Weekly Overseas Health IT Links - 28 January, 2011.

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.

-----

Mobile, Analytics Lead Health IT Trends

Researchers say healthcare providers and insurers will invest heavily in business intelligence tools, wireless technologies, and cloud computing in 2011.

By Nicole Lewis, InformationWeek

Jan. 18, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229000824

Insurance companies and physicians face many challenges in 2011 as new models of care emerge, machine-to-machine transmission of health data increases, more business intelligence tools to analyze health data are used, and the adoption rates for mobile health devices grows.

Published last month, the IDC Health Insights report, "U.S. Connected Health IT 2011 Top 10 Predictions: The Evolving IT Landscape for Payers and Providers," identifies several major trends that will impact the payer and provider IT landscape this year. Among the trends noted in the report are the emergence of new care and reimbursement models and the expanded use of wireless networks to transmit health information from personal monitoring devices.

-----

http://www.healthdatamanagement.com/news/survey-reform-ehr-physicians-41764-1.html

Survey: Docs Skeptical of EHRs, Hate Reform

HDM Breaking News, January 20, 2011

A recent survey of nearly 3,000 physicians shows high levels of displeasure with the Affordable Care Act--and a lot of them don't like electronic health records either.

Of the 2,958 physicians surveyed in September, only 39 percent believe EHRs will have a positive effect on the quality of patient care. Twenty-four percent believe EHRs will have a negative effect on quality, and 37 percent forecast a neutral factor.

HCPlexus, publisher of the The Little Blue Book reference guide for physicians, developed and conducted the survey with content vendor Thomson Reuters. The survey sample came from physicians in HCPlexus' database. The fax-based survey was done in September 2010, with additional information directly gathered via phone or e-mail from hundreds of the surveyed physicians in December and January.

-----

http://healthcareitnews.com/news/top-10-external-factors-ehr-success-hospitals

Top 10 external factors for EHR success in hospitals

January 18, 2011 | Molly Merrill, Associate Editor

FALLS CHURCH, VA – Meaningful use, improved patient care and competition among providers are a few of the reasons electronic health records are succeeding at hospitals, according to one expert.

David Lewis, principal at CSC Consulting, shared with Healthcare IT News his top 10 list of why EHRs are gaining more positive traction, based on what he's seeing from his hospital clients.

In November, Healthcare IT News also interviewed Karen Fuller, a principal with CSC's Health Delivery Group, who weighed in on her top 10 list of why EHRs are succeeding today. The difference between the two lists is that Fuller focused on internal factors that had an impact on EHR implementation, such as leadership and governance, whereas Lewis's list focuses on external factors, such as the government's meaningful use incentives.

-----

http://www.ama-assn.org/amednews/2011/01/17/bil20117.htm

EMR not boosting productivity? It could be a mismatch between system and specialty

A study highlights how technology doesn't guarantee results if the system isn't right for the practice.

By Pamela Lewis Dolan, amednews staff. Posted Jan. 17, 2011.

If it's been many months since you bought your electronic medical records system and you're still seeing fewer patients as you did before you got it, the problem might not be you -- it might be your EMR.

Specifically, it might be that the EMR you bought isn't designed or customized to work with your specialty -- a problem technology industry experts say could become more common and acute as practices rush to buy systems to gain federal financial incentives.

Researchers at the University of California at Davis studied how an EMR implementation at six primary care offices affiliated with the same academic medical center affected physician productivity levels. They found that after an initial dip in productivity during the training period -- which is normal -- internists were able to increase productivity above pre-EMR rates, while pediatricians and family physicians were never able to regain their pre-EMR productivity. Why? Because the EMR system more closely matched the work flow of the internists.

-----

http://www.fierceemr.com/story/accenture-contract-will-examine-emr-real-world-use/2011-01-20

Accenture contract will examine EMR real-world use

January 20, 2011 — 1:45pm ET | By Janice Simmons - Contributing Editor

Under a new contract, Accenture will be working with the Office of the National Coordinator for Health Information Technology to develop and manage real-world "use cases" that ONC will use to help in the exchange of data across the healthcare system.

The use cases will focus on patient‑related information--ensuring that care providers' certified EMR systems can handle patient requests for clinical summaries, according to the Reston, Va.-based consulting and technology services company.

-----

http://www.fierceemr.com/story/what-can-we-expect-stage-2/2011-01-20

What can we expect for Stage 2 of Meaningful Use?

January 20, 2011 — 9:24am ET | By Janice Simmons - Contributing Editor

Survey data released this month by the Office of the National Coordinator for Health Information Technology (ONC) showed promising figures in terms of adoption of electronic health records during the first stage to achieve meaningful use.

In survey data prepared by the American Hospital Association, 81 percent of hospitals said they plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of those hospitals (65 percent) responded that they will enroll during Stage 1 of the incentive programs during 2011-12.

-----

http://www.implementationscience.com/content/6/1/6

Why is it difficult to implement e-health initiatives? A qualitative study

Elizabeth Murray, Joanne Burns, Carl May, Tracy Finch, Catherine O'Donnell, Paul Wallace and Frances Mair

Implementation Science 2011, 6:6doi:10.1186/1748-5908-6-6

Published: 19 January 2011

Abstract (provisional)

Background

The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.

-----

http://www.healthdatamanagement.com/news/klas-clinical-decision-support-report-41759-1.html

KLAS Looks at Clinical Decision Support

HDM Breaking News, January 20, 2011

A new report from vendor research firm KLAS Enterprises examines provider use of clinical decision support software.

Many providers, according to the Orem, Utah-based firm, primarily are focusing on decision support requirements under Stage 1 of the electronic health records meaningful use program.

The report covers order sets, multi-parameter alerting, nursing care plans, reference content and drug information databases, along with non-EHR vendors providing such tools and content.

-----

http://www.healthdatamanagement.com/news/ehr-implementation-lessons-meaningful-use-41761-1.html

Lessons from EHR Pros

HDM Breaking News, January 20, 2011

Consultancy firm Accenture estimates nearly 90 percent of U.S. hospitals will have to install or upgrade electronic health records systems during the next three years to become meaningful users.

Consequently, Accenture recently conducted comprehensive interviews of 15 CIOs from delivery systems that have reached at least Stage 4 on the HIMSS Analytics' scale of EHR achievement to learn their lessons.

.....

For the full report on survey results, click here.

-----

http://www.modernhealthcare.com/article/20110119/blogs02/301199931

Security and identification

One baseline requirement to protect security in a health information exchange is to make sure the record being accessed belongs to the patient in question.

The Privacy & Security Tiger Team, a work group of the federally chartered Health Information Technology Policy Committee, spent a couple of hours Tuesday wrestling with some of the thornier issues of medical records matching.

Absent a national patient identifier, most health information exchanges in the U.S. use some form of probabilistic matching of a handful of data elements to link patients to their records across multiple repositories. Commonly, those data fields include first and last names, date of birth, ZIP code, street address and gender. Cell phone numbers are becoming increasingly useful; Social Security numbers are waning in importance.

-----

http://www.modernhealthcare.com/article/20110119/NEWS/301199937/

CCHIT launches custom-EHR certification

By Maureen McKinney

Posted: January 19, 2011 - 11:30 am ET

The Certification Commission for Health Information Technology has launched an alternative electronic health-record certification program crafted specifically for hospitals that have uncertified legacy software, customized systems or EHR systems developed in-house.

The EHR Alternative Certification for Hospitals, or EACH, will offer specialized assessment tools, online learning and preparation programs and support, according to a CCHIT news release.

-----

http://www.usatoday.com/yourlife/health/medical/2011-01-13-cesmedtech21_ST_N.htm

New technology can be the best medicine

By Mike Snider, USA TODAY

We all know that smartphones, tablet computers and big-screen TVs are transforming the workplace and home. But the newest gadgets could also be a tonic for medicine and health care.

Cellphones have already proven to be a potent medical instrument in improving patient outcomes. Diabetes patients who are sent videos on their cellphones and actually view them are more likely to check blood sugar levels and comply with their care regimens, said U.S. Army Col. Ron Poropatich, who spoke at the International Consumer Electronics Show in Las Vegas last week.

-----

http://www.google.com/hostednews/canadianpress/article/ALeqM5jmpLyPUPakElYi-PaZu7NjCL1p7Q?docId=5671464

Cancer survivor aims to raze treatment, research barriers with an app to enable collaboration

By Marcus Wohlsen (CP)

SAN FRANCISCO — In the late 1990s, Marty Tenenbaum was a hotshot e-commerce entrepreneur riding high on the dot-com boom when he noticed a lump on his body.

His doctor told him it was nothing, but when he finally had it removed, he learned he had melanoma, the deadliest form of skin cancer.

He beat the disease, but he never got over the sense of frustration he felt as he clawed his way through the maze of treatment options, clinical trials and research in search of a way to survive.

Now 67, Tenenbaum still believes he would not have made it if he hadn't had personal connections at the National Cancer Institute who guided him toward cutting-edge experimental treatments that saved his life.

-----

http://govhealthit.com/newsitem.aspx?nid=75973

ONC will simplify guides for establishing exchange standards

By Mary Mosquera

Tuesday, January 18, 2011

The Office of the National Coordinator for Health IT plans to develop a clearer set of technical descriptions for establishing the standard clinical document formats for exchanging summary information as patients move across settings of care.

ONC will also consolidate into a consistent template-based guide the advice offered by multiple organizations for implementing the standard document formats used to share data about patients’ medications and problems.

These are among the first projects that ONC has launched for its Standards & Interoperability Framework, which will tackle persistent challenges that healthcare providers face in successfully exchanging information in order to meet meaningful use requirements of electronic health records (EHRs), according to Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.

-----

http://www.chcf.org/publications/2010/03/ehr-deployment-techniques

Electronic Health Record Deployment Techniques

SA Kushinka of Full Circle Projects

• Chart Abstraction: EHR Deployment Techniques (134k)
• Clinical Documentation: EHR Deployment Techniques (147k)
• Training Strategies: EHR Deployment Techniques (522k)
• Workflow Analysis: EHR Deployment Techniques (559k)

January 2011

Starting in 2006, the California Networks for Electronic Health Record Adoption (CNEA) initiative has worked to speed adoption and lower the cost of electronic health records (EHRs) in California's community clinics and health centers. In August 2008, seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. In 2010, CHCF began publishing a series of tactically oriented issue briefs that highlight lessons learned since the initiative began.

The first issue brief in the series, Chart Abstraction: EHR Deployment Techniques, examines the process of entering or "populating" the electronic chart with clinical data from the paper record. This process entails an inevitable decrease in productivity due to disruption in workflow, user training, and the need to maintain both paper and electronic records during the transition period. Through clinical committees or other consensus building forums, CNEA grantees developed strategies that defined what information would be entered, when, and by whom - weighing the value of the information versus the cost of entering it. The clinics' experiences with these techniques and a discussion of pros and cons are included.

-----

http://www.cmio.net/index.php?option=com_articles&view=article&id=25885&division=cmio

JAMA: PHRs must be patient-centered to work

Written by Editorial Staff

January 18, 2011

Personal health records (PHRs) have great potential to help patients manage their health, but the technology must be designed with the patient in mind—which means doing more than helping patients merely access their health information, according to an editorial in the Jan.19 issue of the Journal of the American Medical Association.

In the editorial, Virginia Commonwealth University (VCU) family medicine physicians Alexander Krist, MD, associate professor in the department of family medicine in the VCU School of Medicine; and Steven Woolf, MD, professor in the department of family medicine and director of the VCU Center for Human Needs, describe a model to guide the creation of more patient-centered PHRs.

PHRs should include five key functions, according to the model:

• Collect and store information from the patient;
• Collect and store information from the patient’s doctor;
• Translate clinical information into lay language;
• Tell patients how to improve their health based on their personal information; and
• Make the information actionable for patients.

Using principles from their model, Krist and Woolf’s research team has created a patient-centered PHR for prevention which shows patients their medical information and tells them what it means in a way they can understand. Further, it guides them to the next action steps.

-----

http://www.fiercehealthit.com/story/ccds-help-upmc-coordinate-care-across-various-settings/2011-01-18

CCDs help UPMC coordinate care across various settings

January 18, 2011 — 10:07am ET | By Ken Terry - Contributing Editor

The continuity of care document (CCD), a standardized care summary designed for information exchange among different kinds of electronic medical records, has not been widely used up until now. But the University of Pittsburgh Medical Center is relying on CCDs to coordinate care as patients move through the system--which will help the hospital and its physicians in meeting requirements for Stages 2 and 3 of meaningful use.

When primary-care physicians in the community refer patients to specialists employed by UPMC, they're encouraged to send CCDs from their EMRs. When the consultants send the patients back, they transmit CCDs to update the doctors on what has happened with the patient. And as patients move from one care setting to another--whether it be the oncology department, the transplant program, or the emergency department--their CCDs go with them online.

-----

http://www.fiercehealthit.com/story/colorado-hie-efforts-spotlight-privacy-issues/2011-01-17

Colorado HIE efforts spotlight privacy issues

January 17, 2011 — 10:17pm ET | By Ken Terry - Contributing Editor

A recent Denver Post article about the Colorado health information exchange reveals the disconnect between the nationwide effort to connect health records online to improve patient care and safety and the continuing worries about the security of online medical records.

To those who follow this field, the most important fact in the piece is that the Colorado HIE--one of 56 state and territorial HIE initiatives that are in line to get federal grants--has already signed up 800 providers. But the major focus of the article was on the critics who say that HIEs will increase the already high risk of unauthorized individuals getting their hands on personal health information. Sure, that's a problem, and one that technology should be able to address. But at this point, what's critical is to get all the information silos connected.

-----

http://www.fiercehealthit.com/story/more-ramps-could-accelerate-provider-connectivity-hies/2011-01-18

More 'on-ramps' could accelerate provider connectivity to HIEs

January 18, 2011 — 10:34am ET | By Ken Terry - Contributing Editor

Considering that the federal government is pouring $563 million into the states to build health information exchanges, it's not surprising that some of the largest technology and telecommunications companies are moving into the business of electronic connectivity.

Hewlett Packard's just-announced foray into information exchange with the Texas Medicaid program is the latest in a barrage of announcements from tech giants within the past nine months.

Covisint, which provides the platform for the American Medical Association's physician portal, recently said that it's expanding its relationship with the Northeast Pennsylvania HIE. Covisint currently provides the exchange with secure clinical messaging. It now will deliver clinical and administrative data to providers at the point of care, as well.

-----

http://www.healthleadersmedia.com/print/TEC-261486/EHealth-Systems-For-Love-or-Money

E-Health Systems: For Love or Money?

Gienna Shaw, for HealthLeaders Media , January 18, 2011

Healthcare providers are marching toward certification and meaningful use of their electronic health systems and thinking about how they'll spend the financial rewards for doing so. But are they doing it for the love of e-health technology? Or are they doing it because the government is all but forcing them to?

A recent survey conducted by the HealthLeaders Media Intelligence Unit, E-Health Systems: Opportunities and Obstacles, suggests healthcare leaders are feeling positive that they'll meet meaningful use requirements. In fact, 91% said they will be ready by 2016 at the latest. And 41% said their systems are already certified by an approved ONC certifying body.

-----

http://www.healthdatamanagement.com/news/EHR-testing-HDM-Polytechnic-Institute-Health-Data-Tech-Labs-41750-1.html

HDM, University to Test EHRs

HDM Breaking News, January 18, 2011

The Polytechnic Institute of New York University and Health Data Management magazine have launched a new health care software testing facility.

Health Data Tech Labs (www.healthdatatechlabs.com) will provide physicians and hospitals with expert, independent reviews of electronic health records software. Reports evaluate installation and maintenance, system configuration, user training and "test drive" use-case scenarios. They also incorporate a unique self-evaluation process that enables professionals to match systems to their own specific requirements. The Tech Labs service will not certify EHRs as meeting meaningful use requirements. It is intended to help providers during the vendor selection process.

-----

http://www.themonitor.com/articles/medical-46277-recall-records.html

Medical records technology helps with drug recall

January 17, 2011 8:56 AM

Jared Janes

The Monitor

McALLEN — When the U.S. Food and Drug Administration issued a recall on the prescription painkiller Darvocet due to heart-related side effects, the use of medical technology saved Dr. Juan Salazar’s nurses countless hours trying to identify his patients on the drug.

Salazar implemented electronic medical records in his clinic on East Nolana Avenue some 14 months ago in advance of federal government guidelines that aim to put the nation’s health care providers on computerized records by 2015. So when the Darvocet recall was issued in late November, Salazar’s staff could use his clinic’s computerized database to quickly identify more than 50 patients on the prescription.

“We got on the computer, pulled data that showed all the patients we prescribed the Darvocet, and it gave us all their phone numbers” to notify them of the recall, Salazar said. “Without (electronic medical records), we would have to go manually through all of my paper charts, which would have been impossible. It would have taken several people and lots of manpower hours to do so.”

-----

http://www.publicintegrity.org/articles/entry/2813

Will Digital Technology Reduce Gap in Health Between Rich and Poor?

Experts Worry Low-Income Clinics Cannot Afford Electronic Health Records

By Emma Schwartz | January 11, 2011

Two years ago, the Ethio American Health Center opened its doors in the nation’s capital, promising the country’s largest community of Ethiopian immigrants a place where doctors spoke their language and understood their culture.

Many of the community’s poorest quickly flocked to the center. But for all the specialized services the center offers patients, there’s one area where it’s fallen short: moving from paper files to electronic health records. They don’t even have a website.

“It would be great, but we can’t afford it,” said Dawit Gizaw, the center’s administrator.

The center is not alone. Although the federal government is directing billions of dollars in economic stimulus money to get electronic health record technology into hospitals and clinics nationwide, some doctors and small clinics indicate they’re unlikely to meet the Obama administration’s goal of going digital in the next five years.

-----

http://govhealthit.com/newsitem.aspx?nid=75907

ONC will focus on interoperability in 2011

By Mary Mosquera

Thursday, January 13, 2011

The Office of the National Coordinator for Health IT will focus in 2011 on activities that will enable healthcare providers to perform complex exchanges of information and on the technical foundation to support secure sharing.

ONC is considering a set of tasks it needs to undertake “in short order” to make it possible for stage 2 of meaningful use to have a more robust exchange of information, said Dr. David Blumenthal, national health IT coordinator, at the Jan. 12 meeting of the advisory Health IT Standards Committee.

Those activities are centered around standards and certification criteria, privacy and security protections, governance of exchange, and the assurance that the public will need that organizations involved in exchanging information have accomplished the conditions that foster trust and interoperability, he said.

-----

http://blogs.computerworlduk.com/the-tony-collins-blog/2011/01/dont-sign-nhs-it-deals-with-csc-or-bt-for-now-mp-warns-health-cio/

MP warns Health CIO: don't sign NHS IT deals with CSC or BT for now

A 2.7bn NHS deal with CSC is imminent – but an MP on the Public Accounts Committee says that signing a deal now could breach civil service responsibilities.

Published 13:40, 17 January 11

Richard Bacon MP, a long-standing member of the Public Accounts Committee, says in his letter, dated 13 January 2011, to Christine Connelly, the CIO at the Department of Health,

“As you know, the National Audit Office is now beginning a further urgent inquiry into developments in the NPfIT, and in particular of the awarding of former Fujitsu sites to BT.

"I would suggest that this inquiry will review a great deal of evidence that is relevant to the question of whether proposed contract renegotiations with BT and CSC really do represent good value to the NHS and taxpayers.

-----

Enjoy!

David.

The International Telecommunications Union Issues A Status Report on E-Health Standards.

An interesting summary report from the ITU appeared a little while ago. The report is titled:

Standards and eHealth

ITU‐T Technology Watch Report January 2011

The full report can be downloaded from here:

http://www.itu.int/dms_pub/itu-t/oth/23/01/T23010000120001PDFE.pdf

V. Conclusion: Standards and eHealth

eHealth standardization is inherently a complicated area. eHealth systems have to connect many stakeholders ‐ hospitals, pharmacies, primary care physicians, patients in their homes, and administrative entities such as insurance companies or government agencies. Each of these entities has an enormous installed base of technologies, information systems, and medical devices, often based upon proprietary specifications. Electronically integrating these entities will be a great challenge for technical standardization. A second requirement complicating the standards landscape for eHealth is the inherently sensitive nature of the information, requiring a high degree of privacy protections, quality assurance, and security. The health sector is also heavily regulated by national authorities. New technologies can present a risk of not meeting those regulations. Furthermore, health practitioners can be inherently risk adverse and reluctant to adopt new technologies.

As described above, many eHealth standards initiatives exist but many questions remain about whether some of these initiatives are in competition or conflict; whether standards will be adequately implemented by health care providers; and whether there will be interoperability among various efforts. There are also different approaches to eHealth standardization in different countries and regions, a condition which will may impinge upon the efficacy of eHealth standards efforts and complicate standards adoption policies of device and systems manufacturers that sell globally.

There is no question that eHealth is in a period of rapid technical, economic, and social transition. In the foreseeable future, common digital formats and structures have the potential to allow for the exchange of integrated patient information among all of the patient’s medical providers. Multimedia and messaging standards can continue to improve remote clinical care, remote patient monitoring, and remote diagnostics. Beyond remote access, it can also facilitate exchange of information and collaboration among various health practitioners, as well as portability of results to be shared, for example, at a later date by the patient with another practitioner. Anonymized and aggregated public health data stored in common, digital formats can improve medical research and digitally stored genetic data can provide more customized medical care to patients. Universal standardization, whether driven through private industry collaborations or through government standards policies, is a necessary precursor for any of these eHealth advancements. There are three reasons for this:

Technical Interoperability: eHealth applications such as remote diagnostic systems and electronic medical records will only be successful if there is a high degree of interoperability among the institutional systems exchanging this information, and a high degree of compatibility among medical devices and digital systems, regardless of manufacturer;

Economic Efficiency: Medical providers and public entities will invest in costly eHealth solutions only if assured that the systems will have some longevity into the future rather than becoming quickly deprecatedbecause of the introduction of yet more eHealth standards options. Globally (or at least regionally/ nationally) agreed‐upon standards can provide the necessary stability to economically incentivize new investments and, if openly available rather than proprietary, can help foster economic competition among compatible eHealth systems and equipment made by different manufacturers or systems developers.

Public Accountability: To an even greater extent than most types of technical standards, the design decisions underlying eHealth standards will have public interest effects in areas such as individual privacy, nondiscriminatory access to healthcare, and the overall public good. These decisions should be made with some type of global public accountability, whether developed in a multistakeholder fashion or at least openly available to the public for oversight.

----- End Conclusions

The report is worth a read as it does explain a good number of the issues and makes clear the complexity that is faced by all involved.

David.

Some Don’t Miss Comments on the PCEHR Post. These Are The Best Ever!

As I note the commenters on this post are trying to do me out of a job!

Click here and get the real lowdown on how things are working and why the PCEHR project is a disaster waiting to happen.

http://aushealthit.blogspot.com/2011/01/pcehr-seems-to-be-still-lacking-real.html#comments

To those providing the input - thanks and keep it coming!

Enjoy (and quietly cry into your beer)!

David.

The PCEHR Seems To Be Still Lacking Real Detail! There is Still No Evidence That DoHA / NEHTA Know What They Are Doing.

The following report of a briefing held last week appeared today.

Bidders seek details on $467m personally controlled e-health record project

• Karen Dearne
• From: Australian IT
• January 26, 2011 1:02PM

POTENTIAL candidates for the job of keeping the $467 million nationwide electronic patient records rollout on track want greater clarity on the sprawling work program.

The Gillard government is seeking a private partner to build an analytical and evaluation framework to monitor and measure progress of the personally controlled e-health record (PCEHR) as it is introduced over the next 18 months.

But bidders have asked for a list or directory of relevant activities being undertaken by the National E-Health Transition Authority to assess the scope of job ahead.

"It seems there are a whole lot of websites all over the place, but no-one’s actually got it all together," one asked Health in a series of questions and answers released yesterday to registered bidders. "Is that part of the tender?"

Another says there appears to be "many health providers, government departments and other organisations that NEHTA has been involved with, either peripherally or centrally. Is there a list that will enable the successful tenderer to properly evaluate and monitor it?"

In response, the Health department said it does not expect tenderers to have a "line by line" understanding of NEHTA’s program at present.

Bidders also questioned whether there was any other system on the same scale as the PCEHR in existence. Health replied: "There is no single solution in place that meets all of the requirements and specifications of the PCEHR program."

"(But) every single component of the PCEHR has been implemented successfully somewhere in the world. So the system components do exist.

"Some PCEHR infrastructure components have already been implemented in Australia, while others have been implemented overseas."

Health acting deputy secretary Megan Morris told an industry briefing last week the PCEHR would provide summaries of patient health information including medications, immunisation and test results over the internet via secure access.

"The government has adopted a combined approach of ‘top down’ initiatives and ‘bottom up’ lead implementation sites," she said. "We will create a national framework to guide development and impose uniform standards, including a national privacy regime and change and adoption framework.

More here:

http://www.theaustralian.com.au/australian-it/government/bidders-seek-details-on-467m-personally-controlled-e-health-record-project/story-fn4htb9o-1225994842659

You can visit the site and see the presentations here:

PCEHR Industry Briefing

On Monday, 17 January 2011 the eHealth Systems Branch, Primary and Ambulatory Care Division of the Commonwealth Department of Health and Ageing held an industry briefing in Canberra. The purpose of the briefing was to provide further information and clarification regarding the Request for Tender (RFT) for a Benefits and Evaluation Partner for the Personally Controlled Electronic Health Record (PCEHR) Program.

Informative presentations were given and attendees’ questions were answered by representatives of the Department of Health and Ageing and the National eHealth Transition Authority (NEHTA) regarding the requirements of the RFT, and the wider PCEHR Program. These are available below for download.

PCEHR System Overview - Speech Notes (PDF 39 KB)

PCEHR System Overview - Slides (PDF 870 KB)

PCEHR Work Program - Slides (PDF 3443 KB)

BEP Scope of Services and Tender Submission Requirements - Speech Notes (PDF 49 KB)

BEP Scope of Services and Tender Submission Requirements - Slides (PDF 231 KB)

Questions and Answers (PDF 18 KB)

Here is the URL:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pcehr-industry-briefing

The Q & A Session was very revealing:

Question: Does a list or directory of NEHTA’s PCEHR Program activities exist? From looking at the website, it seems as though there are a whole lot of websites all over the place, but no one’s actually got it all together, and is that part of the tender?

Answer:

The Department does not expect that tenderers will have a line-by-line understanding of the program of work that’s being undertaken within NEHTA at present. The core documentation associated with the PCEHR Program has been made available to tenderers, and will be sufficient to enable the Department to undertake an appropriate capability assessment of tenders. Other documents that may be relevant have been identified by the Department and will be made available to the successful tenderer.

Question: There appear to be many health providers, government departments, and other organisations that NEHTA has been involved with either peripherally or centrally. Is there a list or directory of all of this activity that will enable the successful tenderer to properly evaluate and monitor it?

Answer:

The evaluation only refers to the eHealth sites and the build and rollout of the PCEHR Program. Wider health reform is a broader program, which is being managed by the Department of Health and Ageing on behalf of the Australian government. The PCEHR Program is only one stream of work within broader health reform. I provided details regarding NEHTA’s broader range of health activities and business blueprint in my earlier presentation and slides. The Draft Concept of Operations for the PCEHR Program is available to tenderers.

Question: You mentioned that the evaluation of tenders for the second wave of eHealth sites is underway. When do you expect that the evaluation process will be completed, and when will we receive information about the size and location of those sites?

Answer:

The applications for second wave eHealth sites closed shortly before Christmas, and the evaluation of applications is still underway. The Department is endeavouring to have a short list finalised within the next few weeks.

Question: As part of the services of the Benefits and Evaluation Partner, will the Department be requiring any capability transfer back to NEHTA or the Department, and by June 2012 from the tenderer back to the Department? Also, are there any conflict of interest restrictions on subcontractors, or any other organisation that may wish to tender for other PCEHR Program work?

Answer:

Yes, the Department expects that the Benefits and Evaluation Partner’s capability will be easily transferable to the Department, NEHTA, and other PCEHR Program partners. There is nothing that would prevent an organisation from tendering for other PCEHR Program work. However, please note that the RFT for the Benefits and Evaluation Partner states that “the Department may, at its sole discretion, exclude a Tender from further consideration, where it considers that a material conflict of interest or potential material conflict of interest would exist if the Tenderer was successful in being awarded a contract” (see Part B, page B24, clause 8.12.2 of the RFT).

Question: Is there any other system or solution that is of the same scale as the PCEHR system?

Answer:

There is no single solution in place that meets all of the requirements and specifications of the PCEHR Program.

Answer:

Every single component of the PCEHR system has been implemented successfully somewhere in the world. So the system components do exist. Some PCEHR system infrastructure components have already been implemented in Australia, while others have been implemented overseas.

Question: In the RFT, it is stated that the successful tenderer will “where possible, consider state and territory eHealth activity which is of relevance to the PCEHR Program” (Part B, page B10, clause 5.2.2(d)). What does the Department mean by “where possible”? Does this mean that the jurisdictions may not provide the PCEHR system with full access to necessary medical information and eHealth summaries?

Answer:

The jurisdictions have been heavily involved with the Department throughout the PCEHR Program, and are a key party to the governance arrangements. It is expected that this level of engagement will continue throughout the build and rollout of the PCEHR Program.

Answer:

State jurisdictions need to make significant investments to enable the PCEHR Program to work. State jurisdictions are developing similar business cases and are allocating funding to their acute sector programs. These acute sector programs will establish links to the PCEHR system.

---- End Q & A.

My view is that all this leaves way more unanswered that actually addressed and I still have the sense the no-one at DoHA or NEHTA actually knows what they are doing. These slides and briefing go no way to assure me anything I wrote here is at all wrong:

http://aushealthit.blogspot.com/2011/01/clinician-controlled-electronic.html

If they were confident they had substantial and credible answers then we would have the PCEHR Concept of Operations available for review and discussion. Until that is released we know that DoHA and NEHTA are as much in the dark as they are keeping the rest of us.

At present all I can see that is going to be delivered by 2012 are a range of incoherent pilots which will take the rest of the decade to be properly delivered so as to provide any value to either providers or consumers.

David.

Where To Next for the Victorian HealthSMART Program? A Major Clinician Guided Mid-Course Review is Vital!

This program has suddenly got itself into the news.

Yesterday we had this:

Health myki faces axe

Kate Hagan

January 24, 2011

THE state government is considering abandoning Victoria's trouble-plagued $360 million health technology program, with Health Minister David Davis admitting he faces ''a genuine dilemma with 'the myki of the health system' ''.

The HealthSMART program - five years late and $35 million over budget - is supposed to link computer systems in hospitals and introduce processes such as electronic prescribing.

But clinical applications are only partially running in just four hospitals, and doctors say patient safety is compromised by inadequate procedures that causes them to duplicate paperwork, chase test results and compete for access to computer terminals.

In a state budget submission, the Australian Medical Association has called for a further $328 million to be invested on health technology over the next four years, with a focus on providing ready access to patient records, test results and medication details.

AMA Victoria president Harry Hemley said health technology in Victoria bordered on the embarrassing, and ''patients would be appalled at the lack of IT, computers and connectivity between different areas of the health system''.

Mr Davis said the HealthSMART program, launched by the former Labor government in 2003, had been ''botched in its introduction'' and was tens of millions of dollars over budget without achieving its stated aims.

''The new government faces a genuine dilemma with the myki of the health system,'' he said. ''On the one side we have large sunk costs, and on the other a system that has failed to meet expectations.''

Mr Davis said technology was ''a critical part of improving the performance and quality of our health system'', and the AMA's submission would be considered as part of the budget process.

Dr Hemley said many promises had been made about HealthSMART's ability to revolutionise technology in hospitals, but the project had been bitterly disappointing despite hundreds of millions of dollars in investment.

''HealthSMART still has potential to deliver a vastly superior health IT system but it needs to be seen as an ongoing investment,'' he said.

More here:

http://www.theage.com.au/victoria/health-myki-faces-axe-20110123-1a17g.html

and here:

Health IT program Healthsmart faces the axe

• Jessica Craven
• From: Herald Sun
• January 24, 2011 12:43AM

THE future of a $360 million program designed to improve care in Victorian hospitals is under a cloud.

The Australian Medical Association has called for an additional $260 million to be invested in the botched HealthSMART program, which is five years late and $35 million over budget.

More here:

http://www.heraldsun.com.au/news/health-it-program-faces-the-axe/story-e6frf7jo-1225993351106

This was followed by these today:

System is sick, not dead

Dr Harry Hemley

January 25, 2011

FOR those unfamiliar with computer systems in Victoria's public hospitals, you would probably have to cast your mind back to the early 1990s to realise just how poor the information technology networks are in our supposedly world-class health program.

We're talking paper-based records, people queuing to use the available computer terminals and the difficulty sharing information with off-site colleagues. For patients in our public hospitals, the ramifications of poor IT systems are serious.

The problem starts from the time a person is treated in the emergency department and doctors and nurses aren't able to get access to the person's history of care with their general practitioner.

In the absence of a central health database that stores the history of patients' illnesses, treatments and medications, medical staff have to piece together this information from the patient's own memory in a process that requires trial and error.

On a good day, the patient will have a list of their medications and illnesses but typically their memory extends more to the colour of the tablet and a vague recollection that the name of the drug begins with an N.

Once the patient is admitted, staff on the wards have to queue to use a computer so they can access the patient's hospital records and diagnostic information. When staff are finally able to get on a computer, the system is slow and clunky and crashes all too common.

The lack of connectivity between different areas of the health system means medication lists, tests, scans and other diagnostic tools are often repeated. Health dollars and clinicians' time are wasted chasing results and duplicating services in an already stretched public hospital system.

The quality of care is compromised and patients are at increased risk of mistakes being made in their treatment, diagnosis and prescription of medication.

More here:

http://www.theage.com.au/opinion/politics/system-is-sick-not-dead-20110124-1a2y4.html

and this:

'Too late' to kill e-health program

Kate Hagan

January 25, 2011

THE state government should stick with Victoria's bungled $360 million health technology program because it was finally starting to deliver some benefits, an e-health expert has argued.

Mukesh Haikerwal, who is the federal government's clinical advisor on e-health, said the HealthSMART program had ''a long tortuous history'' but cost savings would not be made by ditching it, only to start again from scratch to build an electronic system to share patient information in hospitals.

The Age revealed yesterday that the state government was considering abandoning the program, which is five years late and $35 million over budget.

Health Minister David Davis said the new government faced ''a genuine dilemma with the myki of the health system''.

HealthSMART, originally due to be completed in 2007, replaced existing financial management systems in hospitals. It was also supposed to introduce clinical systems for electronic prescribing, ordering tests and reporting results to Victorian hospitals, but those programs are now partially running in just four hospitals.

More here:

http://www.theage.com.au/victoria/too-late-to-kill-ehealth-program-20110124-1a2w2.html

There is also coverage today in the AFR and a few other places.

For those that are interested I have been on this case for a while now:

See here:

http://aushealthit.blogspot.com/2010/06/despite-some-successes-healthsmart-in.html

and as far back as here:

http://aushealthit.blogspot.com/2008/04/healthsmart-pretty-bad-report-card.html

and here:

http://aushealthit.blogspot.com/2007/06/is-healthsmart-as-smart-as-it-claims.html

There are a few facts that need to be clear:

First the program is way behind time and over budget.

Second it seems that there has been pretty intense resistance to many clinical applications from the clinicians who are expected to use the software.

Third if the program is to continue as it is presently planned there are a few years to go before key clinical functionality will be universally available - and remember this was the key goal.

Fourth non HealthSMART initiatives like PACS have gone pretty well as have a range of administrative and basic operational systems.

The bottom line is that all this should not be thrown out - that would be nonsense. What is needed is a clinician focussed in-depth review to establish what is needed to obtain genuine clinician commitment to adoption and use of what is presently on offer for clinicians - with the live option of starting again - with another vendor - in this domain if the present vendor cannot demonstrate they can deliver what clinicians believe they actually need.

This review needs to be externally facilitated, independent and not controlled by the Program in any way. Clinicians need to know their needs are understood and will be answered.

Indeed they need to know they can veto the whole clinical program, by some reasonable democratic process, unless their legitimate needs are actually addressed.

If this is not done - and fast - the entire fiasco will collapse and lead to much increased cost and time wasting. Having come this far and spent this much it is vital that whatever is needed is done to sort out the area of the program where most of the benefits will ultimately flow from!

I note that even after 1 day it is clear this weeks poll is going to say that right now the Program is a total mess!

The national implications for e-Health also should not be ignored, as they are pretty substantial.

David.

Weekly Australian Health IT Links – 24 January, 2011.

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:

I have to say I think the best thing was the discussion that followed the bog on the excellent article on the state of the Health IT software industry last Tuesday from Karen Dearne in the Australian.

See here for the link and to read the comments - currently 27 of them.

http://aushealthit.blogspot.com/2011/01/causes-of-this-mess-are-pretty-clear-in.html

It was also good to note that NEHTA was sufficiently connected to the rest of the world to note the debate that had been triggered by the PCAST report on just how health information should be managed and secured.

I first covered this report in mid-December, 2010 and you can read that coverage here:

http://aushealthit.blogspot.com/2010/12/is-this-really-major-change-for-health.html

It is fair to say that a lot of discussion has indeed followed and that the Office of the National Co-ordinator for Health IT is now conducting formal consultations on the report.

See here:

http://www.modernhealthcare.com/article/20110110/NEWS/110119997/

Deadline for comment have also been extended so I think this is being taken pretty seriously - as one might imagine a Presidential Commission report would be!

I suspect I will have a few comments on the news that the Victorian HealthSmart Project might be canned tomorrow.

See here:

http://www.theage.com.au/victoria/health-myki-faces-axe-20110123-1a17g.html

-----

http://www.theaustralian.com.au/australian-it/record-system-is-back-on-track-defence/story-e6frgakx-1225989788681

Record system is back on track: Defence

• Karen Dearne
• From: The Australian
• January 18, 2011 12:00AM

DEFENCE has kick-started its overdue e-health record system for armed forces personnel, awarding a $6.1 million three-year project management contract to consultant and IT services provider Oakton.

DEFENCE has kick-started its overdue e-health record system for armed forces personnel, awarding a $6.1 million three-year project management contract to consultant and IT services provider Oakton.

The successor to HealthKeys, sidelined in 2009 after years of work with only 40 per cent of medical files converted from paper, was to be a commercial off-the-shelf system.

-----

http://www.theaustralian.com.au/australian-it/electronic-health-market-value-proves-unclear/story-e6frgakx-1225989800859

Electronic health market value proves unclear

• Karen Dearne
• From: The Australian
• January 18, 2011 12:00AM

THE Gillard government's personally controlled e-health records and telehealth incentives are expected to be hotspots for health IT this year.

But potential market size and speed of uptake are still uncertain.

IDC Australia senior market analyst Emilie Ditton is re-examining the prospects, after the research firm forecast in the middle of last year that the local health technology market would reach $2.4 billion this year.

"The government has committed to spending $467m on an electronic medical records system by 2012," Ms Ditton said.

"A number of vendors I have spoken to have identified this as an area of opportunity for them," Ms Ditton added.

-----

http://www.theaustralian.com.au/australian-it/poor-prognosis-for-medical-software-sector/story-e6frgakx-1225989797345

Poor prognosis for medical software sector

• Karen Dearne
• From: The Australian
• January 18, 2011 12:00AM

THE medical software sector hit the wall last year, with large and small players that had geared for expansion hit by a triple whammy.

Long-anticipated e-health projects did not materialise, the global financial crisis had people scrimping every last penny, and currency exchange losses added insult to injury (see table).

Medical Software Industry Association president Geoffrey Sayer said it had been a tough period for the sector.

"The outlook for e-health in 2011 is challenging for everyone, to say the least," he said. If we are to be successful, we will need to establish a transparent leadership partnership between all stakeholders that delivers tangible and measurable benefits."

Australia's largest health IT company, iSoft, crashed hard, but it was by no means the only local firm to bleed red ink in a year that also brought a retreat from the sector.

-----

http://www.smh.com.au/digital-life/games/gamer-danger-kinect-xbox-injury-alert-20110118-19umx.html

Gamer danger: Kinect Xbox injury alert

Louisa Hearn

January 18, 2011 - 2:13PM

It has inspired a legion of gamers to abandon joysticks and couches in favour of jumping and gyrating their way around the lounge room, but doctors warn that Microsoft's Kinect controller may spell the start of a new generation of gaming injuries.

Collisions, sprains, ruptured ligaments and even broken bones now seem as likely to occur in the home as on the sports field for the 8 million people who have bought the new Kinect Xbox 360 controller since its release late last year.

Physical injuries first became associated with computer gaming after the release of Nintendo's Wii motion sensitive controller, which revolutionised game play and, wisely, the Wii remote was always sold with a rubber outer designed to limit the damage from contact with home furnishings and other players.

Now Kinect has dispensed with a controller altogether, replacing it with motion tracking technology, and freeing up gamers' movements completely. With the accompanying release of action-oriented games such as Dance Central and Kinect Sports, the injury count appears to be mounting.

-----

http://delimiter.com.au/2011/01/19/health-departments-shun-official-ipad-trials/

Health departments shun official iPad trials

Consumers love it. Business professionals in a wide range of fields love it. Politicians (hello, Mr Turnbull) love it. Even babies love it. And increasingly, doctors and other medical professionals love it. But six months after the iPad launched in Australia and with the hyped Apple tablet selling like hotcakes, Australia’s health departments don’t yet appear to be that interested in the device.

In separate statements issued over the past week, the health departments of most of Australia’s largest states have made it clear they have so far shunned official trials of the device in medical facilities round the nation.

The Northern Territory, New South Wales and South Australia health departments have no formal proposal for clinical use of the device. Even Victoria — where former Premier, John Brumby, had promised to deliver an iPad to each Victorian public hospital doctor if re-elected, and where 500 devices were already handed over — seems to be far from considering an official trial in the healthcare field.

-----

http://www.seek.com.au/Job/stakeholder-engagement-analyst/in/sydney-cbd-inner-west-eastern-suburbs/18925060

Stakeholder Engagement Analyst

• CBD location, some interstate travel
• Internal & external stakeholder management

Do you want to improve the health of the nation?

Do you want to be part of the largest national e-health transformation project in Australia, the Personally Controlled Electronic Health Record (PCEHR)?

NEHTA is currently recruiting people with a desire to make a difference to health outcomes, that are passionate about the use of ehealth to meet these goals and who have the relevant experience to deliver solutions in a highly complex stakeholder and technical environment. In these roles you will be working with consumers and clinicians who will be defining how models of care can be improved using the PCEHR. You will be delivering the solutions that will be in place for your grandparents, parents and your children... and for you as you engage with the public and private health system.

This is an exciting opportunity for an engagement professional with a proven track record of effective engagement with internal and external stakeholders.

-----

http://www.zdnet.com.au/health-appoints-new-cio-339307430.htm

Health appoints new CIO

By Josh Taylor, ZDNet.com.au on November 22nd, 2010

The Department of Health and Ageing has announced the appointment of former Australian Taxation Office business solutions manager Paul Madden as its new chief information and knowledge officer.

The appointment was announced by department secretary Jane Halton in an email to staff on Friday.

"I am pleased to announce the outcome of the recent Chief Information and Knowledge Officer … recruitment process. As a result of this process, Mr Paul Madden has been promoted to this position," Halton said in the email provided to ZDNet Australia.

-----

http://www.zdnet.com.au/healthscope-looks-for-growth-focused-cio-339308619.htm

Healthscope looks for growth-focused CIO

By Suzanne Tindal, ZDNet.com.au on January 17th, 2011

Healthscope is on the lookout for a new chief information officer, advertising for an executive with at least 15 years IT experience to take the reins of its technology.

The employer of 18,000 staff is currently undergoing rapid growth, according to the advertisements on MyCareer and Seek, with the new CIO to be tasked with overseeing growth in the IT division.

According to a more detailed position description on Healthscope's website, the CIO will be directing a unit with around 60 staff and a budget of $25 million annually.

The department services 45 Healthscope-owned hospital facilities and three facilities managed for the Adelaide healthcare alliance. Healthscope also has an international pathology business comprising of 60 laboratories in Australia, New Zealand, Singapore and Malaysia.

-----

http://www.theaustralian.com.au/australian-it/electronic-health-market-value-proves-unclear/story-e6frgakx-1225989800859

Consultant fills in key role in e-health pilot

• Karen Dearne
• From: The Australian
• January 18, 2011 12:00AM

BUREAUCRAT turned private consultant Anthony Honeyman is overseeing the federal Health Department's handling of more than 90 proposals for grants under the $55 million e-health pilot fund.

A partner of government consultancy specialist Apis Group, Mr Honeyman is filling in for e-health systems branch head Sharon McCarter this month.

Apis won a $1.4m select tender to provide project management services to Health for the personally controlled e-health record (PCEHR) initiative for six months to June 30.

-----

http://www.theaustralian.com.au/news/health-science/web-of-services-helps-battle-the-blues-depression/story-e6frg8y6-1225991969173

Web of services helps battle the blues: depression

* Paul Christensen

* From: The Australian

* January 22, 2011 12:00AM

FROM online men's sheds and iPads to data mining for diagnosis, the national depression initiative beyondblue has seen it all since it was established a little more than 10 years ago.

"It's been a wonderful journey," recalls beyondblue's chairman, former Victorian premier and Hawthorn Football Club president Jeff Kennett. "I never expected it to be a period of enlightenment for me, but it's certainly been that."

For Kennett, that means enlightenment about human nature above all: "There have been some sad stories, there have also been a lot of good stories."

The initiative originally was envisioned as a five-year project, but Kennett believes that what kept it going is a willingness to embrace new forms of communication, such as the Shed Online, an electronic version of the men's shed movement.

-----

http://www.computerworld.com.au/article/373575/tasmanian_department_health_ditches_paper_goes_digital/?eid=-6787&uid=25465

Tasmanian Department of Health ditches paper, goes digital

Over 60,000 patient records to be converted

• Hamish Barwick (Computerworld)
• 17 January, 2011 12:38

As part of its goal to introduce electronic health records, The Tasmanian Department of Health and Human Services is to shortly convert 60,000 paper based records into a digital format.

The records, which are held at North West Regional Hospital and Mersey Community Hospital in Tasmania, will be scanned and put into the North West Area Health Services digital records system. An additional 140,000 records will be digitised in the future.

North West Regional Hospital currently uses a paper-based patient record system that is managed electronically by a software system called iPatient Manager (iPM). This is used state-wide as the Department’s Patient Administration System (PAS). iPM will still be used once patient records are scanned.

-----

http://ehealthspace.org/news/obama-ehealth-report-ignites-controversy

Obama ehealth report ignites controversy

Posted Thu, 20/01/2011 - 15:37 by Josh Gliddon

A report issued to US president Barack Obama on health information standards has caused controversy in health informatics circles.

Written by the President’s Council of Advisors on Science and Technology, the report calls for a single universal standard for the electronic exchange of health information within the US. It also calls for a national infrastructure to facilitate the creation of the standard.

“It is a controversial report,” said NEHTA chief architect Andy Bond. “It is very broad in its coverage, and is based on a presumption that you can create XML to create the building blocks of a universal exchange language. It’s a nirvana vision, and it disregards the fact that people have been working in this area for the last two decades.”

The President’s Council of Advisors on Science and Technology has a glittering membership, including Craig Mundie, chief research and strategy officer at Microsoft, and Eric Schmidt, chairman and chief executive of Google.

-----

http://www.mjainsight.com.au/view?post=juanita-fernando-privacy-lags-as-e-health-rolls-out&post_id=1414&cat=comment

Juanita Fernando: Privacy lags as e-health rolls out

CONCERNS about e-health privacy are growing around the world.

Most recently, the British Medical Association Scotland called for stronger measures to protect patient confidentiality, particularly with the way patient information can be shared between medical users.

The Australian Privacy Foundation (APF) has highlighted similar concerns about the situation in Australia.

Empirical research findings show clinical end-users frequently covertly share credentials such as user names and passwords so they can share health data.

This may occur because the clinician who has the necessary password access to health data is absent or a particular system has not been used for a while and their password has expired.

-----

http://www.businessspectator.com.au/bs.nsf/Article/Vodafone-security-still-vulnerable-report-pd20110116-D648Y?OpenDocument

Vodafone security still vulnerable: report

Published 2:47 PM, 16 Jan 2011

Telecommunications provider Vodafone has moved to urgently overhaul its security systems, with a series of breaches leading the firm to order daily password changes and scrap shared access logons, according to a Fairfax Media report.

Last week, Vodafone staff in New South Wales were fired for hacking into databases to illegally access customer information, leading to NSW police being called in.

The company has launched an investigation to determine whether any of its employees sold customer database passwords to criminals.

-----

http://www.theaustralian.com.au/national-affairs/julia-gillard-backs-foi-exemption-for-taxpayer-funded-nbn/story-fn59niix-1225990173260

Julia Gillard backs FOI exemption for taxpayer-funded NBN

• James Massola
• From: The Australian
• January 18, 2011 10:17AM

JULIA Gillard is standing by an exemption from freedom of information laws for NBN Co - the publicly-owned company building Australia's biggest infrastructure project.

As an incorporated company, NBN Co will avoid FOI scrutiny, unlike Australia Post, the ABC, SBS and Telstra before it was privatised.

The Prime Minister today confirmed the public would not get access to information held by the company rolling out the $36 billion National Broadband Network.

“My understanding is that this is the ordinary operation of the Freedom of Information Act; that a body like NBN Co would not be subject to it,” Ms Gillard said.

-----

http://www.theaustralian.com.au/australian-it/vint-cerfs-message-to-australia-internet-censorship-isnt-effective/story-e6frgakx-1225992330849

Vint Cerf's message to Australia: internet censorship isn't effective

• UPDATED Fran Foo
• From: Australian IT
• January 21, 2011 7:38PM

JULIA Gillard's bid to censor the internet is not an "effective move", says Vint Cerf, one of the founding fathers of the internet and Google's chief web evangelist.

Dr Cerf's advice is to attack the source of a problem at the production layer, instead of focusing on the distribution layer.

The federal government wants to force every ISP to filter websites rated with a refused classification tag, in accordance with a secret government blacklist.

-----

http://www.theaustralian.com.au/australian-it/exec-tech/your-bonsai-corporate-data-centre-network-attached-storage-devices/story-e6frgazf-1225989743852

Your bonsai corporate data centre: network attached storage devices

• EXECTECH: Ian Grayson
• From: The Australian
• January 18, 2011 12:00AM

NETWORK attached storage boxes are finding their way into growing numbers of homes and small businesses.

Essentially a box filled with hard drives, a NAS device provides the centralised, secure storage that's becoming increasingly necessary in today's digital world. With gigabytes of data stored in everything from notebook PCs and tablets to mobile phones and cameras, managing it all has become a challenge.

In large organisations, such management is the responsibility of the IT department, but in smaller businesses and the home, it often rests with the resident techie. Charged with keeping track of everything from files and documents to photos and video, they find themselves searching for a straightforward way to keep everything in order.

-----

Enjoy!

David.

AusHealthIT Poll Number 54 – Results – 24 January, 2011.

The question was:

Will Australians Get Value for Money for the $55 Million to Be Spent on the PCEHR Wave 2 Projects?

The answers were as follows:

For Sure

- 3 (10%)

Possibly

- 6 (21%)

Neutral / Don't Know

- 1 (3%)

Probably Not

- 8 (28%)

It Will Be A Waste of Money

- 10 (35%)

Votes: 28

Well that is pretty clear cut! Only 10% of respondents are confident we will see value for money on the Wave 2 Projects! I reckon a rethink is needed!

Again, many thanks to those that voted!

David.

Here is Another Study That Will Stir Some Debate! Take it From Me it Is Essentially Useless Rubbish - But I Would Say That Wouldn’t I?

The following article appeared in the Health Section of the Saturday Australian on Saturday.

Experts challenge e-health critique: researchers suggests they may not be worth the money

• Leigh Dayton, Science writers
• From: The Australian
• January 22, 2011 12:00AM

DESPITE widespread support for electronic patient records, electronic prescribing and other e-health technologies, a global review by British researchers suggests they may not be worth the money.

Specifically, a team led by physician and epidemiologist Aziz Sheikh with Edinburgh University reported this week in the journal PLoS Medicine that evidence supporting the benefits of e-health technologies is weak and inconsistent, "despite being frequently promoted by policy-makers and techno-enthusiasts".

Worse, they found some evidence that introducing e-health technologies can generate new risks, such as prescribing practitioners becoming over-reliant on the technology, resulting in errors.

This may surprise Australian taxpayers who, in the two years to June 2012 will have spent $467 million on a national e-health record system that does not yet exist.

That excludes another $218m spent during the same period on the National E-health Transition Authority, established in 1995 by the Australian, state and territory governments to develop better ways of electronically collecting and securely exchanging health information.

Sheikh and his colleagues analysed systematic reports, so-called meta-reviews, published from 1997 to 2010, identifying 53 that evaluated the impact of e-health technologies on the quality, cost and safety of healthcare delivery.

They conclude that given the lack of evidence supporting e-health, it's vital that e-health technologies should be rigorously evaluated against a comprehensive set of measures, from design to implementation and adoption.

According to Australian Medical Association vice-president Steve Hambleton, the PLoS paper shows that data being collected "isn't useful" and that evaluation of e-health technologies has "been exceptionally poor to this point".

Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, agrees evidence is patchy and better methods of evaluation are needed. But he disputes the claim by Sheikh and co that there's no good evidence e-health technologies are cost-effective and improve patient outcomes. "They looked at weak literature as opposed to primary sources," says Coiera.

More commentary is found here:

http://www.theaustralian.com.au/news/health-science/experts-challenge-e-health-critique-researchers-suggests-they-may-not-be-worth-the-money/story-e6frg8y6-1225991983661

There has also been coverage here:

Little Evidence To Support Most E Health Technologies, Such As Electronic Patient Records

19 Jan 2011

Despite the wide endorsement of and support for eHealth technologies, such as electronic patient records and e-prescribing, the scientific basis of its benefits-which are repeatedly made and often uncritically accepted-remains to be firmly established.

Furthermore, even for the eHealth technologies that have proven to be successful, there is little evidence to show that such tools would continue to be successful beyond the contexts in which they were originally developed. These are the key findings of a study by Aziz Sheikh (University of Edinburgh, Edinburgh, Scotland) and colleagues, and published in this week's PLoS Medicine.

In the study, the authors systematically reviewed the published systematic review literature on eHealth technologies and evaluated the impact of these technologies on the quality and safety of health care delivery. The 53 reviews (out of 108), that the authors selected according to their criteria and critically reviewed, provided the main evidence base for assessing the impact of eHealth technologies in three categories: 1) storing, managing, and transmission of data, such as electronic patient records; 2) clinical decision support, such as e-prescribing; and 3) facilitating care from a distance, such as telehealthcare devices.

The authors found that the evidence base in support of eHealth technologies was weak and inconsistent and, importantly, that there is insubstantial evidence to support the cost-effectiveness of these technologies. They also found some evidence that introducing these new technologies may sometimes generate new risks, such as prescribing practitioners becoming over-reliant on clinical decision support for e-prescribing or overestimate its functionality, resulting in decreased practitioner performance.

More here:

http://www.medicalnewstoday.com/articles/213661.php

The article also got coverage in Time Magazine

Are Electronic Health Systems Cost Effective? Not So Much

By Alice Park Wednesday, January 19, 201

If you've visited the doctor or a hospital recently, you can't help but notice how much of your care depends on some form of electronic information exchange. From the prescription your doctor writes to the chart she consults, medicine is very definitely going digital.

But how effective is all this electronic data capture? Is it making the health care system more efficient? And what about patient care — are e-health technologies improving health outcomes for people who are sick?

Unfortunately, the answer is no, according to research published in PLoS Medicine. And this is despite the billions that governments like the U.S. have poured into such technologies — the Obama administration approved $38 billion to digitize the American health care system.

After analyzing 53 reviews of electronic technologies in health care, researchers led by Dr. Aziz Sheikh at the University of Edinburgh report that there is little or weak evidence to support the massive investment that policy makers have made in electronic systems such as electronic health records and computerizing physician orders and other decision-making. The strongest evidence in support of digitizing medical information came in electronic prescriptions, which showed a small benefit in reducing errors and streamlining ordering.

More here:

http://healthland.time.com/2011/01/19/are-electronic-health-systems-cost-effective-not-so-much/

There is a very interesting comment on the Time Article

Paul Shekelle

As the author of 3 of the reviews summarized in the original PLoS article, I am concerned that readers of this summary, and of the PLoS article, might inadvertantly come away with the impression that the evidence is that electronic health systems don't improve patient care and are not cost effective. I don't think that's what the data support. Rather, I think the published data support that the evidence is mixed, but that in some institutions the electronic health system has been transformative in the way care is delivered, with real and measurable improvements in care. So the question is - how can these results be realized by more health care organizations? At the time of our original 2005 review, there were no examples published outside of the few leaders in the field. By the time of our 2008 update, there were published a small number of successful results at other institutions. This is a fast moving field - the PLoS "review of reviews" isn't going to capture what's happened recently, and will tend to give more emphasis to older studies - in some cases, more than a decade old. Almost nobody today uses the mobile phone or computer that they used 10 years. I don't think data from 10 years ago on the value of electronic health systems is very informative for what's going today, and what is possible tomorrow and next year.

You can read about the commenters biography here:

http://www.rand.org/about/people/s/shekelle_paul_g.html

My reaction to that comment is that Dr. Shekelle MD PhD is right on the money!

That view is further confirmed by downloading the file found here.

http://www.plosmedicine.org/article/fetchSingleRepresentation.action?uri=info:doi/10.1371/journal.pmed.1000387.s002

This file lists the papers that were reviewed and what I found impressive was just how many were over a decade old. These papers were written before not only the iPad but also the iPod. Technology and our experience of what works and what doesn’t has advanced quite a way since 1990 when some of the papers seen as contributing to the evidence reported here were written - meaning the work was done in the 1980’s when all sorts of things were yet to come - e.g. the graphical user interface.

The second point is that this paper is a review of reviews. At no point did the authors use primary sources as far as I can tell. This is not the way things sensibly work. Science works by building on previous direct observation and experience - not by reading about it in summaries and then constructing conclusions from summaries papers. Meta, meta analysis is just too silly for words when attempting to draw any conclusions from the findings of studies with ages of up to 20 years and scopes and objectives that are quite different.

Last point is that we know there are examples where e-Health really works - viz Kaiser Permanente in the US, a number of Scandinavian countries and elsewhere as well.

Frankly this paper is just an ill-considered distraction to the pursuit of how to do things better and learn from the mistakes made. Just looking at summary reviews does not get you there in my view.

David.