Flash: Dr. David Blumenthal Steps Down As National Coordinator For Health Information Technology.

Dr. David Blumenthal just announced his resignation from the position of National Coordinator for Health Information Technology. In this position, Blumenthal led the implementation of a nationwide interoperable, privacy-protected health information technology infrastructure as part of the American Recovery and Reinvestment Act. Along with this, he led the effort to influence doctors and hospitals to adopt electronic medical record systems.

Dr. Blumenthal will leave this Spring and return to Harvard University.

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I guess this might just show how hard all this can be!

David.

NEHTA Receives Yet More Money and a Blog Correspondent Responds! Astonishingly Fun Stuff if it Were Not So Sad!

We had the following appear yesterday.

NEHTA scores $38.5m for e-health record rollout

• Karen Dearne
• From: Australian IT
• February 02, 2011 5:49PM

THE federal Health department has released $38.5 million to the National E-Health Transition Authority for the next stage of the $467m personally-controlled e-health record rollout.

Under the six-month contract to June 30, NEHTA will provide management support services as private-sector partners are hired for four key roles: a national infrastructure partner; a change and adoption partner; a benefits realisation partner and an external assurance adviser.

Bidders are currently being sought for the benefits realisation partner, whose brief is to monitor and measure progress through an analytical and evaluation framework. The tender deadline has been extended a week to February 18, after potential candidates called for more information on the PCEHR program. Bidders seek details.

NEHTA chief executive Peter Fleming said the $38.5m was the first funding to be released for the PCEHR work.

“As you would expect, there will be a number of very significant builds underway this year,” he said.

“On the infrastructure side, there’ll be an indexing service, repository services and template services, so we’re looking for an infrastructure partner, or partners, for that.

More here:

http://www.theaustralian.com.au/australian-it/government/nehta-scores-385m-for-e-health-record-rollout/story-fn4htb9o-1225998925462

The news is also covered here:

NEHTA receives next instalment of $466.7m e-health project

The funding of $38.7 million will assist the organisation in the next stage of its personally-controlled electronic health record (PCEHR) project

• Chloe Herrick (Computerworld)
• 03 February, 2011 12:45

The National e-health Transition Authority (NEHTA) has confirmed it has received the latest tranche of a total of $466.7 million in funding from the Federal Department of Health for the next stage of its personally-controlled electronic health record (PCEHR) project.

According to a NEHTA spokesperson, the funding will be provided for a six month period to 30 June this year under which the organisation will provide management support services as private-sector partners are hired for four key roles: a national infrastructure partner; a change and adoption partner; a benefits realisation partner and an external assurance adviser.

The PCEHR project is scheduled to deliver an e-health record for all Australians by June 2012 and will enable medical records to be transferred between medical providers such as hospitals and general practitioner doctors electronically, rather than through paper records.

The NEHTA spokesperson did not comment on future funding plans for upcoming stage of the project, stating the Federal Government would make its own announcement on future funding.

More here:

http://www.computerworld.com.au/article/375382/nehta_receives_next_installment_466_7m_e-health_project/?fp=4&fpid=5

The first of these two provoked this astonishing response from a reader:

Anonymous said...

I read your post and 5 minutes later read an article in the Australian about NEHTA getting an additional $38.5 million to spend over a mere 6 month contract to project manage the next bureacratic stage of the fanciful PCEHR white elephant.

I work in the hospital system (and used to work for an Australian health IT vendor that folded about 5 years ago), but also have to visit outpatient services every month for Warfarin management. So I've been affected by the lack of e-health from a few different perspectives and I'm a real believer that simple use of appropriate information technologies can make a big difference in improving safety or helping patients have a better quality experience.

I read your post and then the big-noting, egotistical arrogance of NEHTA's CEO Peter Fleming and I could bearly contain the expletives.

I am disgusted, appalled, incensed, infuriated and incredulous at this waste. Patients in Australian hospitals and communities are suffering awful quality of care, unsafe hospitals because of poor morale, bad communication and poor morale of overloaded nurses and doctors, we have shockingly poor mental health treatment options and an indigenous population that dies 10 years before they should. We have a cyclone devastating North Queensland, floods displacing thousands in Queensland and Victoria and bushfires in NSW and Perth.

And some idiot believes that a good investment of tax-payer money is to spend $38.5 million for a bunch of bungling bureaucrats to decide how to spend the next $400million on eHealth projects that promise the world and deliver nothing. Then we have the audacity of the chief bungling bufoon, Peter Fleming to say "With the work on the other components, the benefits realisation, change management and so on, we’re going to see a lot of activity focused on communities this year.”

Not my bloody community!!!!

So with a rising blood pressure, I scanned the last five years of NEHTA's annual reports and only got more irate. Here's what NEHTA spent apparently and is likely to spend in 2010/11 (assuming this extra $38.5 million builds on last years base):

2006: $8.5 million
2007: $17.3 million
2008: $31.2 million
2009: $66.7 million
2010: $89.5 million
2011: $133.6 million

Total: $347 million

They've almost doubled their spending every single year. At this rate, they're doing better than Google or Facebook and could be a $4 billion business in just another 5 years!!

But I want to know the answer to this question: Having spent more than five years and a treasure chest of almost $350 million dollars, show me one single patient who has had a better experience, one single area of safety improvement or one single doctor or nurse who has been able to provide better care. I don't believe there is one and I can see no evidence from NEHTA of having achieved anything expect line their own pockets, justify their own existence and decimate a forest with paper documents.

I dowloaded a presentation from Leonie Katakar -Nehta's Director of Clinical Leadership (whatever that means) and found the last slide in her presentation said it all:

- Nehta is funded to provide the national infrastructure required to meet the needs of a clinically computerised and electronically connected health sector

-Computerisation and uptake of nehta products are the responsibility of the health sector

Wow - what a clinical leader you are. All care, no responsibility

When will there be some inquiry into this disgraceful waste - when will some auditor or politician hold these people to account? I find it deeply, deeply offensive.

---- End Comment.

I don’t know but the bar for quality comments has really been raised somehow in the last few months. Whoever you are - thanks - could not have said it better myself!

Of course this funding goes till June 30, 2011 -after that there will be more I guess - and even if the Tenders for these planned partners are all ready to roll - it seems unlikely even the procurements will be done by the time the funds run out - unless some extremely shonky procurement process - in the name of Government urgency - is undertaken.

So these will be pretty expensive tenders and those winning won’t have long to deliver before the July 1, 2012 PCHER pseudo and rather fraudulent deadline.

If the track record of delivery is anything to go by NEHTA are also not all that efficient at evaluation. We still don’t seem to have an outcome for the NASH Tender - released mid-September last year!

Of course we still don’t know what the PCEHR actually is as well but that seems to be a minor detail!

This all has the feeling of happening in some sort of parallel universe where you can buy things without specifications and find partners without knowing what they are to do!

Utter madness!

David.

Now Hear Is Something Else NASH and the HI Service Could Help With! And It Is Actually Also Needed!

The following appeared a day or so ago.

Govt should subsidise prescribing resources

MEDICAL leaders want electronic prescribing resources for doctors to be subsidised and regularly updated as the federal government puts more emphasis on e-health initiatives.

Professor Jon Emery, professor of general practice and head of the school of primary, Aboriginal and rural health care at the University of Western Australia, said quality use of medicines was an important issue and the federal government should look at ways to make the Australian medicines handbook (AMH) freely, or at very least more cheaply, available to all GPs.

The AMH currently costs $160 for an annual online subscription.

Professor Nick Buckley, consultant clinical pharmacologist and chair of the AMH editorial advisory committee, said the cost of the AMH or the Therapeutic guidelines should be subsidised because the community and patients paid a very high price when poor prescribing decisions were made.

Professor Buckley estimated it would cost less than 10 cents per GP prescription to subsidise the AMH or the Therapeutic guidelines.

He said such a subsidy would be cost-effective in improving health and would be likely to generate net savings.

“The total budget for the two organisations providing these resources is less than the average PBS [Pharmaceutical Benefits Scheme] expenditure on just one of the 717 … subsidised medicines,” Professor Buckley said.

The two experts were commenting on a study reported in Family Practice, which looked at GPs’ use of electronic information sources and computerised clinical decision support systems (CDSSs) for prescribing.(1)

More here:

http://www.mjainsight.com.au/view?post=Govt+should+subsidise+prescribing+resources+&post_id=2674&cat=news-and-research

It seems to me that this is really a very un-ambitious proposal. In the National E-Health Strategy in 2008 it was proposed that a modest sum should be spent ensuring all clinical practitioners have access to a service similar to the Clinical Information Access Program (CIAP) offered by NSW Health to public health employees in NSW.

The limitation in providing extended services to other groups is that the information providers retain copyright on some of the material and want to know the number of users so the correct fees can be charged.

With the HI Service and NASH we are promised that we will know who is accessing what and when they are doing that. This would be a great situation to have, with robust professional authentication, when negotiating the relevant licensing conditions with information providers.

We know the CIAP program has been especially useful to the more remote practitioners and a true nationwide extension would be not only be good clinically (CIAP has been evaluated and found to improve care) and better would be something that might bring faster adoption of the HI Service and NASH as there would be a reason for practitioners to adopt using the identifiers and credentials.

Sadly I fear this might just be too sensible to actually happen. Pity!

David.

What Value Does Academic Research Bring to the E-Health Table? Some Of It Brings Very Little Is My View!

There seems to have been a bit of a rush of academic studies that are suggesting the use of EHRs is not associated with any improvements in the quality and safety of care delivered.

The following summarises the issue

EHRs and the quality conundrum

January 27, 2011 — 2:55pm ET | By Janice Simmons - Contributing Editor

A quick peek at the past few days in the literature on whether electronic health records are capable of improving quality care shows EHRs taking it on the chin a few times. Despite the efforts and expense of installing EHRs in practices, EHRs are not improving overall quality as much as might be expected, several researchers said. But taking a closer look, it's important to ask ourselves: Are we all on the same page when it comes to defining quality?

After covering the issue of healthcare quality for the past two decades, it's become apparent to me that there's no one single definition of quality. It can mean many things, such as improving the overall well-being of a patient, or creating a better standard of living for a group of individuals or a population.

What we all can agree on, though, is that achieving quality care is an important goal. But exactly how do we monitor and measure it--and can EHRs provide the means to do it?

In a study appearing online in the Jan. 24 issue of the Archives of Internal Medicine, Stanford University researchers Max Romano and Randall Stafford, MD, PhD, reviewed guideline adherence for 250,000 outpatient visits using data from the National Ambulatory Medical Care Survey and from the National Hospital Ambulatory Medical Care Survey from 2005 to 2007.

Overall, what they found was that among 20 indexes of care quality, only diet counseling for high-risk adults showed "significantly better performance" in visits where EHRs were used when compared with visits using other types of record-keeping systems. "There were no other significant quality differences" regarding the clinical benefits of EHRs and clinical decision support, they said.

However, in a commentary appearing in the same journal, two National Library of Medicine (NLM) researchers--Clement McDonald, MD, and Swapna Abhyankar, MD--said that they suspected that the EHR and clinical decision support systems in use at the time of Stanford study were "immature," failed to cover many of the guidelines that the study targeted, and had incomplete patient data.

They also said that EHRs without clinical decision support do not affect guideline adherence because without that support, "most EHRs function primarily as data repositories that gather, organize, and display patient data--not as prods to action."

Most of the guidelines in the Stanford study concerned medication use, but none dealt with such areas as immunizations or screening tests. "In our experience, care providers are less willing to accept and act on automated reminders about initiating long-term drug therapy than about ordering a single test or an immunization," they wrote.

In another study appearing online Jan. 18 in the Public Library of Science (PLoS), British researchers--looking at the use of eHealth technologies including EHRs--said that little empirical evidence was found to substantiate their claims of quality and safety.

More here:

http://www.fierceemr.com/story/ehrs-and-quality-conundrum/2011-01-27

Extra details of the studies are provided here:

Stanford researchers find EHRs don't boost care quality

By Joseph Conn

Posted: January 25, 2011 - 11:15 am ET

A pair of researchers at Stanford University, Palo Alto, Calif., has released results of a three-year study that indicates EHRs did little to improve the quality of care.

"There's a lot of enthusiasm and money being invested in electronic health records," senior author Dr. Randall Stafford said in a news release. "It makes sense, but on the other hand it's an unproven proposition. When the federal government decides to invest in healthcare technology because it will improve the quality of care, that's not based on evidence. That's a presumption."

Stafford is an associate professor of medicine at the Stanford Prevention Research Center. A seven-page article based on the study, "Electronic health records and clinical decision support systems: Impact on national ambulatory care quality," appears online in the Archives of Internal Medicine.

In the new study, Stafford and former Stanford undergraduate student Max Romano, who is now a medical student at Johns Hopkins University in Baltimore, analyzed data from nearly 250,000 patient visits in 2005 through 2007. They looked at whether computerized, clinical decision-support tools in EHR systems improved the quality of care.

Their conclusions? There was "no consistent association between EHRs and CDS and better quality," according to the report. "These results raise concerns about the ability of health information technology to fundamentally alter outpatient-care quality."

More here:

http://www.modernhealthcare.com/article/20110125/NEWS/301259986/

Here is a comment from the site

Steveno

I think that this study was done too soon to accurately gauge how effective an EHR will be in improving the quality of medical care. The clinical decision-support tools are still too new, and as Dr Stafford noted, "These are complicated systems used by individuals who have received little formal training, at least until recently." Once the training has been completed and the physicians, nurses, pharmacists, and all other medical ancillary personnel increase their expertise is using these systems, quality of medical care should increase. The magnitude of the increase will still be determined by each individual on the health care team by how well they do their job. These tools and systems will make those tasks easier to do and will have the capability to highlight possible errors. We just need a little bit of patience with the industry as the systems come together and everyone starts to use the systems effectively. A similar study in the next decade should provide a much better picture as to how much an EHR did to improve medical care.

And here:

January 21, 2011, 12:34 PM ET

Study Looks For, Can’t Find Much Evidence of E-Health’s Benefits

With the U.S. and the U.K. heading full steam towards electronic medical records and other health IT applications, how much evidence is there that they improve care?

Not a whole lot, according to a review of existing research on the topic published this week by PLoS Medicine. While governments and other proponents are claiming that digitizing health records can save lives and increase efficiency, the review’s “key conclusion is that these claims need to be scrutinized before people invest quite large sums of money in these technologies,” Aziz Sheikh, lead author of the study and a professor of primary care research and development at the Center for Population Health Sciences at the University of Edinburgh, tells the Health Blog.

Sheikh and his colleagues scrutinized 53 reviews of the evidence surrounding technologies including electronic medical records, computerized provider order entry and computerized decision-support systems. The strength of the evidence varied from technology to technology, but in general the review found that “many of the clinical claims made about the most commonly deployed [digital health] technologies cannot be substantiated by the empirical evidence,” the authors write.

More here:

http://blogs.wsj.com/health/2011/01/21/study-looks-for-cant-find-much-evidence-of-e-healths-benefits/

Regular readers will remember some comments on a paper with a similar message here:

http://aushealthit.blogspot.com/2011/01/this-is-sure-to-get-lot-of-coverage.html

And regular readers will also remember my comments on this latter study found here:

http://aushealthit.blogspot.com/2011/01/here-is-another-study-that-will-stir.html

All this in the last month prompted me to wonder just what might be happening here and why we are seeing such a diversity of study outcomes.

The first point that needs to be made is that there is a pretty large evidence base supporting the use of EHRs. The Agency for Health Care Research and Quality (AHRQ) has assembled a good range of this material.

The key elements of this - and studies of accepted high quality - can be found here:

http://healthit.ahrq.gov/portal/server.pt/community/knowledge_library/653/health_it_bibliography/12790

There are a large range of topics covered with the coverage of clinical decision support being most useful.

There are a few defining characteristics of these reports as best I can tell.

1. They are all retrospective analyses of data that was created for other purposes and with other intended uses - i.e. the research core data was not collected with the study in mind to ensure relevance and accuracy for that purpose.

2. They are typically at least 4-5 years behind current practice

3. They are all relying on large data sets that are not all that well defined or definable.

Additionally it could be there is a bias in news reporting for bad outcomes and hence we hear more about these studies.

To me this is not the way science progresses. We need work undertaken that is prospective, designed to answer specific questions that are actually clearly defined and capable of answer, and work that actually addresses current practice.

It is clear some work of this sort has been analysed by the AHRQ and found to be quite at odds with these reports cited above. My view is that well designed, prospective and controlled studies will show quality Health IT makes a positive difference. What is really needed is for more analysis of the successful implementations around the world to be undertaken. Of course those with the successes are more interested in improving rather spending time touting their success so it may be we do not hear enough about them (Kaiser, Intermountain and Partners come to mind - they publish but maybe not enough to get their message out!).

The successes in Africa with the use of simple systems to better manage AIDS care similarly argues that simple things done well can really help!

I simply do not believe the studies cited above are example of what I would call anywhere near conclusive evidence - as the authors to their credit point out. More better work is needed to nail this!

I advise a very critical and sceptical mind-frame looking at e-Health research - especially aggregate studies of disparate entities and functionality.

Health IT has enough issues to address in utility, quality and safety without having to respond to methodologically challenged research!

David.

Weekly Australian Health IT Links – 31 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:

Well, Australia Day has passed and 2011 has begun in earnest.

The main news last week was dominated by discussions about what should happen to HealthSMART. It will be interesting to see how it plays out.

My suggestions are here:

http://aushealthit.blogspot.com/2011/01/where-to-next-for-victorian-healthsmart.html

There are also some good comments from the readers.

We can expect a similar review in NSW within weeks of the March 2011 election there - which it looks like the Coalition will win in a landslide or more. Will be interesting to see how that plays out also.

We also need to see some answers from NEHTA and DoHA on key forward directions real soon now - as the year has really now begun!

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http://www.6minutes.com.au/news/computers-usurp-gp-in-consults

Computers usurp GP during consultations

• By Michael Woodhead on 28 January 2011

The presence of computers has altered the dynamics of a GP consultation, with patients now subconsciously relating more to the computer than the doctor as the ultimate source of information, a Melbourne study suggests.

Video analysis of patients’ body language during 141 GP consultations has shown that the doctor-patient relationship has become ‘triadic’ by also involving the computer.

Writing in the Journal of the American Medical Informatics Society (online 24 Jan), study author Dr Chris Pearce says computers have shifted the balance of power in the doctor-patient relationship, allowing patients to set or alter the agenda of the consultation.

Patients presenting for a prescription or test results, for example, may gaze intently at the computer screen rather than the doctor, and thus shift the focus of the consultation.

”No longer are doctors seen as the ultimate authority in the consultation. In fact, the computer was often brought into play by patients to directly challenge the doctor’s authority,” Dr Pearce observes.

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http://www.computerworld.com.au/article/374818/gps_ready_e-health_records/?eid=-6787&uid=25465

GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

• James Hutchinson (Computerworld)
• 28 January, 2011 12:19

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).

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http://www.nehta.gov.au/media-centre/nehta-news/800-mh

NEHTA congratulates Dr Mukesh Haikerwal (AO)

Congratulations to Dr Mukesh Haikerwal who was made an Officer (AO) in the General Division of the Order of Australia "for distinguished service to medical administration, to the promotion of public health through leadership roles with professional organisations, particularly the Australian Medical Association, to the reform of the Australian health system through the optimisation of information technology, and as a general practitioner."

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http://www.theage.com.au/national/doctor-applauds-colleagues-and-community-20110125-1a4cp.html

Doctor applauds colleagues and community

January 26, 2011

TWO years after a brutal assault that nearly claimed his life, a Williamstown doctor has been recognised in the Australia Day honours for his work helping others.

Mukesh Haikerwal will today be appointed an Officer of the Order of Australia.

In September 2008, he underwent emergency surgery at Footscray's Western Hospital to remove blood clots from his brain after being bashed with a baseball bat near his Williamstown home.

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http://www.theaustralian.com.au/australian-it/orion-in-the-right-place-at-the-right-time/story-e6frgakx-1225993884268

Orion in 'the right place at the right time' for e-health growth

• Karen Dearne
• From: The Australian
• January 25, 2011 12:00AM

NEW Zealand software company Orion Health is the surprise linchpin of emerging e-health consortiums both globally and in Australia.

Orion is on an expansion drive, with its e-health records and information exchange products boosting revenue 80 per cent in the first half of 2010-11 compared with the previous year.

With 22 major projects in 12 countries, Orion believes prospects are finally looking up in Australia, with the federal government's new emphasis on e-health.

Late last year, Orion, with consortium leader Accenture and partners IBM, Oracle and Hewlett-Packard, bagged a $146 million contract to deliver Singapore's national e-health records (NEHR) project.

Singapore's Ministry of Health says NEHR is a key part of its vision for "one Singaporean, one health record" for 5 million citizens. It builds on previous investments in integrated clinical management systems, a hospital records exchange hub and a GP IT program.

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http://www.theaustralian.com.au/news/health-science/aussies-blinkered-in-vision-race-local-researchers-face-global-competition-in-bionic-market/story-e6frg8y6-1225995765005

Aussies blinkered in vision race: local researchers face global competition in bionic market

• Leigh Dayton
• From: The Australian
• January 29, 2011 12:00AM

WHEN this picture ran on the front page of The Australian in April 2008, Minas Coroneo and his tiny team had a prototype bionic eye ready for human trials. All that was missing was $200,000- $300,000 to run the trials with the 10 volunteers.

"While the device will not immediately achieve 20-20 vision, as the technology advances the bionic eye will evolve," he said then, adding that simply having the ability to navigate "would be a huge breakthrough" for people with impaired vision.

Since then much has happened, none of it foreseen by Coroneo, an ophthalmologist, researcher and chairman of the Genetic Eye Foundation in Sydney.

Following former prime minister Kevin Rudd's 2020 summit, the government committed $50 million over four years to support development of a functional bionic eye. Bionic Vision Australia received $42m; Monash Vision Group got $8m for its direct-to-brain bionic eye project; and Coroneo's group, nothing.

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

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.

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

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.

The patient management system was designed to link hospital computer systems.

Health Minister David Davis told the Herald Sun the program was under review but would not be drawn on reports the Government was considering axing it.

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

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.

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

'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.

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http://www.news-medical.net/news/20110124/Victoriae28099s-e-health-system-may-still-yield-benefits-Experts.aspx

Victoria’s e-health system may still yield benefits: Experts

24. January 2011 21:22

By Dr Ananya Mandal, MD

According to e-health experts, the state government should continue to patronize Victoria’s $360 million health technology program because it was finally starting to deliver some benefits.

According to Mukesh Haikerwal, who is federal government’s clinical advisor on e-health added that the HealthSMART program may not have been a roaring success but abandoning it now would only mean starting from the scratch to build an electronic system to share patient information in hospitals. There has been news 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 make of the health system.”

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http://www.hospitaliteurope.com/article/24196/iSOFT_apps_now_on_BlackBerry

iSOFT apps now on BlackBerry

Wednesday 26th January 2011

iSOFT Group Limited has joined the BlackBerry Alliance Program as a BlackBerry Alliance Elite Member under moves to introduce applications for care beyond traditional settings and hospital walls.

The company is working on a range of applications to help clinical staff deliver care more efficiently and patients to manage their conditions more effectively. These include apps for doctors to download daily workloads and appointments, for community nurses to record patient details and for patients to check vital signs, arrange appointments and referrals, and order repeat prescriptions.

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http://www.theage.com.au/victoria/thousands-of-nurses-to-miss-registration-deadline-20110124-1a2vo.html

Thousands of nurses to miss registration deadline

Julia Medew

January 25, 2011

THOUSANDS of Victorian nurses and midwives are at risk of being unable to work next week because they have not registered with the new national registration and accreditation scheme for health professionals.

A spokeswoman for the regulation agency, Nicole Newton, said about 5000 of the state's 84,000 nurses had not had their applications processed yesterday, despite being told last year the deadline was December 31.

She said a grace period of one month meant any nurse or midwife not registered by Monday would not be able to practise and would have to start the registration process again rather than transferring from the Victorian register to the national one.

Comment: Remember this agency is meant to provide the source information for NASH and the HI Service.

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http://www.zdnet.com.au/qld-health-starts-ipad-trial-339308777.htm

Qld Health starts iPad trial

By Renai LeMay, ZDNet.com.au on January 25th, 2011

Queensland Health this week revealed it was running a trial of Apple's hyped iPad tablet, deploying the device within its administrative employees, although tests with clinical staff have not yet kicked off.

The department's executive director of ICT service delivery, Phil Woolley, said the department was running a limited pilot program to determine potential solutions and services suitable for iPads and other similar devices. However, Woolley said, the deployment was restricted to administration staff only and the iPads have not been trialled for clinical purposes yet.

"Queensland Health has not formulated a view on the performance or usability of the iPad in clinical environments at this stage," he said.

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http://www.smh.com.au/entertainment/restaurants-and-bars/you-want-a-drink-give-us-your-fingerprints-20110129-1a8x3.html

You want a drink? Give us your fingerprints

Natalie O'Brien and Eamonn Duff

January 30, 2011

THOUSANDS of clubbers and pub patrons are being forced to submit to fingerprint and photographic scans to enter popular venues, seemingly unaware of the ramifications of handing over their identity.

Biometric scanners, once the domain of James Bond movies, are flooding the pub market as the fix-all solution to violence and antisocial behaviour. The pubs are exerting more power than the police or airport security by demanding photos, fingerprints and ID. Police can only do it if they suspect someone of committing a crime and they must destroy the data if the person is not charged or found not guilty.

Yet one company boasts that the sensitive information collected about patrons can be kept for years and shared with other venues in the country - in what appears to be a breach of privacy laws.

There are no official checks and balances on how the data is collected, stored, used or shared. Federal Privacy Commissioner Tim Pilgrim has warned he does not have the power to audit the systems and the lack of regulation has even industry players calling for tighter controls.

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http://www.theaustralian.com.au/news/world/web-addresses-drying-up/story-e6frg6so-1225993244015

Web addresses drying up

• From: The Australian
• January 24, 2011 12:00AM

THE internet is running out of addresses.

With everything from smartphones to appliances and cars getting online, the group entrusted with organising the web is running out of the "IP" numbers that identify destinations for digital traffic.

The touted solution is a switch to a standard called IPv6 that allows trillions of internet addresses, while the current IPv4 standard provides a meagre four billion or so. "The big pool in the sky that gives addresses is going to run out in the next several weeks," said Google engineer Lorenzo Colitti, who is leading the internet giant's transition to the new standard. "IPv6 is the only . . . solution."

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http://www.theaustralian.com.au/australian-it/googles-guru-puts-the-case-for-ip-version-6/story-e6frgakx-1225993888103

Google's guru puts the case for IPv6

• Karen Dearne
• From: The Australian
• January 25, 2011 12:00AM

AFTER years of talk, internet pioneer Vint Cerf says it's time to act on switching to the new internet address standard, IPv6.

Google's chief internet evangelist said he would "do everything I possibly can" to get Google involved in demonstrations and testing over coming months.

"The IP version 4 address space will be formally exhausted from ICANN's (Internet Corporation for Assigned Names and Number) point of view within the next few weeks, maybe less," he said at an Internet Society of Australia reception in Sydney.

"The allocation of the last of the IPv4 blocs to regional internet registries is an important milestone.

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http://www.cio.com.au/article/374381/libreoffice_3_3_released_first_since_openoffice_split/?eid=-601&uid=25465

LibreOffice 3.3 released, first since OpenOffice split

More enhancements scheduled for February 2011

• Rodney Gedda (Techworld Australia)
• 26 January, 2011 01:00

LibreOffice, the fork of the open source OpenOffice.org productivity suite, has released it’s first stable product in version 3.3, now available for download.

LibreOffice is a project of the newly formed The Document Foundation which started in September last year following Oracle’s acquisition of Sun Microsystems, the principal sponsor of the OpenOffice.org project.

Since its inception, LibreOffice has grown from 20 to more than 100 contributors, many of whom left the OpenOffice.org community project.

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Enjoy!

David.

AusHealthIT Poll Number 55 – Results – 31 January, 2011.

The question was:

Should The New Victorian Government Cancel / Review and Modify the HealthSMART Program?

The answers were as follows:

Yes - It is a Mess

- 24 (66%)

Maybe a Major Review

- 8 (22%)

It Just Needs Some Tweaking

- 1 (2%)

No - We Just Have to Be Patient

- 3 (8%)

Votes : 36

Oddly at about day 3 the poll went a bit odd - never done it before. The count seemed to have reset. The count then was 27/10/1/2.

Whatever happened the answer that it is a mess that needs a major review seems to be strongly supported!

Again, many thanks to those that voted! Sorry about the glitch!

David.

The RACGP Provides A Budget Submission for 2011/12. In E-Health They Seem To Have Got A Bit Lost!

This report a few days ago prompted me to go and have a look what the RACGP had to say in the e-Health Domain - given their close sponsored relationship with NEHTA.

http://www.computerworld.com.au/article/374818/gps_ready_e-health_records/?eid=-6787&uid=25465

GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

• James Hutchinson (Computerworld)
• 28 January, 2011 12:19

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).

“The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training,” the association’s submission reads. “General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.”

While GPs are widely recognised as key stakeholders in the widespread implementation of e-health, they are often stereotypically portrayed as Luddites and obstacles to cultural change within the health system.

However, according to the association this was largely due to the relative lack of technical resources available to individual doctors, leading to poor processes and security culture when using electronic equipment such as e-health records.

As a result, the submission argues for ongoing education and training programs as well as incentives provided to doctors to encourage adoption of e-health standards.

Here is the e-Health text of their submission.

The College summarised the overall submission thus:

Key messages

The RACGP advocates that the Federal Government should:

• Continue significant investment in e-health
• Build the capacity of general practice
• Enhance health outcomes for regional, rural, and remote communities
• Enhance the health of Aboriginal and Torres Strait Islanders communities
• Recognise and reward for general practice
• Support international medical graduates.

The document is here:

http://www.racgp.org.au/reports/40968

The specific e-Health component of the submission is here (Pages 4 and 5):

1. Investing in the future of e-health - readiness for a Personally Controlled Electronic Health Record (PCEHR)

The implementation of an efficient and effective e-health system is a long-term undertaking across the stages of planning, implementation, and financing. The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training. The method of delivery of general practice services will need to evolve in order to incorporate nationally established guidelines and solutions, ultimately achieving safer, more accessible, and efficient health services.

The RACGP supports and encourages a national standards based approach to e-communication, and acknowledges the work of NeHTA in establishing standards that will build consistent messaging and communication between different software solutions. However training and support is required to up-skill the general practice profession in the technical and functional interoperability of e-health solutions.

A Personally Controlled Electronic Health Record (PCEHR) will be available from July 2012. Expansion of investment in e-health, to include support to develop user skills and knowledge in the importance of quality patient information, will be well received by health care providers.

To prepare general practice for the PCEHR and to be e-health ‘ready’ will require an investment across:

· Change management within the practice

· Training and education of practice staff

· Implementation of systems (technical systems).

Recommendation:

• Invest in the national implementation of e-health guidelines and standards and ensure access to e-health communication tools and decision support solutions.

1.1 Technically ready for the PCEHR

An essential pre-requisite for an efficient and effective e-health system is the electronic exchange of accurate and relevant patient information across the health sector, including different health care providers, private and public sectors, and patients. General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.

General practice requires investment in development or enhancement of existing software systems to better address patient identification and authentication, and investment in hardware infrastructure to securely share patient health information via the PCEHR.

Recommendation:

· Invest in general practice software and hardware to ensure that practices have the technical capability to support implementation of the PCEHR.

1.2 Functionally ready for the PCEHR

Uptake of the PCEHR by health care providers will be aligned to confidence in the quality and usefulness of the PCEHR in being able to support continuing care across geographical and professional boundaries.

Further investment is needed to deliver change management and education and training in general practice to ensure rapid dissemination of new knowledge, support change, and guarantee adoption of the new technologies and systems.

Recommendations:

· Invest in education and training for general practice staff in the use and benefits of the PCEHR.

· Provide incentives for general practices to dedicate human resources specifically for the quality analysis, and quality improvement, of data in GP e-health summaries outside of the patient consultation through either Practice Incentive or Service Incentive Payments.

1.3 Information Security

Increased use of e-health initiatives must be combined with effective security measures. These security measures must be designed to ensure that highly sensitive and confidential information relating to: individual patients; the health professionals who provide care; and the business component of the general practice is securely managed.

General practice has specific needs for computer and information security, as it can often be a challenge for general practices to find security experts and technical service providers who understand the business of delivering care in the general practice environment.

Some issues contributing to this challenge include:

· Inadequate risk analysis and identifying gaps in security

· Lack of designated authority (person) to ensure robust security processes are documented and adopted

· Poor data management processes to ensure that information is backed up and can be recovered easily if there is a system failure

· Inadequate business continuity and disaster recovery planning

· Lack of and/or poor password security

· Lack of security ‘culture’ and leadership.

Recommendation:

· Introduce a national strategy aimed at providing ongoing education and training for general practitioners, practice nurses, and practice staff regarding data security in primary healthcare.

---- End Extract.

I think a few comments on this are warranted - remembering that this is a Budget Submission - i.e. a request for funds for General Practice:

1. Despite all the wonderful stories the RACGP publishes with NEHTA about how wonderful things are in e-Health the very first paragraph says more ‘evolution’ is needed.

2. The College then goes on in paragraph two to suggest that GPs need more training and support to move forward on e-Health.

3. In paragraph 3 they rather bizarrely seem to suggest that improving user ( public ) skills and knowledge in ‘quality patient information’ will be well received by health care providers and that the PCEHR will all be available by July 2012. I don’t know many providers who are looking forward to patients providing their view of ‘quality patient information’. Do you?

4. Before this date we are alerted to the need for change management, training and education and to actually get new improved systems in place.

5. Then we are told we need investment in national implementation of ‘e-Health guidelines and standards to ensure access to e-health communication tools and decision support solutions’. Does anyone actually know what that collection of words actually means?

6. The rest of the section then goes on to ask for support for new improved systems and all the activities to foster their adoption and use.

7. As best as I can tell there is not a single dollar amount attached to any of this.

Bottom line is that this is the sort of budget submission you put in, on e-Health, when you really don’t know what the PCEHR is, what impact it might have and how you may be impacted.

They would have done better to say ‘we think we will need some help with aspects of the PCEHR once we are clear what it will actually turn out to be and when it will be ready’. That way they would not have had to put in this rambling un-costed and un-scoped drivel.

I note there is not one word on the place of General Practice in provision of clinical summary information for the PCEHR. I wonder why that is?

I wonder which marketing genius in the College came up with these 2 pages and how closely the e-Health Subcommittee scrutinised what was done?

David.

A Useful Set of Comments for the US Government on the Presidential Commission’s Health IT Proposals.

The following was provided to the US Government as week or so ago.

http://www.markle.org/publications/1456-information-rich-ecosystem

An Information-Rich Ecosystem

Collaborative Comments in Response to the Office of the National Coordinator’s Request for Information regarding the PCAST Report on Health IT

January 19, 2011 | Collaborative Comment

Markle Connecting for Health Community

Markle Connecting for Health collaborators respond to HHS's request for information on PCAST's report on health IT.

Download Executive Summary

Download Collaborative Comments

The President‘s Council of Advisors on Science and Technology (PCAST) report Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans1 envisions an information-rich health ecosystem. Like PCAST, we seek to accelerate the use of modern information tools to improve health outcomes, increase the cost-effectiveness of care, and encourage innovation while protecting privacy.

Markle Connecting for Health, a public-private collaborative of more than 100 organizations across the spectrum of health care and information technology (IT), appreciates the opportunity the Office of the National Coordinator for Health Information Technology (ONC) has provided for commentary on this very important report.

Our comments fall into three parts. We start by addressing the basic parameters of the PCAST vision, one that has many parallels to the Markle Connecting for Health Common Framework (Markle Common Framework). Next we provide input on some of the specific recommendations of the report, and here our comments fall into two categories: As in all of our past work, we emphasize the importance of starting with clear goals and a policy framework to guide technology choices and solutions, and we consider some of the novel technology approaches that PCAST proposes and their implications for the vast, heterogeneous environment that characterizes US health care today. Lastly, based on the collective experience of our broad collaboration, which has worked together on solutions to health IT challenges for nearly a decade, we provide ONC a set of forward-looking recommendations that we believe can accelerate the use of health IT to improve health outcomes and cost effectiveness while protecting privacy.

A Vision Supported by the Markle Connecting for Health Common Framework

The PCAST report offers a compelling vision for an information-rich health care system that we support. The Markle Common Framework is aligned with and supportive of the PCAST vision for:

• A nationwide capability for secure health information exchange using the Internet, not a new network.
• A distributed network for information-sharing.
• A model for linking patient information across sites of care using existing identifiers.
• An approach to technology that emphasizes innovation and a diversity of solutions to support broad participation and new entrants.
• A comprehensive set of privacy and security practices to support trust in information sharing.
• A universal exchange language for sharing health information securely over the Internet.
• Population health improvement and analysis using distributed networks.

However, we also identify areas for further development and analysis based on our experience with three foundational principles. These principles, which have guided our work for nearly a decade, most notably the Markle Connecting for Health Common Framework, offer grounding for our comments on the PCAST report.

----- End Quotation.

This material is well worth a download and browse! They have a range of very interesting proposals and ideas to take forward what has been suggested.

David.