Weekly Overseas Health IT Links - 17 September, 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.

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http://www.rand.org/health/projects/clinical-decision-support/

Advancing Clinical Decision Support

Clinical Decision Support

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses computerized alerts and reminders to care providers and patients, clinical guidelines, condition-focused order sets, patient data reports and summaries, documentation templates, diagnostic support, and other tools that enhance decision making in clinical workflow.

From the Office of the National Coordinator for Health Information Technology

"Advancing Clinical Decision Support" is an intensive, multi-part project funded by the U.S. Office of the National Coordinator for Health Information Technology (ONC) to address the major barriers to achieving widespread use of clinical decision support. The project is being led by the RAND Corporation and Partners Health Care / Harvard Medical School. A particular focus of the project is on making CDS more-ready to serve among the requirements for "meaningful use" of electronic health record (EHR) systems.

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http://www.e-health-insider.com/news/6227/end_of_npfit_to_be_announced_today

End of NPfIT to be announced today

09 Sep 2010

The National Programme for IT in the NHS is set to end in its current form, a ministerial statement will announce this morning.

A further £700m will also be cut from the cost of the programme, with £500m coming from ‘local savings’ and £200m from the local service provider contract with CSC.

E-Health Insider expects the ministerial statement to be made at around 10.30am.

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http://www.e-health-insider.com/news/6228/npfit_future_is_modular_and_locally-led

NPfIT future is modular and locally-led

09 Sep 2010

The National Programme for IT in the NHS’ centralised and national approach is “no longer required” and trusts will instead be able to operate “a more locally-led plural system of procurement”, health minister Simon Burns has announced.

In a ministerial statement this morning, Burns said that a Department of Health review of the national programme had concluded that a new, “modular” approach to implementation should also be adopted.

The statement said that the two changes together would allow “NHS organisations to introduce smaller, more manageable change in line with their business requirements and capacity.”

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See here also:

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119293

The future of the National Programme for IT

• Published date:

9 September 2010

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http://www.ihealthbeat.org/features/2010/onc-names-temporary-certification-bodies-for-meaningful-use-program.aspx

Tuesday, September 07, 2010

ONC Names Temporary Certification Bodies for 'Meaningful Use' Program

by Kate Ackerman, iHealthBeat Senior Editor

Last week, the Office of the National Coordinator for Health IT unveiled one of the final missing puzzle pieces of the "meaningful use" incentive program by naming the Certification Commission for Health IT and the Drummond Group as the first ONC-Authorized Testing and Certification Bodies under the temporary electronic health record certification program.

The 2009 federal economic stimulus package included Medicare and Medicaid incentive payments for physicians and hospitals that demonstrate meaningful use of certified EHRs. Prior to the announcement, no certifying groups were in place to determine whether vendors' EHR products have the functions necessary for health care providers to meet the federal government's meaningful use Stage 1 criteria.

National Coordinator for Health IT David Blumenthal said the announcement "is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems."

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http://www.fiercehealthit.com/story/peel-pushes-informed-consent-over-every-element-patient-data/2010-09-07

Peel pushes for 'informed consent' over every element of patient data

September 7, 2010 — 7:14am ET | By Neil Versel

Depending on your point of view, Dr. Deborah Peel and her Patient Privacy Rights Foundation either continue to rail against the national push for EHRs or take further steps to hold policymakers honest. (We're not going to go as far as ZDNet Healthcare's Dana Blankenhorn, who recently called Peel a "Luddite" whose organization's goal "appears to be keeping healthcare in the paper-based dark ages.")

The latest from Patient Privacy Rights is a white paper making "The Case for Informed Consent" to give patients more complete control over their personal health information. In the paper, Peel dismisses arguments that it's too technically difficult and too expensive to design health IT systems that offer patients granular control over what elements of their records healthcare organizations can share.

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http://www.fiercehealthit.com/story/health-it-systems-often-overlook-care-management/2010-09-07

Health IT systems often overlook care management

September 7, 2010 — 2:02pm ET | By Neil Versel

When it comes to designing health IT systems, more than a few organizations may be missing the big picture in terms of integrating care management workflows into their technology.

A new survey of how IT is changing case management largely corroborates findings from a 2008 survey that providers, payers, case managers and others that support care coordination are making only modest progress toward automating care management.

The study, conducted by TCS Healthcare Technologies on behalf of the Case Management Society of America and the awkwardly named American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), found that just 23 percent of IT systems are fully interoperable with external applications and that a similar share of organizations had gone paperless in care management.

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http://www.govhealthit.com/newsitem.aspx?nid=74559

ONC seeks reusable approach to future NHIN services

By Mary Mosquera

Tuesday, August 31, 2010

The Office of the National Coordinator is developing an “interoperability framework” designed to eliminate the need for technical planners to start from scratch in identifying standards and services for future uses of the nationwide health information network (NHIN).

The upcoming start of health IT incentive program has put pressure on the ONC’s policymakers to come up with a streamlined approach to identifying specs and standards for new health information exchange features and services that might be created to help boost health IT adoption.

A reusable approach will reduce the time it takes ONC to identify the demand for the standards and then apply them to emerging services, according to Dr. Doug Fridsma, ONC’s acting director of ONC’s standards and interoperability office.

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http://www.ehiprimarycare.com/news/6204/chronic_medication_service_launches

Chronic Medication Service launches

02 Sep 2010

Scottish health secretary Nicola Sturgeon has launched the country’s Chronic Medication Service, which aims to set up shared care records between GPs and pharmacists by the end of the year.

The service is one of four elements in Scotland’s e-pharmacy programme, which the Scottish Government has said will cost £5.2m a year to deliver.

The CMS aims to enable shared care of patients with long term conditions between GP practices and pharmacists, backed by IT links between the two.

When a patient signs up for the CMS, the pharmacy’s patient medication record will send an electronic notification to the GP’s IT system. This will allow the GP to choose whether to enter into a shared care agreement, with an option to generate serial prescriptions for up to 48 weeks.

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http://www.healthleadersmedia.com/content/TEC-256089/Advances-in-Science-Technology-Informed-Consent.html

Advances in Science, Technology, Informed Consent

Gienna Shaw, for HealthLeaders Media, September 7, 2010

Science and technology are at a fortuitous crossroads: As we’re learning more about how variations in human genetics affect health and disease, we’re expanding our use of the electronic medical records systems that make it easier to gather, store, sort, and analyze genetic data. And growing right alongside clinical and technological medical advances: The importance of informed consent and its kissing cousin, re-consent.

So, how many times do you have to get permission from patients before you use their medical data for research? From the patients’ point of view, the answer is “every time,” a new study suggests. It doesn’t matter if the data is de-identified or if they’ve already approved its use for one purpose. If you want to use it again, they want you to ask them again, say investigators at Group Health Research Institute and the University of Washington (UW) in a report called “Glad You Asked,” which was published in the September 2010 Journal of Empirical Research on Human Research Ethics.

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http://www.fiercepracticemanagement.com/story/scribes-help-doctors-eliminate-emr-downsides/2010-09-08

Scribes help doctors eliminate EMR downsides

September 8, 2010 — 5:30am ET | By Debra Beaulieu

Do your physicians fret over how their productivity might slow down upon implementing an electronic medical record? Are they worried that the effort to learn the new technology will distract them from patient care? If so, you may want to consider hiring a scribe--an emerging type of medical professional who shadows clinicians and inputs all necessary data into the EMR.

Most do the job part-time as college students and plan to go on to full-time careers in medicine or nursing. Because of the valuable head start offered by the experience, scribes often are willing to work for $8 to $10 an hour with no benefits, the Los Angeles Times reports.

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http://www.fierceemr.com/story/emrs-help-improve-people-planet-profits/2010-09-09

EMRs help to improve 'people, planet, profits'

September 9, 2010 — 11:33am ET | By Neil Versel

You want an EMR, but you also want a return on your investment. At least one non-healthcare pundit believes you should look past just the financial bottom line and see that EMRs can provide benefits for the "3 Ps" of sustainability--people, planet, profits.

A post on the Triple Pundit blog says that EMRs deliver on all three areas, with better patient care, a smaller environmental footprint and fewer write-offs of accounts receivable.

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http://www.modernhealthcare.com/article/20100909/NEWS/100909933/

Guest commentary: Privacy issues overlooked

By Latanya Sweeney

Posted: September 9, 2010 - 11:00 am ET

From my son's pediatrician to my father's specialist, physicians are talking about electronic health records. Widespread EHR adoption is a goal of the American Recovery and Reinvestment Act of 2009, which provides financial compensation to healthcare providers and hospitals for meaningful uses of EHRs in years 2011 to 2015.

If successful, the ARRA will ignite a mass exodus from a prehistoric paper age into a tech-savvy networked cosmos called the Nationwide Health Information Network in which patient information flows seamlessly across computers, devices, organizations and locations as needed. For lasting success, special care must be taken to allow widespread sharing of patient information while protecting patient privacy, and that brings into question the recently released list of requirements from the CMS that include no privacy incentives and the current NHIN approaches from the Office of the National Coordinator that lack privacy and utility.

Read the full story here.

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http://www.healthleadersmedia.com/content/TEC-256203/Physicians-Mobile-Devices-Expedite-Decision-Making

Physicians: Mobile Devices Expedite Decision Making

John Commins, for HealthLeaders Media, September 9, 2010

Two thirds of physicians say they are using personal devices for mobile health solutions that aren't connected to their practice or hospital IT systems, but nearly a third said their hospital or practice leaders will not support the use of mobile health devices.

As for patients, 40% would be willing to pay for a remote monitoring device that sends health information to their doctors, according to a new online survey and report by PricewaterhouseCoopers' Health Research Institute.

The findings of the survey, published in a report titled Healthcare Unwired were presented this week by PricewaterhouseCoopers at the mHealth Initiative 2nd International mHealth Conference in San Diego. Physicians' interest in mobile technologies reflects the growing market for remote and mobile health applications and business opportunities for organizations using consumer technologies to support preventative, acute, and chronic care, PWC said.

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http://www.ihealthbeat.org/perspectives/2010/electronic-health-records-hold-great-promise-for-longterm-care-facilities.aspx

Friday, September 10, 2010

Electronic Health Records Hold Great Promise for Long-Term Care Facilities

by Eric Ford

Health IT holds great promise for improving health care quality and safety and reducing the costs of providing care in long-term care facilities. Numerous empirical studies conducted in other health settings support the view that health IT can help health care providers to reduce errors, improve safety and quality, and decrease costs. While acute care settings and physician practices are adopting electronic health record systems at a brisk pace, LTC settings, specifically licensed nursing facilities, have been slower to embrace such technologies

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http://www.eweek.com/c/a/Health-Care-IT/Medical-Smartphone-Apps-May-Need-New-Federal-Regulation-607844/

Medical Smartphone Apps May Need New Federal Regulation

The FDA is evaluating if medical smartphone apps require additional federal regulation, according to reports.

The Food and Drug Administration is looking into whether smartphone apps that allow patients to monitor their vital signs wirelessly should earn FDA approval before implementation.

Bradley Merrill Thompson, an attorney with law firm Epstein, Becker & Green, who studies health care issues, told GigaOM that the FDA is keeping an eye on app stores to see which medical applications for smartphones might require regulation. "The FDA is actively engaged in surveillance of various app stores to see if apps should trigger their involvement," Thompson told GigaOM for an Aug. 31 report. "Applications where a smartphone is connected in any way to imaging are under scrutiny, in particular. Any app that is used to transmit images to a medical facility requires FDA approval."

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http://www.healthdatamanagement.com/news/health-care-technology-news-accreditation-medical-homes-40977-1.html

Joint Commission to Accredit Medical Homes

HDM Breaking News, September 8, 2010

The Joint Commission in 2011 will offer a "Primary Care Home" option to ambulatory organizations for accreditation of their medical home programs.

Under the medical home model, primary care practices are designated patients' "medical home" to coordinate the continuum of care. The practices are redesigned to be more functional and workflow-friendly, and new processes are developed to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.

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http://blogs.wsj.com/health/2010/09/08/how-much-would-you-pay-for-a-remote-health-monitoring-device/

• September 8, 2010, 2:34 PM ET

How Much Would You Pay for a Remote Health Monitoring Device?

Patients are willing to use remote or mobile monitoring devices to transmit health info right to their physicians — they just don’t want to pay much for them.

We’ve written about telemonitoring before, in the context of managing high blood pressure and in looking at all the tech-industry companies dipping a toe into the market.

But the question of who pays for all of this looms over the entire subject. A new PricewaterhouseCoopers study finds that 40% of 2,000 consumers surveyed said they’d be willing to pay for a remote or mobile monitoring device, such as a scale, blood pressure cuff, glucose meter or heart-rate monitor — but when we asked to dig into that data, we learned that of those willing purchasers, 64% said they’d ante up only if a device cost less than $50. About 41% said they’d be willing to pay for a monthly subscription to send data automatically via a remote or mobile device to a health-care provider — but 47% of them said their limit was $5 per month.

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http://govhealthit.com/newsitem.aspx?nid=74602

Health IT group sets sights on NHIN road rules

By Mary Mosquera
Wednesday, September 08, 2010

A new federal health IT advisory panel has set to work on setting up a means of governing the nationwide health information network (NHIN) in a way that will earn the trust of healthcare providers and consumers and expand its use by the health care community.

There are no official rules-of-the-road for the NHIN, a basket of standards and services for enabling providers to exchange patient information securely over the Internet.

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http://www.ehealtheurope.net/comment_and_analysis/625/expert_view:_loukianos_gatzoulis

Expert view: Loukianos Gatzoulis

01 Sep 2010

The next shift in healthcare will be towards a more personalised and patient-centric care process. Information and Communication Technologies can contribute by offering personal health systems - both for chronically ill patients and for people at risk. This is a trend the European Commission is supporting through a number of research projects.

When we are ill, we suffer at home or at work. Symptoms can occur suddenly in the situations in which we need them the least. More often than not, there is no doctor or therapist available to offer immediate help or to check what is wrong.

Illness, in other words, can turn our lives upside down. But most of us tend to visit the doctor only on rare occasions, and often we wait until things go very wrong. Then we can end up being hospitalised.

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http://www.ehealtheurope.net/comment_and_analysis/622/expert_view:_robyn_tolley

Expert view: Robyn Tolley

24 Aug 2010

The managing director of NoemaLife argues the Italian experience shows that English trusts will benefit from the likely demise of NPfIT.

Three months on from the general election, we not only have a new coalition government, but a white paper that promises a radical shake-up of the NHS.

Healthcare IT managers will be hoping that ministers will also free them from the straight-jacket of the National Programme for IT in the NHS.

For the past six years, English trusts have either been grappling with the practicalities of NPfIT or weighing up the options while waiting to see what a change of government might bring.

Meanwhile, their European counterparts have been ploughing ahead, assessing and implementing technologies which are bringing new efficiencies and cost savings to their operations.

The Italian Job

Take Italy. As with the UK, there’s a strong reliance on the public sector, particularly when it comes to the nation’s health, and hospitals are managed at a regional level.

Yet Italian hospitals have had much greater flexibility and freedom when it comes to selecting what technology to invest in and, more importantly, which companies to purchase it from.

Not having a ‘one designated supplier for all’ approach has helped to keep offerings and prices competitive. Hospitals have been able to select the solution which best meets their requirements, however niche they may be.

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http://www.ehealtheurope.net/news/6213/compugroup_targets_us_market_in_buyout

CompuGroup targets US market in buyout

07 Sep 2010

German software company, CompuGroup Medical, has signed an agreement to purchase US company, Visionary Healthware Group.

The group, which includes American Healthcare Holdings, Visionary Medical System and Visionary RCM, is a provider of practice management software and electronic health records to more than 10,000 GPs in the US.

The company also provides laboratory information systems and revenue cycle management services across Europe.

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http://govhealthit.com/newsitem.aspx?nid=74599

HHS launches site for disaster medical volunteers

By Mary Mosquera

Tuesday, September 07, 2010

The Health & Human Services Department launched a Web site that provides a single point of entry for health professionals across the nation to sign up to volunteer in advance of an emergency or disaster in their state.

The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a national network of state-based programs that verifies the identity, licenses and credentials of health professionals before an emergency happens.

The Web site would makes it easier and faster to register potential volunteers by connecting them with each state’s ESAR-VHP program. Health professionals include doctors, nurses, dentists, veterinarians, medical technologists, clinical social workers, medical records technicians and mental health counselors.

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http://www.who.int/goe/ehir/2010/7_sep_2010/en/index.html

eHealth Intelligence Report.

7 September 2010

Scientific Articles

:: Deployment of e-health services – a business model engineering strategy (J Telemed Telecare 2010;16:344-353

Abstract: We designed a business model for deploying a myofeedback-based teletreatment service. An iterative and combined qualitative and quantitative action design approach was used for developing the business model and the related value network. Insights from surveys, desk research, expert interviews, workshops and quantitative modelling were combined to produce the first business model and then to refine it in three design cycles. The business model engineering strategy provided important insights which led to an improved, more viable and feasible business model and related value network design. Based on this experience, we conclude that the process of early stage business model engineering reduces risk and produces substantial savings in costs and resources related to service deployment.

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http://www.healthleadersmedia.com/content/TEC-256055/Healthcare-Breach-List-Hits-150-Mark

Healthcare Breach List Hits 150 Mark

Dom Nicastro, for HealthLeaders Media, September 7, 2010

The number of healthcare entities reporting breaches of unsecured PHI affecting 500 or more individuals has crossed the 150 mark, nearly one year after the first such breach was reported.

The Office for Civil Rights (OCR) breach notification website lists 153 entities as of Thursday, Sept. 2. The HIPAA privacy and security rule enforcer began publishing the breaches in February of this year, per the HITECH, but breaches date back to September 22, 2009.

The list is required in the breach notification interim final rule, which is in effect but under review by OCR before a final rule is submitted to the Office of Management Budget (OMB).

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http://www.modernhealthcare.com/article/20100907/NEWS/100909975/

Diagnostic errors merit more attention: Pa. agency

By Maureen McKinney / HITS staff writer

Posted: September 7, 2010 - 12:01 am ET

Despite their potential to cause serious medical harm, instances of missed, incorrect or delayed diagnoses rarely receive the attention garnered by other patient-safety problems such as medication errors. That's according to a recently released report from the Pennsylvania Patient Safety Authority, a Harrisburg-based independent state agency charged with collecting and analyzing safety data.

For the report, the agency reviewed 100 patient-safety events related to diagnostic errors that took place between June 2004 and November 2009.

"Misdiagnoses represent a substantial unmeasured source of preventable mortality, morbidity and costs," the authors wrote in the report. "However, it is not possible to focus on misdiagnosis-related harm without first understanding the broader issue of diagnostic error."

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http://www.healthleadersmedia.com/content/COM-256179/5-Tips-for-Avoiding-Diagnostic-Errors.html

5 Tips for Avoiding Diagnostic Errors

Cheryl Clark, for HealthLeaders Media, September 8, 2010

Now that the quality movement seems to be chugging along on a well-conceived, evidence-based track, some thoughtful person has come along tooting a horn to warn us to "wait here just a darn minute. Aren't you all forgetting something that's really, really important?"

Or words to that effect.

The man who made such a stir this week, and got my attention, is hospitalist and patient safety expert Robert Wachter MD, an author and associate chair of the University of California San Francisco Department of Medicine.

Measurements of quality—checklists, process measures, and pay for performance score cards—are all fine as ways to reduce medical errors, Wachter says. But they neglect to force us to repair an enormous defect that now exists in the way we care for patients.

Far too often we're getting the diagnosis wrong.

Turns out, the healthcare system performs rather terribly in this earliest stage of the healthcare delivery system. And hospitals, physician groups and quality experts together need to start paying attention, he says.

Wachter gave some examples in his article published this week in the journal Health Affairs "Why Diagnostic Errors Don't Get Any Respect—And What Can Be Done About Them."

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http://www.fiercehealthit.com/story/are-compliance-regulations-failing-healthcare/2010-09-06

Are compliance regulations failing healthcare?

September 6, 2010 — 10:58pm ET | By Neil Versel

Financial institutions suffer more data breaches than healthcare organizations, right? Wrong. It's healthcare--by a factor of three to one.

A recent report from the Identity Theft Resource Center showed that compromised data stores from healthcare organizations outstrip those in other industries. According to the ITRC, healthcare organizations disclosed 119 breaches this year through early August, compared to 39 reported breaches in the financial services industry. Why is this happening?

To start, let's acknowledge history: the financial services industry has always been safeguarding valuable assets, like money, gold, jewelry and documents. But the traditional focus of healthcare is the patient. Securing patient data is a relatively new imperative, one that has been mandated through extensive regulations.

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Enjoy!

David.

There Seems to Be A Consensus That A Cost - Benefit Study on the NBN is Needed.

It seems to me that now we have a new Government it really is time to address just what the full build of the National Broadband Network will cost, what it will actually deliver and to get some assurances that this is really the optimal way to be doing this.

To restate my basic position on all this, it is that I think fast broadband is a really ‘good thing’ and I happily pay for a pretty fast link from Optus Cable. (see bottom of blog to see how fast that is!). I also think that for all fixed high volume use it is clear ‘fibre’ is future proof and sensible way to go.

My questions mostly sit in the area of what is actually needed today, what might make sense in the life of this project (say the next decade) and how much should we sensibly pay to get the most out of the Internet while not overdoing it, or indeed underdoing it - recognising some of the investment will be very long lived (the fibre etc.) while other parts will be progressively evolved to gigabit or even faster speeds.

My other question is just what the right mix of fibre, satellite, wireless and whatever gets invented next should be.

When someone like Paul Budde says we need a study I tend to take notice.

See here:

What's the NBN really worth?

Paul Budde, Election 2010

Published 6:44 AM, 30 Aug 2010 Last update 10:01 AM, 30 Aug 2010

When the NBN announcement was first made and the issue of the cost-benefit analysis came up, BuddeComm’s comment was that it would be necessary to be aware of all the ingredients of such a plan before one could carry out such an analysis.

This is not just an issue for Australia. Other governments are also grappling with it. If the analysis were to be based simply on the use of traditional telecommunications services, it wouldn’t even be worthwhile starting on it, as it would not hold together.

One could argue that this is national infrastructure – as distinct from simply telecommunications infrastructure – and that no national cost-benefit analyses were provided for previous large-scale infrastructure projects.

But the reality is that we live in different times.

Nevertheless, governments still have the option of launching such a project, but perhaps they should not link it to a commercial return – as soon as that link is forged the market can, quite rightly, request a proper cost benefits analysis.

Full commentary here:

http://www.businessspectator.com.au/bs.nsf/Article/The-true-price-of-the-NBNThe-cost-of-the-NBNWhatS--pd20100827-8Q3QF?OpenDocument&src=srch

We also had this a few days ago.

Broadband plan is smoke and mirrors

• Peter J. Cox
• From: The Australian
• September 11, 2010 12:00AM

THE objective to build a high-speed National Broadband Network is visionary but the strategy for the NBN - building fibre direct to 93 per cent of Australian homes to deliver up to 100 megabits per second, let alone the suggested gigabit - is based on some false assumptions.

The case to spend $43 billion has been pursued largely by the beneficiaries; the consultants, technologists and Telstra competitors selling a series of myths to influence politicians, the media and the public.

No other country is remotely proposing such expensive government expenditure.

Nevertheless, these myths have grown up around the government's NBN venture.

1. It's an enabling technology: Broadband internet has been compared with the great enabling technologies of history such as the wheel, the steam engine, the printing press, electricity, the telephone, computers and the internet. But broadband is not a new invention, it is only a means of delivering existing and well proven technologies in a faster way.

2. We need speed: In the US the Federal Communications Commission national broadband plan is for download speeds of at least 4Mbps and upload speeds of at least 1Mbps to deliver "universal access". Though some countries offer far higher speeds, the US maintains this plan offers one of the highest universalisation goals in the world.

In Britain, the Digital Economy Act, known as Digital Britain, allows for 90 per cent coverage in Britain by 2012 with a minimum speed of 2Mbps.

The ability to provide at least 12Mbps nationally through wireless and satellite will enable all people, including those living in outer metropolitan, country and remote areas, to be able to receive the same email, social networking, internet, music, movies, videos, health, education, teleconferencing and public services as those with fibre in the cities.

3. Speed is expensive: The US congress and Barack Obama, under the Recovery Act, committed the US to spending $US7.2bn ($7.8bn) to improve the country's broadband infrastructure. More than $US2.5bn of this is exclusively for infrastructure projects to take broadband to rural and remote communities.

Of the remainder, $US4.4bn goes to support anchor institutions such as hospitals, schools, public safety broadband networks and public computing centres, and to teach Americans the skills and to provide centres for easier access to high-speed internet.

The US also intends to move $US15.5bn during the next decade from the existing Universal Service Fund, which would have been spent on telephone services, to support broadband in unserviced areas.

The proposed expenditure in Britain is even more meagre, with the government's pound stg. 300 million ($501m) home access scheme for low-income families. It further plans to provide pound stg. 200m for the delivery of its universal service commitment on a mix of technologies.

The US and Britain believe in the need for universal broadband but intend to spend only a fraction of the $43bn Australia is spending on the NBN alone, which does not even include the costs of educating and training the public in its use or the provision of services.

……

This is an edited extract from a full version on www.coxmedia.com.au.

Peter J. Cox is a media economist and analyst with Cox Media.

The link is here (with a great Bill Leak Cartoon!):

http://www.theaustralian.com.au/news/opinion/broadband-plan-is-smoke-and-mirrors/story-e6frg6zo-1225917689577

And then we have material like this.

US regulator set to back ‘WiFi on steroids’

By Joseph Menn in San Francisco

Published: September 12 2010 22:30 | Last updated: September 12 2010 22:30

The prospect of new wireless devices resembling “WiFi on steroids” will open up next week when US regulators will vote to liberalise an important part of the airwaves.

The new spectrum is set to end the frustration of users who lose connectivity when they move rooms. It will also bring affordable broadband access to tens of millions of rural users.

Full article here:

http://www.ft.com/cms/s/2/8b165ee6-beab-11df-a755-00144feab49a.html

The bottom line to me is that some form of well-considered NBN is vital for effective use of e-Health. The question is just how well considered the present proposal is - McKinsey Study or no. Before this all happens I would really like to see a proper debate, while being aware that there seems to be almost religious conviction that this is a ‘good thing’ at any cost vs. those who reckon we can have what we need for 20% of the cost. I would just like to have a few more facts and plans to consider. I note today The Age is reporting that the business case is to be released in a few weeks - see here:

http://www.theage.com.au/national/broadband-network-will-save-jobs-swan-20100916-15eo4.html

That would be a really good first step!

David.

This Just Gets More and More Amazing! Talk About Co-ordination Failure in E-Health PIP Delivery.

Today we had this little bombshell appear.

Doctors paid for phantom e-health standard

• Karen Dearne
• From: Australian IT
• September 15, 2010 6:20PM

DOCTORS were paid $83 million for using a secure messaging standard that did not exist, the Audit Office has found.

GPs have been making claims for using the system since August 2009 through an e-health Practice Incentive Program (PIP), managed by Medicare on behalf of the federal Health Department.

But there was no such system as the National E-Health Transition Authority had not finalised the specifications required for the standard then.

The e-health specific PIP scheme replaced an earlier IT for GPs incentive and aimed to encourage general practices to keep up with e-health developments through developing the capacity to exchange patient information.

When the scheme commenced on August 1, GPs qualified for payment simply by demonstrating use of an "eligible supplier" which had agreed to participate in NEHTA's consultation process and comply when the requirements were established.

"The risk of delay was identified in August 2008, but no specific action plan was developed,” the audit office said.

"NEHTA's subsequent feedback to Health in January 2009 indicated that the specifications, while drafted, had not been tested with industry, nor used in any products, and that consultation and take-up would take between one and two years."

In fact, NEHTA's secure messaging specification was accepted by Standards Australia in March this year, but the audit office said no timeline had been agreed as to when eligible suppliers needed to comply with it.

The second component involved secure authentication of doctors using the system - ultimately through the proposed National Authentication Service for Health (NASH).

Although practices and GPs were required to apply to Medicare for PKIs to claim the incentive payment, there was "no obligation for either the practice or their GPs" on usage.

Medicare had advised that its certificates were designed for electronic billing and claiming purposes only.

Health told the audit office the PKI requirement was included to "encourage practices to accept the principle of digital certification as a necessary part of practice technology", in support of NEHTA's work towards the NASH.

"But Medicare's PKI certificates are designed for the specific purpose of communicating with Medicare - rather than to enable the secure exchange of patient information as envisaged by the PIP," the report said.

Medicare initially raised the issue with Health in December 2008, the department referred it to NEHTA and the parties agreed there would be a "seamless transition" once the NASH was built, with the secure messaging software based on NEHTA's specifications becoming fully operational once the NASH PKI certificates were available.

Although NEHTA advised it expected to have the capability to issue NASH PKIs by July 2011, only yesterday it released a major tender for the entire smartcard and PKI project.

Lots more here:

http://www.theaustralian.com.au/australian-it/government/doctors-paid-for-phantom-e-health-standard/story-fn4htb9o-1225924171377

You can grab the full report from here:

No.5 - Practice Incentives Program

http://www.anao.gov.au/director/publications/auditreports/2010-2011.cfm

For good measure this is not the only part of the programme that has been rorted.

http://6minutes.com.au/articles/z1/view.asp?id=523360

GP and nurse phone lines found wanting

by Michael Woodhead

Two new reports have found deficiencies in nurse-run phone advice lines and also the responses from PIP-funded GP practice after hours lines.

An investigation by the Victorian auditor general into the state’s 24-hour nurse-on-call service found that it generally provided an effective service but that almost one in 20 callers received unsafe advice.

…..

Meanwhile, a report from the Australian National Audit Office found that GP practices receiving Tier 3 of the PIP After hours Incentive, may be failing to meet the requirement that patients have access to after-hours care by a practice doctor 24 hours a day, seven days a week.

Test calls made to 34 practices found that none of them answered the calls in person. Answering machines provided callers with an after-hours number for a practice doctor in only half the cases, with two practices indicating that no practice doctors were available after hours.

16 September 2010

The part of most interest to me is this bit: (Page 62)

eHealth Incentive

2.48 The PIP eHealth Incentive was announced as a 2008–09 Budget measure with expected annual expenditure of $83 million. The Incentive, which replaced the IM/IT and proposed Electronic Decision Support Incentives, aims to encourage general practices to keep up to date with the latest developments in eHealth, through developing the capacity to exchange patient information and promoting the use of electronic clinical resources.

2.49 While being announced in May 2008, DoHA’s consultations with the National eHealth Transition Authority (NEHTA)66 and Medicare Australia on the role of these agencies in the implementation of specific requirements of the Incentive were delayed, owing to the evolving nature of the national eHealth approach at the time. This impacted on the rollout and function of fully interoperable secure messaging software for the exchange of patient information.

2.50 Applications were required from practices by 30 April 2009 for the first payment in August 2009. In order to qualify for the first payment, PIP practices needed to meet three requirements outlined in Table 2.4.

E-Health Requirements:

1. Practices required a secure messaging capability that allows the exchange of patient clinical and medical information, provided by an eligible supplier. In practice, by 31 July 2009, general practices needed to sign up for the supply of practice software from a supplier that had agreed to:

• participate in the NEHTA consultation process leading to secure messaging specifications and compliance timelines; and
• subsequently comply with specifications and implementation timelines.

2. Practices required (or applied for) from Medicare Australia by 30 April 2009, a location/site Public Key Infrastructure (PKI)67 certificate for the practice and each practice branch. Practices also needed to ensure that each medical practitioner from the practice had (or had applied for) an individual PKI certificate. PKI certificates were to be used to securely send and/or receive information via the practice’s messaging system where possible.

3. By 30 April 2009, practices needed to provide their medical practitioners with access to a range of key electronic clinical resources.

2.51 In effect, however, only Requirement 3 places conditions on general practices to make changes to their operations in line with the PIP objective.68

2.52 With regard to Requirement 1, the secure messaging software has limited interoperability until suppliers redevelop their software against NEHTA specifications, and these versions are taken up across health and medical services, such as specialists and pathology laboratories. NEHTA advised that specifications have been determined and published by Standards Australia in March 2010, but no timeline has been agreed as to when eligible suppliers need to comply with specifications.

2.53 The risk of delay in software suppliers adopting NEHTA specifications was identified in August 2008, but no specific action plan was developed to address this risk. NEHTA was actively engaged late in the process on the use of its specifications as a key design factor in the required messaging software.

NEHTA’s subsequent feedback to DoHA in January 2009 indicated that the specifications, while drafted, had not been tested with industry, nor used in any products, and that consultation and take‐up by industry would take between one and two years. DoHA advised that it addressed this risk by requiring eligible software providers to comply with the specifications within the anticipated implementation timelines.70

However, as the timelines have not been agreed to date, DoHA’s approach to constraining the delay has been limited.

2.54 Under Requirement 2, once general practices receive their Medicare Australia PKI certificates, there is no obligation for either the practice or their GPs on their use. Medicare Australia has been issuing PKI certificates which facilitate electronic billing and claiming, as well as access to a range of other Medicare Australia online services, to practices and medical practitioners since 2003.

2.55 DoHA advised the ANAO that the inclusion of the PKI requirement was to encourage practices to accept the principle of digital certification as a necessary part of practice technology. It was expected that Requirement 2 would also significantly support NEHTA’s work towards a national authentication system based on PKI. However, Medicare Australia’s PKI certificates are designed for a specific purpose—communication with Medicare Australia—rather than to enable the secure exchange of patient information as envisaged under Requirement 1.

2.56 PKI certificates required by practices to receive the incentive that fully supported secure messaging software developed under the NEHTA specifications, was raised with DoHA by Medicare Australia in December 2008. DoHA drew this issue to NEHTA’s attention, with the parties agreeing on the importance of a seamless transition process to replace the Medicare Australia PKI certificates once the NASH71 solution was built. Secure messaging software based on NEHTA specification will be fully operable once NASH PKI certificates are available to practices and GPs.72

----- End Extract (Italics mine)

It seem what I wrote almost a year ago has turned out to be true:

http://aushealthit.blogspot.com/2009/12/news-alert-serious-differences-seem-to.html

This all has the flavour of DoHA and NEHTA basically just not co-operating and with the Audit ‘let the finger pointing begin’!

From the recently released tender we learn NEHTA expect the NASH will be operational by June 30, 2012 and that full implementation will take 5 years (that’s 2017). I wonder when the PIP payments will actually start sponsoring some actual outcomes. Not soon at this rate!

Heaven can only know the impact this sort of behaviour will have on things like the PCEHR initiative.

Again leadership and governance seem to have failed.

David.

Some One Needs To Be Held Accountable for This NEHTA Fiasco.

The following appeared late yesterday.

NEHTA to release smartcard tender

• Karen Dearne
• From: Australian IT
• September 14, 2010 7:21PM

THE design and build of the National Authentication Service for Health will be done by the private sector, despite years of work on the project by NEHTA.

The National E-Health Transition Authority is set to release a "fairly significant" contract tomorrow for the NASH smartcard and public key infrastructure (PKI) project - the user authentication system originally planned to be in place to support the launch of the Gillard government's controversial Healthcare Identifiers scheme.

Head of infrastructure services Stephen Johnson said NEHTA had been working on NASH "for quite some time" and had realised its complexity warranted participation by experienced industry players.

"We've been trying to define and design the authentication needs for healthcare in the e-health domain for the years to come, and we've realised it's a very complex affair," he said.

"The more we looked into the design aspects from all perspectives - healthcare providers, suppliers and so on - the more we found it lent itself well to (approaching) the marketplace."

Mr Johnson declined to reveal the value of the contract but said it would be fairly significant although not in the hundreds of millions of dollars.

NASH was touted as the key means of ensuring patient privacy and secure professional access to information as regulations underpinning the HI service were pushed through Parliament in June.

It was intended to ensure only authorised people could access patient details held by the Medicare-operated HI service, and establish an audit trail in the event of problems.

In March this year, NEHTA chief executive Peter Fleming told the Senate inquiry into the HI legislation that NEHTA was "moving quickly" with the Queensland government to develop the encryption technologies needed to support NASH.

Mr Fleming said "small-scale implementations, rather than pilots" of the building block components - identifiers, NASH and secure messaging - would begin from mid-year, "using real patients and real data".

After the laws passed, on July 1 every Australian was mandatorily issued with a unique 16-digit number to uniquely identify personal records as health information begins to flow more broadly across the healthcare sector.

The request for tender shows NEHTA wants someone to provide an end-to-end design, detailed specifications for technical and business operations and a delivery plan - to be followed by a buildout and commencement of operations.

NEHTA has been working on NASH in tandem with the identifiers program since 2005; the design, test and development of the NASH software interfaces was originally scheduled for 2008, with deployment of the system through early adopters slated for 2009.

But Mr Johnson said there had been a misunderstanding over NASH's readiness to launch with the HI service.

"That's certainly not a message NEHTA has put out," he said. "There is an authentication requirement for participants in the HI service in certain circumstances.

"That specific authentication medical providers need for the identifier service is already catered for by Medicare, which is our HI service provider.

More here:

http://www.theaustralian.com.au/australian-it/government/nehta-to-release-smartcard-tender/story-fn4htb9o-1225922843106

Here is the tender announcement.

http://www.nehta.gov.au/about-us/tenders/705

Request For Tender For The Provision Of The National Authentication Service For Health (Rft 2010/01)

The National E-Health Transition Authority (NEHTA) was established by the Australian Commonwealth, State and Territory governments in July 2005 to develop better ways of electronically collecting and securely exchanging health information. It is responsible for the design of e-health initiatives on a national basis, the first of which is the Healthcare Identifier Service which commenced on 1 July 2010. NEHTA works collaboratively with stakeholders across the health sector to develop the specifications and standards for the national e-health infrastructure and applications.

NEHTA is seeking organisation(s) with proven ability to deliver the design, build and operations of a National Authentication Service for Health (NASH).

The NASH will provide the necessary strong authentication for the healthcare sector, including the provision of Public Key Infrastructure (PKI) and secure tokens such as smartcards for healthcare providers and supporting infrastructure.

NEHTA is seeking the provision of services from suitably experienced parties to provide the following services for the NASH:

• Deliver an end to end detailed design;
• Develop detailed specifications for the technical service(s) and business operations of the service;
• Provide a detailed delivery plan, resource plan and costs;
• Build and commence operation of the necessary Credential Management Services (PKI) and Token Management Services to support e-health; and
• Provide an ongoing operational capacity / capability for these services.

The Tender will be released on 15 September 2010 and will be available from 12:00 hours (Australian Eastern Standard Time). To obtain a copy of the RFT you must first register, visit www.tendersearch.com.au/nehta for details.

A Tenderer Briefing will be held on: 20 September 2010 commencing from 14:00 hours (Australian Eastern Standard Time) at the Sydney Harbour Marriott, Circular Quay, 30 Pitt Street. Sydney Australia. Security clearances are not required to attend this briefing.

Please register for this briefing via email: nashrft@nehta.gov.au no later than 14:00 hours (Australian Eastern Standard Time) 17 September 2010.

----- End Quote:

You can find my commentary here:

http://aushealthit.blogspot.com/2010/06/nash-this-is-sleeper-of-problem-i.html

and here:

http://aushealthit.blogspot.com/2009/06/nehta-is-simply-not-ready-for-any.html

among heap of others (Just search the blog for NASH for lots of material).

In summary for almost 3 years we have been told NASH is coming and now we discover it was just a twinkle in someone’s eye and will now be designed and developed externally because NEHTA can’t quite work out how to do it.

Incompetence piled on deception adds up to me to a serious need for some management accountability to be delivered with some major resignations for having wasted public money.

David.

Weekly Australian Health IT Links – 13 September, 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:

A very interesting week with a new Government established and a new Cabinet put in place a day or so ago.

It will be a little while until we can form a view as to how it will all work out.

Specific e-Health and Internet and NBN matters will doubtless become clearer over coming weeks.

We will just have to ‘stand by’.

-----

http://www.theaustralian.com.au/australian-it/information-revolution-transforms-healthcare/story-e6frgakx-1225915000159

Information revolution transforms healthcare

• Karen Dearne
• From: The Australian
• September 07, 2010 12:00AM

ARCHITECTS, doctors and IT professionals are discussing how technology can transform healthcare services.

The discussion comes as public hospital projects worth more than $33 billion are in the design or construction phase nationally.

A two-day digital hospital design workshop in Melbourne attracted 130 people, who planned to explore ways of overcoming healthcare and workforce problems through better operational processes and more integration with primary care.

NSW Children's Hospital Westmead information services and planning director Ralph Hansen said connectivity and integration through technology had changed healthcare delivery.

-----

http://www.theaustralian.com.au/news/health-science/aiming-for-co-ordinated-care-public-hospitals-are-undergoing-a-quiet-revolution/story-e6frg8y6-1225916794259

Aiming for co-ordinated care: public hospitals are undergoing a quiet revolution

• Karen Dearne, IT writer
• From: The Australian
• September 11, 2010 12:00AM

PUBLIC hospitals are undergoing a quiet, if stop-start, revolution.

They are moving away from "doctors' egos and heroic interventions" to a culture of teamwork and community outreach. The shift is reflected in a new willingness among medicos, architects, administrators and technologists to hammer out key design issues together.

At stake is the $33 billion or so being spent on facilities under construction or being planned across the nation. These new hospitals will form the healthcare backbone for the next 50 to 60 years.

Reflecting a keen interest to get it right, this month 130 doctors, nurses, architects and information technology professionals gathered in Melbourne for a two-day Digital Hospital Design workshop hosted by Sydney-based Cisco Systems.

"For a long time, healthcare IT was about delivering a piece of information; now it's about bringing people together," explains Brendan Lovelock, Cisco's health practice leader. "We're discussing ways to combine IT with the built environment to make hospitals more effective and create better experiences for patients."

-----

http://www.theaustralian.com.au/australian-it/government/acs-calls-for-it-ministry/story-fn4htb9o-1225915501001

Election result a win for IT, e-health

• Fran Foo, Karen Dearne
• From: Australian IT
• September 07, 2010 5:52PM

THE Australian Computer Society has renewed calls for a minister dedicated to an IT portfolio as industry awaits a new Finance Minister.

The call was made as key rural independents Rob Oakeshott and Tony Windsor decided to back Labor, giving Julia Gillard the numbers to form the next government.

Mr Windsor said the most critical issue to winning his support was Labor's NBN.

"To miss that opportunity for millions of country Australians was too good an opportunity to miss ... you do it once, you do it right and you do it with fibre," Mr Windsor told reporters today in Canberra.

ACS chief executive Bruce Lakin hopes the Gillard government will consider consolidating IT into a single portfolio. He lamented the fact that in the past there have been instances where the ACS had to deal with several ministers to resolve a single IT issue.

-----

http://www.motioncomputing.com/about/news/press_release_081210.asp

Aged Care Residential Home Chooses Tablet PCs to Drive Mobility and Paperless Initiative

Motion’s new C5v Mobile Clinical Assistant ‘sold itself’ as mobile wireless solution

SYDNEY and AUSTIN, TX – August 12, 2010 – Residential aged care home Jacaranda Village is one of the first Australian healthcare organisations to take delivery of the new Motion C5v Mobile Clinical Assistant (MCA) as it commits itself to mobility solutions and aims to be paperless within two years.

The aged care facility ordered the new Motion C5v for nursing staff through Melbourne-based aged care solutions experts Axishealth; and early reaction to the new wireless technology is universally enthusiastic.

Jacaranda Village CEO Susan Bowditch said that they wanted to work more efficiently, while operating within their limited resources. “We have been working for some time finding ways to work smarter. So far this has generally been in areas of work practices and equipment, such as trying to cut down staff time spent walking up and down corridors. This is our first serious venture into technology solutions.

“We discussed our goal of going paperless for greater efficiency with Axishealth’s Doug Smith, who suggested adding a solution of mobile tablet PCs to more efficiently use our specialist aged care software i-Care.

-----

http://www.whatech.com.au/technology-releases/enterprise-software/2606-jacaranda-healthcare-launches-landmark-electronic-hospital-information-system-in-papua-new-guinea

Jacaranda Healthcare Launches Landmark Electronic Hospital Information System in Papua New Guinea

Monday, 06 September 2010 14:10

Technology Releases - Enterprise Software

Today Australian-based Jacaranda Healthcare launched Papua New Guinea’s first Electronic Hospital Information System with the Deputy Prime Minister of Papua New Guinea, Don Polye present.

Ken Blaikie, Director of Jacaranda Healthcare said that through the vision of the Directors of the Port Moresby Private Specialist Medical Centre, a major step forward has been taken for health management in Papua New Guinea.

The software system being implemented by Jacaranda Healthcare allows for seamless access of data between multiple hospital departments and ensures patient information is instantly available to suitably authorised healthcare workers. Delivering significant improvements in the coordination of general medical services, specialist medical consultations, pharmacy, radiology, pathology, dental, obstetrics, minor surgery and other services within the centre.

“This will increase patient care standards and improve the efficient use of resources within the Centre. The system will also allow virtually unlimited expansion of services and users, future-proofing the use and access to vital health information.

----

http://www.smh.com.au/nsw/hospitals-failing-to-treat-critical-cases-on-time-20100909-153aq.html

Hospitals failing to treat critical cases on time

Julie Robotham

September 10, 2010

BIG regional hospitals are struggling to treat on time emergency department patients who need urgent attention, according to independent statistics that highlight a continuing bottleneck in the NSW health system.

The figures reveal a big variation across the state in how quickly patients in triage category 3 - whose condition is deemed ''potentially life threatening'' - are able to begin receiving medication or recommended treatment.

Government benchmarks say 75 per cent of such patients should start their treatment within 30 minutes of being assessed by the triage nurse.

But at Manning Base Hospital only 50 per cent were able to do so. At Calvary Mater in Newcastle the figure was 53 per cent, while at Lismore, Tamworth and Port Macquarie Base hospitals it was 56, 60 and 61 per cent, respectively.

-----

http://www.misaustralia.com/viewer.aspx?EDP://1284080364109&section=news&xmlSource=/news/feed.xml&title=Aged+care+turns+away+from+Microsoft

Aged care turns away from Microsoft

Julian Bajkowski

Australia's aged-care industry has started rapidly developing low-cost alternatives to Microsoft's proprietary products after not-for-profit providers were slugged with licensing fee increases of up to 400 per cent by the software giant.

-----

http://www.theaustralian.com.au/australian-it/clinical-systems-clarify-medical-messages/story-e6frgakx-1225915000454

Clinical systems clarify medical messages

• Karen Dearne
• From: The Australian
• September 07, 2010 12:00AM

CHANGING demands in healthcare are behind changes in technology used in hospitals, Cisco Systems health practice lead Brendan Lovelock says.

"Ten years ago, IT in hospitals was all about accounting and building management systems, and if you were lucky there was a basic patient administration system," Dr Lovelock said.

"Now, health IT is an integral part of the clinical process, from intelligent monitors talking to the medication management system and collaboration not only internally but also with the patient's GP, family and other carers back in the community."

"Patient-centric" care relies on more effective communication and collaboration between all parties.

-----

http://www.tradingmarkets.com/news/stock-alert/occaf_isoft-brothers-turn-full-circle-1151106.html

iSoft brothers turn full circle

Posted on: Sun, 05 Sep 2010 17:36:06 EDT

Symbols: OCCAF

Sep 05, 2010 (The Australian Financial Review - ABIX via COMTEX) --

Gary Cohen resigned as CEO of iSoft after the firm he co-founded posted a $A382 million net loss for 2009-10. It is only three months since Cohen, who founded the firm with brother Brian, quit as chairman so that leading shareholder Oceania Capital Partners could put its MD, Robert Moran, into the role. Experts disagree about whether iSoft will enter administration or undergo a trade sale. The firm has survived rocky patches in the past.

Publication Date: 4 September 2010

-----

http://www.e-health-insider.com/news/6223/darent_valley_first_with_isoft_kiosks

Darent Valley first with iSoft kiosks

08 Sep 2010

ISoft has won a deal to provide Dartford and Gravesham NHS Trust with five self-service kiosks, which will be used to cut queues and reduce the pressure of incoming patients on reception and nursing staff.

The deal is iSoft’s first sale of Savience kiosks since agreeing a partnership with the company in February.

The kiosks will be implemented in Darent Valley Hospital’s reception area and fracture clinic and will allow patients to check-in for appointments and update their demographic information.

Paul Wilson, the trust’s outpatient project manager, said they should also help to cut 'did not attend' rates.

-----

http://www.e-health-insider.com/news/6230/little_change_on_lsp_contracts:_connelly

Little change on LSP contracts: Connelly

10 Sep 2010

The Department for Health’s director general for informatics has emphasised that local service provider contracts are still in place; although negotiations with CSC have yet to be concluded.

In a briefing at Richmond House to expand on a ministerial statement about the future of NPfIT, Christine Connelly said: “The Coalition government looked at the [BT and CSC] contracts and the best way to provide value for money is to fully honour them."

However, she added: "We will be looking to reduce what we spend both with suppliers and internally.”

She also confirmed that trusts choosing to go outside the programme will have to pay for systems themselves.

-----

http://www.theregister.co.uk/2010/09/10/npfit_erm/

NHS IT juggernaut rumbles on

Coalition's conservative cuts

By Chris Williams

Posted in Government, 10th September 2010 11:23 GMT

Analysis The major casualty of an overhaul of NHS IT has been revealed. The National Programme for IT (NPfIT) is no more - up to a point.

The death of an unwieldy acronym is hard to mourn, but otherwise the coalition's changes to the scheme are marginal. Indeed, if anyone is to suffer as a result of the decision to trim £700m from the scheme, it's unlikely to be BT or CSC, the last contractors standing.

Christine Connelly, the Department of Health's director general of informatics since 2007, insisted yesterday their multibillion pound contracts will be honoured by taxpayers.

"The best way to deliver value is to honour the contracts," she said.

-----

http://www.theaustralian.com.au/australian-it/government/regional-areas-an-nbn-priority-gillard/story-fn4htb9o-1225915505553

Regional areas an NBN priority: Gillard

• Joe Kelly, Fran Foo
• From: Australian IT
• September 07, 2010 6:02PM

JULIA Gillard said the federal government will work with NBN Co to ensure a priority roll out in regional Australia based on a uniform wholesale price.

Ms Gillard said the initiative would equalise the cost of telecommunications across the country, noting that a normal phone call from Tamworth to Sydney currently costs more than a local call made from within Sydney.

"Obviously we will be working through with NBN Co to do this priority roll out in regional Australia," she told reporters in Canberra today after rural independents Tony Windsor and Rob Oakeshott threw their support behind Labor allowing her to form the next government.

-----

http://www.theaustralian.com.au/national-affairs/deal-on-national-broadband-network-to-cost-billions/story-fn59niix-1225916138585

Deal on National Broadband Network to cost billions

• Mitchell Bingemann and Anthony Klan
• From: The Australian
• September 09, 2010 12:00AM

JULIA Gillard's promise to deliver the ambitious National Broadband Network to regional areas before major cities will cost taxpayers billions of dollars and undermine the project's business case, the opposition has warned.

The Prime Minister promised to roll out the $43 billion NBN to regional areas first as part of a deal to secure the support of two independents needed to form a minority government.

But opposition finance spokesman Andrew Robb warned yesterday that rolling out the NBN to the bush before lucrative metropolitan markets could jeopardise the project's economic case.

"The NBN business plan was to minimise the cost of the rollout and keep the maximum public exposure to $26bn by first attaining a critical mass in the cities that would allow them to generate revenues to assist the regional rollout, but now that whole thinking has been turned on its head," Mr Robb told The Australian.

-----

http://www.theaustralian.com.au/business/redrawn-nbn-rollout-to-put-rural-users-first/story-e6frg8zx-1225916099298

Redrawn NBN rollout to put rural users first

• Mitchell Bingemann
• From: The Australian
• September 09, 2010 12:00AM

THE government and the NBN Co will meet in coming days to tweak the business case for the ambitious $43 billion National Broadband Network.

The changes are intended to ensure that broadband-starved users are the first to receive the promised superfast internet services.

After a seven-week moratorium on the NBN's work schedule -- upheld during the lead-in to the election -- NBN Co chief executive Mike Quigley can get back on with his job of connecting 93 per cent of the nation to a fibre-to-the-home network capable of 1000 megabit-per-second internet access speeds.

However, the task of completing the eight-year build will now take on new direction, as the concessions required to secure the support of the key rural independents Rob Oakeshott and Tony Windsor mean broadband-deprived rural areas will be the first to be connected.

-----

http://www.theaustralian.com.au/business/telco-sees-nbn-pitfalls/story-e6frg8zx-1225916117381

AAPT chief executive Paul Broad sees NBN pitfalls

• Tracy Lee
• From: The Australian
• September 09, 2010 12:00AM

THE head of the nation's third-biggest telco has warned that the National Broadband Network could duplicate existing fibre in some areas.

He also said there were no guarantee that increased competition would lead to better prices.

"We've got fibre running down the centre of (independent MP) Tony Windsor's electorate -- I don't know if he knows that," said AAPT chief executive Paul Broad.

"We've got 24 strands of fibre up and down the east coast and we're only using two of them.

"Our number one worry is that we're going to re-nationalise the network and overbuild what's already there."

-----

http://www.theaustralian.com.au/national-affairs/industry-demands-nbn-cost-benefit-analysis/story-fn59niix-1225916766974

iiNet chief executive demands NBN cost-benefit analysis

• Tracy Lee, Mitchell Bingeman
• From: The Australian
• September 10, 2010 12:00AM

THE country's third-largest internet service provider has renewed calls for a cost-benefit analysis of the National Broadband Network.

iiNet chief executive Michael Malone argued that any subsidy to provide access in rural and remote areas should be transparent.

"The one thing that's been missing from this debate is transparency. When [former prime minister] Kevin Rudd and [Communications Minister] Stephen Conroy came to power, they promised transparency but they've reneged on that," he said.

With the NBN rollout set to prioritise rural areas ahead of urban centres, there is speculation the change in implementation will push out the timeframe for the project to achieve a commercial return and could require a subsidy to connect the most remote users.

-----

http://www.theaustralian.com.au/australian-it/government/isp-filter-plan-could-be-buried/story-fn4htb9o-1225915395171

ISP filter could be buried

• Fran Foo
• From: Australian IT
• September 07, 2010 3:44PM

LABOR'S controversial internet filter plan faces near-death despite the ascension of Julia Gillard as Australia's 28th prime minister.

Ms Gillard won the backing of independent MPs turned powerbrokers Tony Windsor and Rob Oakeshott despite Bob Katter supporting the Coalition and Tony Abbott.

The country has been in limbo since the August 21 poll didn't deliver an outright winner.

Labor went into the 2007 election pledging to censor the internet but since then Communications Minister Stephen Conroy has changed the shape of his plan several times. At last count Senator Conroy ordered a 12-month review into how refused classification content is rated.

Labor's mandatory filtering program will force all internet service providers to block web pages rated as refused classification on a secret blacklist.

The Coalition vowed to dismantle the plan regardless of last month's election outcome. And with the Greens set to hold the balance of power in the Senate from next July, it is almost certain Labor's filtering aspirations are as good as dead.

-----

http://www.computerworld.com.au/article/360154/fact_fiction_top_8_linux_myths_debunked/?eid=-219

Fact or fiction? Top 8 Linux myths debunked

Think Linux is just for experts, or that it's less secure than Windows or Mac OS? It's time to dispel such false perceptions

• Katherine Noyes (PC World (US online))
• 10 September, 2010 05:19

If the idea of using Linux in your business is one that makes you nervous, chances are you've fallen prey to one or more of the many myths out there that are frequently disseminated by competing vendors such as Microsoft. After all, each Linux user means one less sale for such companies, so they have a powerful motivation to spread such FUD.

In fact, the ranks of businesses and government organizations using Linux grows every day, and for good reason: it's simply a good business choice. Let's take a look, then, at some of the top anxiety-causing myths and dispel them once and for all.

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Enjoy!

David.

More Evidence About How Hard Mega Projects Are and How There Are Probably Better Ways.

A few days ago an important paper was published in the British Medical Journal.

BMJ 2010; 341:c4564 doi: 10.1136/bmj.c4564 (Published 2 September 2010)

Cite this as: BMJ 2010; 341:c4564

Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation

1. Ann Robertson1,
2. Kathrin Cresswell1,
3. Amirhossein Takian2,

For full list see the paper - there are about 20!

1. Correspondence to: A Sheikh, professor of primary care research and development, aziz.sheikh@ed.ac.uk

• Accepted 5 August 2010

Abstract

Objectives To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service.

Design A mixed methods, longitudinal, multisite, socio-technical case study.

Setting Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete.

Data sources and analysis Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data.

Main results Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities.

Conclusions Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations’ perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems.

The full paper is accessible from here (free) along with some additional web-only material.

http://www.bmj.com/content/341/bmj.c4564.full

What I found most interesting in this were the voices of the individual clinicians who clearly seemed to recognise the value in a working system but who were frustrated about the inflexibilities, slowness and inefficiencies that seemed to be associated with reaching a practical end-point.

It is also clear that and complex system implementation needs to be addressed at a coherent organisation that can work well internally to solve problems. This means there needs to be, in my view, implementation flexibility at the level of the area health service or region. The approach of state-wide implementations and equally the approach of giving every tiny organisation too much choice in how they proceed both seem to be problematic - as we have seen here in Australia.

The key to success I believe is to be clear just what aspect of any initiative need to be locally driven, what needs to be state driven and what should be nationally consistent. Getting this right can save a lot of money and angst!

This work and the papers that follow will become regarded as classics of the Health IT literature and those who worked on it are to be congratulated.

The lessons are pretty clear. I hope the relevant authorities are listening.

David.

Educational Pre-Conference Seminar Announcement - System Dynamic Modelling in the Emergency Department.

Here is the information from the web-site:

Systems Thinking and Modelling for Health: The Emergency Department-Medical Imaging interface with a focus on Patient Flow Improvement

Date: Wednesday 10 November 2010

Time: 2:00pm - 5:00pm

Location: Swiss Grand Bondi Beach

Cost: $50 per person (includes afternoon tea)

REGISTER NOW

*Delegates who have already registered for the conference, please contact Conference Works directly on Ph: 03 9870 2611 Email: events@conferenceworks.net.au

The health care system is a complex collection of interactions. Navigating the health care system is an increasingly difficult and frustrating task. This applies for patients, carers, clinicians, policy makers, funders, politicians and citizens. This is particularly true in the Emergency Department, and an emerging focus of attention is the clinical interface between Emergency Medicine and Medical Imaging. This focus has included aspects of patient safety, quality of care, communication/teamwork, and error including diagnostic error. Inappropriate use of imaging, and the downstream impacts on patient flow, and ED overcrowding, is also on the radar. Recent healthcare reforms now mean there is an quality improvement imperative in the Emergency Department with a specific emphasis on identifying and removing impediments to patient flows. This workshop will therefore be of specific interest to those involved in analysing and improving patient flows in Emergency Departments and Medical Imaging.

A continual stream of new technologies and health conditions adds a dynamic dimension to this confusing world. These advances in biomedical knowledge and technologies have forced specialized clinicians and policy makers to focus on understanding and analyzing the parts of the system rather than taking an overall systems approach. Tools and methods for understanding complexity and designing social systems are being developed and applied, particularly in the systems science and engineering disciplines. Their use in healthcare, including at the Emergency Medicine-Medical Imaging interface, is increasing with the wider availability of powerful computer simulation tools which can be applied to patient flow issues in the Emergency Department for example.

However, overall uptake has been slow due to health professionals’ lack of familiarity with the concepts, technical language and tools required to tackle the dynamics of complex systems. One such tool is system dynamics modelling.

In this workshop, simple computer models will be used to teach health professionals and researchers with minimum or no experience in modelling some of the key health system dynamics applicable in real world problems such as those found in the Emergency Department. This will be a hands-on workshop using computer models to understand the concept of how structure determines behaviour by running virtual “what-if” experiments. This will include patient flow in the Emergency Department, and the impact of Emergency Department-Medical Imaging interface interactions.

Audience/Key participants:

Emergency Department staff,

Medical Imaging staff,

Managers/Administrators,

Quality, Safety, Performance and Risk staff,

Quality and systems researchers

Learning Outcomes:

You will understand the difference between process maps and dynamic system models, the approach and language of systems modelling and the methods of system dynamics model development and use for what-if experiments, with particular emphasis on the Emergency Department, the ED-Medical Imaging interface, and patient flow analysis and improvement.

Facilitator:

Geoff McDonnell is Simulation Research Fellow at the Australian Institute of Health Innovation , UNSW, and trained as a specialist physician and engineer at UNSW, Harvard and MIT, with public and private health sector experience, including IBM Asia Pacific. He is a cofounder of the Health Policy Special Interest Group of the international System Dynamics Society.

The web site and the full conference details can be found from here:

http://www.conferenceworks.net.au/apsf/workshop

I raise this as Dr.Geoff McDonnell is an old ‘mate’ and I know that it would be helpful for those wanting to understand just how Systems Dynamics Modelling can help in the health sector and in this domain particularly.

David.