blogspot.com/2010/08/two-very-interesting-posts-what-does-it.html

it seems that others are also picking up that ‘business as usual’ for NEHTA is probably not appropriate going forward and that the time has come for another directional ‘transition’.

Third we really need to have a plan of how we move forward, how leadership and governance is to be provided, how engagement is to be obtained and how funding is to be provided.

Fourth we need to not only recognise the complexity of achieving an e-Health transition but also be prepared to learn from many other countries and health systems who have managed to make considerable headway from which useful lessons can be understood and adapted. This can be made to work but requires both health sector, consultative, technical and management skills!

Fifth we need to recognise that there are public concerns about the security, safety and privacy of their health information and that these concerns need not only to be allayed but clearly addressed.

Sixth, the time for technicians and government bureaucrats dreaming up plans in secret and then just ‘dropping them’ on the sector and public must surely be over. (Mr Rudd must be keenly aware just how foolish that approach is by now!). We need a new paradigm to match the new political reality in which we find ourselves.

Second last we do need to recognise that there are some good things happening around the country- and nurture them - while stamping out the silliness and obsession on the part of some who simply fail to grasp the 80/20 rule and seek perfection rather than practical useful outcomes.

Last I don’t believe we need to wait the many years for the NBN to be up and running before moving on this issue. (I almost wrote ‘moving forward (big grin!)). We already have the infrastructure we need to get started while other things evolve!

Were I the independents I would be wanting a proper detailed briefing on Health Issues (including e-Health) from both sides as well as the more high profile financial briefings and the like before making what will be pretty serious decisions.

We can only hope!

David.

AusHealthIT Poll Number 33 – Results – 29 August, 2010.

The question was:

Is The Full Investment in the NBN of $43 Billion Critical for e-Health in Australia?

Absolutely - e-Health Needs it All

- 15 (42%)

Possibly - But It is a Lot of Money

- 6 (17%)

I Think e-Health Can Work for A Good Deal Less

- 8 (22%)

About 1/2 the Funds is Enough for E-Health

- 0 (0%)

The $6B from The Opposition Would Do

- 6 (17%)

Votes: 35

This is a interesting outcome. I would have anticipated a little more scepticism about the need to spend $43B on NBN – based on the impact it might have both on e-Health and its other benefits.

There is definitely some uncertainty about the scale of the spend on Broadband needed to enable e-Health.

Again, many thanks to all those who voted!

David.

Two Very Interesting Posts - What Does it Mean?

Passed on without comment we have:

http://www.ehealthcentral.com.au/2010/08/greenhalgh-troubling-view-of-australian-ehealth/

and from Eric Browne:

http://blog.healthbase.info/?p=67

Read closely and see what you think. Comments encouraged!

David.