It Seems That In the UK Patients Are Not All That Interested in Their Health Records. Important Lesson for Proposed PCEHR Possibly!

The following appeared a day or so ago.

Low figures for HealthSpace use revealed

8 February 2011 Fiona Barr

Just 60 patients a month - out of almost 5m with a Summary Care Record - are viewing their SCR via the government’s patient portal, HealthSpace.

The latest figures obtained by EHI Primary Care show that patients have so far demonstrated very little appetite for online access to their record via the portal.

The figures have come to light as the Department of Health works on its forthcoming information strategy, in which online access to records for patients is likely to feature prominently.

The DH has described online record access as a “headline objective” for its NHS reforms and this week a spokesperson told EHI Primary Care that an outline business case to enhance the HealthSpace service was in the approvals process.

The previous, Labour government launched HealthSpace’s advanced account in 2007.

This enables patients to view their SCR through the portal, which was originally set up as an online health organiser.

However, in more than three years, fewer than 3,000 patients have chosen to set up such an account.

Just ten primary care trusts are offering patients advanced accounts; 2,971 of their patients had set up an advanced account by 26 January this year; and 673 patients have viewed their SCR via the portal.

More details here:

http://www.ehi.co.uk/news/primary-care/6623/low_figures_for_healthspace_use_revealed

Alert readers will note just how close this portal is, in concept, to the proposed PCEHR. It seems the idea has received the big ‘thumbs down’ in the UK.

I am sure there are all sorts of reasons for this lack of interest could be advanced:

- System was not user friendly.

- The use of the system was not well explained.

- The content was not rich enough to be interesting

- Others I have not thought of.

It is clear the good Professor Greenhalgh’s suggested questions (down further in the article) all need answers, and soon. DoHA and NEHTA should also be very interested!

We need to know, and soon, if the public find this sort of system useful and valuable, or not, before a great deal more money is spent!

David.

Flash: COAG Meeting Where Health Reform Is Major Topic Now On Sunday 13 Feb, 2011

The date has been changed due to sad funeral of most recent Afgan battle casualty on Monday the SMH is reporting.

This meeting is a very important one I suspect and it seems that the most likely outcome will be closer than most of us want to the status quo.

David.

Draft : The Person-Controlled Electronic Health Record (PCEHR) - A Uniquely Australian Approach to E-Health.

(For a Health Magazine - Comments Welcome)

In late 2008 Australian Health Ministers endorsed a National E-Health Strategy for Australia which had been developed for the Australian Health Minister’s Advisory Council by Deloittes. At its very simplest this Strategy said Australia needed to continue working on the nation’s e-Health infrastructure (secure clinical messaging, identifiers and terminologies) while investing in improving the quality and penetration of computer systems being used by healthcare providers. With this well underway it was suggested it would then be the time to start to promote health information sharing between the various actors in the health system (hospitals, practitioners, service providers etc.) to facilitate improvements in the quality, safety and efficiency of care. The Strategy also suggested that progress was required in the way E-Health initiatives were planned, managed and governed.

The endorsement of the National Strategy was not associated with any additional budgetary funding, so essentially Government felt this was a good idea but that they were not going to fund implementation. That was apparently left to the Health System.

In June 2009 the National Health and Hospitals Reform Commission (NHHRC) delivered their final report to Government. In this report (see Executive Summary Page 14) they said what was needed was a PCEHR. In their view the introduction “The introduction of a person-controlled electronic health record for each Australian is one of the most important systemic opportunities to improve the quality and safety of health care, reduce waste and inefficiency, and improve continuity and health outcomes for patients. Giving people better access to their own health information through a person-controlled electronic health record is also essential to promoting consumer participation, and supporting self-management and informed decision-making.”

Amusingly some wags have taken to calling the PCEHR the ‘politically correct’ EHR in recognition of the apparently political rather than clinical agenda the proposal seems to be advancing.

The other key recommendation in the E-Health domain the NHHRC but thus:

“We are also recommending that clinicians and health care providers are supported to ‘get out of paper’ and adopt electronic information storage, exchange and decision support software. The Commonwealth Government must set open technical standards which can be met by the vendor industry while ensuring the confidentiality and security of patient information. Most importantly, we urge governments to expedite agreement on a strengthened national leadership structure for implementing a National Action Plan on E-health, with defined actions to be achieved by specified dates.”

The first of these recommendations led to the Commonwealth Health Department announcing a near half billion package in the most recent (2010) Budget with the promise that anyone who wanted a PCEHR would be able to register for it by July 2012 - now just 16 months away. It needs to be noted that the National Action Plan on E-Health has never appeared and that support to have clinicians ‘get out of paper’ has also not been forthcoming.

Do date (as of the time of writing in early February 2011) no significant details on how the PCEHR is to actually work have been released.

From a range of sources the following draft overview of the PCEHR has been assembled.

“The PCEHR system will consist of a range of PCEHR-conformant repositories operated at the national and regional level by a mix of public and private organisations. The PCEHR system capability will transition over time to provide access to richer clinical data stored in a range of PCEHR-conformant repositories.

The PCEHR system will consist of:

• A nationally operated repository, designed to provide a distributed set of secure highly available repositories for PCEHR records on a national basis.

This PCEHR-conformant repository will be used to ensure that there is a minimum level of health information available nationally and to support the sharing of critical health information when there is no other suitable repository available locally. It is likely that the national repository will be used to store health summaries and discharge summaries.

• Other PCEHR-conformant repositories will be accessible over time. These repositories will typically be multi-purpose repositories that may have been designed for other purposes and now include new features to allow it to become conformant with the PCEHR system. Potential candidates include, but are not limited to:

– state, territory and regionally operated SEHRs (e.g. NT SEHR, NSW SEHR);

– Medicare Australia operated repository (e.g. for ACIR and Organ Donor Information);

– privately operated diagnostic services (e.g. repositories operated for/by Pathology and Diagnostic imaging companies);

– other sources including Australian Childhood immunisation register (ACIR), Adverse Drug Event Reporting (ADRAC), implant registers, cancer registries, breast screen registries, etc; and

– commercially operated PHRs (although this is subject to further policy review).”

It seems it is planned that once ‘persons’ have voluntarily registered for their PCEHR that they will be provided with access to some sort of internet portal where they, and those they authorise, can review the information held in the PCEHR system repositories.

There are a very large number of unanswered questions around what is now a project that has had so large an amount of resources dedicated to it. These include:

1. Where are the health summaries and discharge summaries to populate the repositories going to be sourced from, and why would the current information custodians make this information available to Government?

2. Who will be accountable - and presumably paid - for keeping them current even after they have been uploaded to the repositories?

3. Who will be responsible and accountable for errors in the summaries?

4. How will other non-government entities be paid for their time and trouble to populate the proposed repositories?

5. Who will fund the update of all the affected systems, given the lack of financial support to clinicians and their software providers so far?

6. Who will train and support all the new e-Health users?

7. What happens if your GP, or other provider, does not want to share his records with the Government?

8. More important has anyone actually thought about any of this, and why is the public in the dark about just what is happening?

It is vital readers be aware of two facts.

First a system of the sort proposed has never been implemented anywhere in the world without the underpinning of a fully developed provider EHR infrastructure which the Government seems to think will appear out of thin air when it is ready to collect information for its PCEHR system. It does not exist at present.

Second there is no evidence base supporting the value and impact of the PCEHR system as it is presently proposed as far as I can find. The whole proposal also lacks a public benefits case, a public implementation plan and indeed any public review or discussion.

Bluntly I believe the plan for the PCEHR is a major strategic misstep on the part of the Government where essentially the cart (the PCEHR) is being put before the horse (clinician automation and information sharing).

I confidently predict major changes to the proposal before anything sees the light of day in mid 2012, in the unlikely event that anything useful is delivered in that time-frame.

Sadly this whole proposal feels to me like a slow moving train wreck that is going to cost us all a lot of money.

-----

David.

The Chickens Are All Coming Home To Roost. It’s Looking Like A Huge Mess!

A couple of really quite astonishing articles appeared in The Australian IT Section today.

First we had this:

Health record identifier held up because of safety concerns

• Karen Dearne
• From: The Australian
• February 08, 2011 12:00AM

THE Health Department has banned the use of the $90 million Healthcare Identifier service in any live environment due to concerns over the system's safety.

The service, operated by Medicare, was declared live by Health Minister Nicola Roxon in July, but has been sitting idle while software interface specifications, licensing arrangements and compliance issues are thrashed out.

Last week, the department prohibited use of the service until all concerns were resolved.

Despite the fanfare over meeting Ms Roxon's deadline for the start of the service -- Medicare issued every Australian with a 16-digit unique number on July 1-- fears have grown of the potential for mis-identification of patients and mis-matching of medical records.

Only state health departments have tested the service so far. Broader adoption depends on finalisation of Medicare's Notice of Integration and conformance processes that ensure all software interacts correctly with the service.

A department spokeswoman said pre-production testing of related systems was important for privacy and safety reasons.

"In order to obtain identifiers for use in live systems, the software must first pass two types of testing," she said. "Medicare tests the software to make sure the integrity of the HI service system is not compromised when the (external) software obtains the identifiers.

"In addition, independent accredited testing laboratories will test the software to ensure that identifiers are used safely within the healthcare providers' systems.

More is found here if you can bear it:

http://www.theaustralian.com.au/australian-it/health-record-identifier-held-up-because-of-safety-concerns/story-e6frgakx-1226001760208

And then we have this.

No budget for huge health e-record development task

• Karen Dearne
• From: The Australian
• February 08, 2011 12:00AM

SOFTWARE vendors face 10-15 staff years of development work to meet the complex requirements of the $467 million e-health record program, but there's no plan to pay for it.

Health Communication Network chief executive John Frost said the federal government was spending "obscenely large" sums on the personally controlled e-health record, including $38.5m over the next six months on the National E-Health Transition Authority (Nehta).

"That money, frankly, will be spent on consultants," he said. "The government has allocated $12.5m for the three lead implementation sites, $55m for second-wave sites, and $467m for just the first phase" of the personalised e-health record program.

"But the funding proposed for the people who are really going to make it happen is just laughable."

HCN, which supplies the market-leading GP software Medical Director, is one of five desktop vendors invited to join Nehta's software panel, to help "test and fine-tune" the currently undefined personalised record specifications so they can be used at the three lead sites.

Lots more gruesome details here:

http://www.theaustralian.com.au/australian-it/no-budget-for-huge-health-e-record-development-task/story-e6frgakx-1226001776601

Taking the Health Identifier (HI) Service first, regular readers will know I have been saying for ages there are issues about the data quality of the base HI Service and its fitness for record matching.

See here from back in 2009.

http://aushealthit.blogspot.com/2009/07/nehta-tries-to-fudge-it-again-when-are.html

This led me to suggest we need incrementally scaled pilots to prove utility and safety. Now - eight months after the fanfare start - it seems we are not much advanced and even the Department is not sure if what they have is actually viable. Bit late to discover that after 2-3 years of development etc.

The second article just shows how fabulously out of touch Government and NEHTA are about how projects such as this should be planned, managed, funded and delivered.

Taken together these two articles just shout incompetence and stupidity about national program delivery.

Heaven help us! The risk of all this just imploding around us must be amazingly high!

David.

Weekly Australian Health IT Links – 07 February, 2011.

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:

There has been essentially no progress that anyone can detect in the National E-Health scene. We still have no HI Service Implementation Plans and no public release of how the PCEHR is to actually work.

On the broader front, with the Coalition now running Victoria and WA and about to take over in NSW both the Financial Review and The Australian are reporting we are about to see some major changes in the National Health Reform Proposals:

See here for example:

http://www.theaustralian.com.au/national-affairs/julia-gillard-to-junk-kevin-rudd-health-reform/story-fn59niix-1226000488507

Julia Gillard to junk Kevin Rudd health reform

• EXCLUSIVE Sean Parnell and Dennis Shanahan
• From: The Australian
• February 05, 2011 12:00AM

JULIA Gillard is preparing to dump Kevin Rudd's plan to make the commonwealth the dominant funder of hospitals, favouring an alternative model so unpopular among states that any hope of reaching a national health reform agreement appears lost.

After 12 months of wrangling with the states and the signing of a historic health funding agreement in Canberra last year, the federal government is developing a new model to deliver its funding directly to hospitals, and without the states receiving promised funds for expenditure growth and capital works.

In an attempt to finalise the new health funding agreement before the meeting of state and federal leaders in Canberra on February 14, the federal government has put forward a tough new proposal from Treasury and Prime Minister and Cabinet.

----- End Extract.

We are also seeing some concern about the so called ‘Medicare Locals’ which I wrote about last year:

http://aushealthit.blogspot.com/2010/11/medicare-locals-and-e-health-does-it.html

According to the AMA they have gone rather off the rails, with clinician roles being downgraded in Hospitals etc.

http://ama.com.au/node/6350

Lead Clinician Groups discussion paper an insult to clinicians

28 January 2011 - 2:00pm

AMA President, Dr Andrew Pesce, said today that the Government’s proposed Lead Clinician Groups are doomed to fail if arrangements set out in a recently-circulated discussion paper are to proceed.

Dr Pesce said the fact that the discussion paper - Lead Clinicians Groups: enhancing clinical engagement in Australia’s health system - was circulated to stakeholder groups after business hours on the eve of Australia Day suggests there is some nervousness within the Government and the bureaucracy about the proposed arrangements.

“The discussion paper is an insult to clinicians. It proposes that doctors’ input to decision making would be limited to clinical practice issues, not overall hospital and health service management,” Dr Pesce said.

“This is contrary to the intended clinician role announced by former Prime Minister Rudd in a speech to the AMA National Conference in May last year.

“Mr Rudd said that Lead Clinician Groups would also guide Local Hospital Networks in ‘service planning and the most efficient allocation of clinical services …’ and ‘developing innovative solutions that best address the needs of local communities’.

“The paper sets out ways to suppress and limit clinician engagement in decision making, not enhance it – it is a plan for lead clinicians not to lead.

“It appears that all the advice from the AMA and other medical groups has been completely ignored.

----- See more at the link above:

The AMA is also not happy about the Medicare Locals consultation process. See here:

http://ama.com.au/node/6226

So we seem to have all sorts of forces wondering if what Mr Rudd planned is still appropriate and if there are other ways forward. It looks to me that the COAG Meeting, on February 14 I believe, might be pretty important in working out what will happen! There are some pretty concerned major stakeholders out there.

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http://www.abc.net.au/health/thepulse/stories/2011/02/03/3129119.htm

An app a day to keep bad health away

by Suzannah Lyons

Could the path to a healthier, more active you be as close as your mobile phone?

Want to record how many steps you take, keep track of your blood glucose levels, or know when you need sun protection?

Then look no further than your mobile phone.

Our love of ever more sophisticated smartphones has the potential to turn what used to be 'just a phone' into an essential tool for good health, as a growing number of us use our mobiles to access specialised health and fitness apps (short for applications).

And research suggests how we currently use our phones as health tools is only the beginning.

A report released last November found there were 17,000 mobile phone health apps available for both consumers and healthcare providers in major app stores.

The report's authors, market research firm research2guidance, also predicted that 500 million people globally, out of a total of 1.4 billion smartphone users, will be using health apps by 2015.

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http://www.computerworld.com.au/article/375578/connectivity_remains_key_telehealth_success/?fp=4&fpid=5

Connectivity remains key to telehealth success

Broadband, technical support shortages likely to hamper telehealth, say industry stakeholders

• James Hutchinson (Computerworld)
• 04 February, 2011 16:57

The Federal Government must focus on providing suitable broadband connectivity and technical capability to general practitioners and other healthcare providers in order to ensure the success of telehealth services in rural Australia, health professionals have warned.

The scheme, first announced by Prime Minister Julia Gillard during the 2010 federal election, offers $402.2 million in government funding over four years to provide Medicare rebates for some 495,000 online consultations to patients in rural, remote and outer metropolitan areas. The funding will also provide financial incentives and training to health professionals to encourage take-up of the scheme, and $50 million in funding to provide online triage and basic medical advice through videoconferencing.

In a discussion paper released in November last year, the Department of Health and Ageing identified financial incentives and procurement models as some of the obstacles to be addressed ahead of implementation.

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http://www.medicalnewstoday.com/articles/215669.php

GP Health Summaries - Clear Guidelines Needed To Ensure Consistency, Australia

04 Feb 2011

A need to clearly define the key elements of the GP health summary and its application in an electronic health record has prompted the Royal Australian College of General Practitioners (RACGP) to develop a set of seven factsheets to provide advice to general practice and their teams.

The 4th edition of the RACGP Standards for general practices requires that practices can demonstrate that at least 75 percent of their active patient health records contain a current health summary (criterion 1.7.2). To meet the requirements for a satisfactory summary, elements such as allergies and adverse reactions, current medicines list, current health problems, relevant past health history, health risk factors, immunisation, relevant family history and relevant social history need to be included. But what does 'current' or 'relevant' mean?

RACGP e-health spokesperson Dr Chris Mitchell said that there is a need to clearly define the core elements of the GP health summary as health information available through an accurate and current health summary will ensure safe and high quality care for patients.

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http://www.zdnet.com.au/act-health-loses-cio-looks-for-new-one-339308854.htm

ACT Health loses CIO, looks for new one

By Suzanne Tindal, ZDNet.com.au on January 31st, 2011

in brief Australian Capital Territory Health has put out feelers for a new chief information officer to head up the organisation's information services branch.

The position has previously been held by Owen Smalley, who has now resigned, according to the Office of the Deputy Chief Executive.

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http://www.zdnet.com.au/act-health-looks-into-tablets-339308909.htm

ACT Health looks into tablets

By Marina Freri, ZDNet.com.au on February 1st, 2011

ACT Health this week revealed it was investigating the potential use of tablet devices in Canberra Hospital, an initiative that will involve examining Apple's hyped iPad device and other platforms.

Although denying any official trials of the iPad, acting chief information officer Judy Redmond said the department had just initiated a project to examine the functionality of tablet devices both for clinical and administrative use.

She said the iPad was just one of the options available and that ACT Health would be investigating and trialling a number of different tablet devices. Redmond said introducing tablets in an enterprise environment was a challenging practice that involved managing security and updates, workflow changes and the cost of data usage.

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http://www.medicalobserver.com.au/news/ehealth-evaluation-plan-govt-priorities-questioned

E-health evaluation plan: Govt priorities questioned

1st Feb 2011

Caroline Brettingham-Moore

After ongoing criticism of its slow progress on the rollout of the personally controlled electronic health record (PCEHR), the Federal Government has now come under fire for “jumping the gun” with a tender process to find an independent evaluator for the project.

The criticism is the latest blow to the $467 million project, with Medicare recently forced to revise Individual Healthcare Identifier contracts with medical software providers after they were deemed unworkable.

Despite Health Department claims that an evaluation framework was crucial during the program’s development, Health IT consultant Dr David More questioned the logic behind commencing an assessment when the PCEHR remained far from completion.

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http://www.australiandoctor.com.au/articles/d9/0c06e8d9.asp

Patients get ’appy over iPhone apps

3-Feb-2011

By Michael East

TWO iPhone applications have been launched to help patients find GPs in their area or when they are on the move.

Last week, the WA Government launched a new iPhone application to help patients find after-hours general practices in the state.

The application allows users to find their nearest after-hours practice and contains opening hours and contact details.

Once patients find their nearest after-hours practice, they can save the practice details into their phone contacts.

-----

http://www.computerworld.com.au/article/375510/tablets_double_edged_sword_mater_health_services_cio/?eid=-6787&uid=25465

Tablets a 'double edged sword': Mater Health Services CIO

Desktop virtualisation of 3500 PCs also underway

• Hamish Barwick (Computerworld)
• 04 February, 2011 09:36

While some Australian hospitals have embraced tablet PCs, one major health services provider is holding off deployment until improvements are made in the form factor.

According to Brisbane-based Mater Health Services' CIO, Malcolm Thatcher, weight and battery life issues with tablet PCs, such as the Apple iPad, are a major drawback. The CIO also cites voice recognition as a much needed addition, among others.

“We have trialled some various form factors including tablets and mobile devices such as smartphones," Thatcher told Computerworld Australia.

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

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.

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http://www.zdnet.com.au/nehta-given-38-5m-in-e-health-funding-339308953.htm

NEHTA given $38.5m in e-health funding

By Josh Taylor, ZDNet.com.au on February 3rd, 2011

in brief The National E-Health Transition Authority (NEHTA) has been handed $38.5 million in funding for e-health records from the Federal Government as part of the Gillard Government's $466.7 million investment in e-health.

The funding was first revealed by The Australian today and has been allocated to NEHTA by the Department of Health and Ageing as part of the government's two-year investment in e-health.

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http://www.newsmaker.com.au/news/7159

Decrease in Medication Errors at Dunedin Hospital after iSOFT Medication Management Implementation

Wednesday, February 02, 2011 - iSOFT Group

Three months after implementation of the iSOFT Medication Management solution (formerly known as MedChart), Dunedin Hospital of Otago on New Zealand’s South Island has seen a reduction in medication error and an increase in staff efficiency. In two wards, incorrect or missing information was reduced from 82% down to zero.

Staff support for the electronic prescribing system has been strong, with one charge nurse reported as saying there “would be a riot” if the wards reverted to the old system.

The results at the Dunedin hospital, which introduced the electronic medication chart system on 14 October 2010, are in line with a study presented at the 2010 Health Informatics Conference by Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research, University of New South Wales, in August of last year.

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http://www.telegraph.co.uk/technology/8303547/Patient-privacy-is-just-one-problem-for-the-NHS-IT-plan.html

Patient privacy is just one problem for the NHS IT plan

Our report today about criticism of the privacy standards of the Secondary Uses Service (SUS) - the NHS' new system for sharing medical records with researchers - is the latest of many controversies to hit the National Programme for IT.

The massive project, conceived under Labour as the world's largest public sector IT project, is already years behind schedule.

Medical staff have been among the strongest critics of NHS IT plans

Several major suppliers have dropped out, one of the principal software designers, iSoft, nearly went bust, and many doctors and nurses remain to be conviced the National Programme for IT will deliver clinical benefits in return fot the massive outlay by taxpayers. Despite cuts by Labour and the coalition - which also dropped its name - it is set to cost more than £11bn.

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http://www.theage.com.au/victoria/staff-chaos-hits-hospitals-20110201-1acfh.html

Staff chaos hits hospitals

Julia Medew

February 2, 2011

THOUSANDS of Victorian health professionals are either unable to work or are doing so illegally this week after missing a registration deadline set by Australia's new trouble-plagued health practitioner regulation agency.

An update provided by the organisation yesterday said that 5029 Victorian nurses, dentists, physiotherapists, optometrists, osteopaths, pharmacists, podiatrists and psychologists had not renewed their registration to practise with the national body by Monday's deadline.

Some hospitals, including the Royal Melbourne and Monash Medical Centre, yesterday said they were changing their rosters because of unregistered nurses who couldn't work.

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http://www.theaustralian.com.au/national-affairs/health/roxon-steps-in-over-health-register-bungles/story-fn59nokw-1225999806193

Roxon steps in over health register bungles

• Sue Dunlevy
• From: The Australian
• February 04, 2011 12:00AM

FEDERAL Health Minister Nicola Roxon has been forced to intervene to ensure the patients of up to 10,000 physiotherapists, health workers and doctors can claim Medicare rebates after bureaucratic bungling left the professionals unable to practise.

However, the patients of the health workers and doctors may still be unable to claim private health insurance rebates and they could be left without medical indemnity coverage because of teething problems with a new national medical registration system.

The health workers failed to gain medical registration under a scheme introduced in July as the under-resourced Australian Health Practitioner Regulation Agency struggled with the task of registering 290,000 practitioners.

Some of them continued to work because they were unaware their registration had lapsed.

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

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.

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http://www.pharmacynews.com.au/news/Guild-gets-free-access-to-eMIMS-for-interns

Guild gets free access to eMIMS for interns

• By Nick O'Donoghue on 31 January 2011
• 0 comments

Interns taking part in the Pharmacy Guild of Australia’s clinical training program will get free access to MIMS Australia.

The deal between the Guild and MIMS means pharmacy interns who choose the Guild as their training provider will be able to use the eMIMS program, which has been available to pharmacy students and interns on the Pharmaceutical Society of Australia (PSA) program.

David Bryant, a Guild spokesperson, welcomed the agreement, describing MIMS as a vital text for those coming out of university courses.

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http://www.theaustralian.com.au/australian-it/digital-magnetic-resonance-scanner-will-aid-researchers/story-e6frgakx-1225997708573

Digital magnetic resonance scanner will aid researchers

• Karen Dearne
• From: The Australian
• February 01, 2011 12:00AM

RADIOLOGISTS are hoping the first fully digital broadband magnetic resonance imaging system will soon find a home in Australia.

Philips unveiled its Ingenia MR unit at the Radiological Society of North America conference in Chicago late last year, but the product is undergoing regulatory approval processes and is not yet available in the US.

Australian Diagnostic Imaging Association president Ron Shnier said the technology offered enormous potential for new forms of medical research, based on high-quality data obtained from clinical use.

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http://ehealthspace.org/news/enrico-coiera-affirms-ehealth-support

Enrico Coiera affirms ehealth support

Posted Mon, 24/01/2011 - 12:29 by Josh Gliddon

It was the late 1980s and one of the hottest topics in health informatics was artificial intelligence.

One day soon, the thinking went, a clinician would enter a patient’s conditions into a computer and a diagnosis would spit out the other end. As a recent medical graduate, AI was a field that inspired Enrico Coiera. So he started a PhD in artificial intelligence and computer science at the University of New South Wales.

“Back in those days expert systems were hot,” laughs Professor Coiera. “I went from doing my PhD and moved to the UK for ten years, where I was a senior scientist at HP Research, in Bristol.”

When 1999 rolled around Prof. Coiera decided that the time was right to move back to Australia. He was appointed foundation professor of health informatics at UNSW and, along with colleague Branko Celler, now at the University of Western Sydney, co-founded the Centre for Health Informatics.

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http://www.theage.com.au/technology/security/900m-internet-explorer-users-vulnerable-to-datastealing-hack-20110201-1abmd.html

900m Internet Explorer users vulnerable to data-stealing hack

Asher Moses

February 1, 2011 - 10:29AM

Microsoft has warned that the 900 million users of its Internet Explorer browser are at risk of having their computers hijacked and their personal information stolen by hackers.

The company has yet to develop a permanent fix for the security hole but users are being told to apply a temporary fix that prevents hackers from exploiting a hole to install malicious scripts. Users could be targeted simply by visiting an infected website.

In a security bulletin, Microsoft said the flaw affected all versions of Windows and although it had yet to encounter "indications of active exploitation of the vulnerability", the flaw was serious and it was aware of proof-of-concept code exploiting the issue.

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http://www.zdnet.com.au/no-ad-hoc-biometrics-sharing-privacy-chief-339308954.htm

No ad hoc biometrics sharing: privacy chief

By Suzanne Tindal and Colin Ho, ZDNet.com.au on February 3rd, 2011

Australian Privacy Commissioner Timothy Pilgrim has warned pubs and clubs collecting biometric information from their patrons not to "automatically" share that information with other clubs unless they have notified their patrons.

This week the news emerged that the collection of personal information such as biometrics and driver licence details by pubs and clubs has soared. Clubs and pubs use the information to reduce the risk of violence by pinpointing offenders and banning them from venues.

"The office is aware of the use of this technology by some organisations. Any pubs and clubs using this technology should be aware that under the Privacy Act, organisations must provide individuals with notice of what will happen to the collected information," Pilgrim said.

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http://www.cio.com.au/article/374422/open_source_ready_enterprise_ovum/?eid=-601&uid=25465

Open source 'ready for the enterprise': Ovum

ESR to provide greater options for IT managers

• Lisa Banks (Computerworld)
• 25 January, 2011 14:43

Open source software has been found to be functionally sufficient across most organsations and its advancement enables IT managers to choose from a variety of options, according to Ovum.

A new report, Enterprise Search and Retrieval: Exploiting all of the organisation’s information assets, by Ovum analyst, Mike Davis, found that the development of open source software has provided IT managers with more options.

“Free-to-use open source enterprise search and retrieval (ESR) solutions are now ready for the enterprise,” he said in a statement.

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http://www.smh.com.au/technology/sci-tech/nasa-spots-54-potentially-lifefriendly-planets-20110203-1aeaf.html

NASA spots 54 potentially life-friendly planets

February 3, 2011

An orbiting NASA telescope is finding whole new worlds of possibilities in the search for alien life, spotting more than 50 potential planets that appear to be in the habitable zone.

In just a year of peering out at a small slice of the galaxy, the Kepler telescope has discovered 1235 possible planets outside our solar system. Amazingly, 54 of them are seemingly in the zone that could be hospitable to life — that is, not too hot or too cold, Kepler chief scientist William Borucki said.

Until now, only two planets outside our solar system were even thought to be in the "Goldilocks zone". And both those discoveries are highly disputed.

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Enjoy!

David.

AusHealthIT Poll Number 56 – Results – 07 February, 2011.

The question was:

Will NEHTA, DoHA and The Implementation Partners Successfully Deliver a Fully Operational and Functional PCEHR?

The answers were as follows:

For Certain

- 3 (5%)

Yes - With a Few Problems Along The Way

- 11 (18%)

It Will Probably Get Cancelled A Year or So From Now

- 17 (28%)

Not a Snowflakes Chance In Hell

- 28 (47%)

Well that is pretty clear. Readers reckon the PCEHR is a doomed dud! Good to see so many votes!

Votes : 59

Again, many thanks to those that voted!

David.

The PCEHR Seems To Be Something that Needs A Lot More Than 16 Months To Deliver!

In case you were wondering what a the PCEHR System NEHTA has in mind is conceived to be I provide a brief extract from the late November, 2010 Concept of Operations.

On page 50 (as numbered) we read:

5.7 PCEHR-conformant repositories

The PCEHR system will consist of a range of PCEHR-conformant repositories operated at the national and regional level by a mix of public and private organisations. The PCEHR system capability will transition over time to provide access to richer clinical data stored in a range of PCEHR-conformant repositories.

The PCEHR system will consist of:

• A nationally operated repository, designed to provide a distributed set of secure highly available repositories for PCEHR records on a national basis.

This PCEHR-conformant repository will be used to ensure that there is a minimum level of health information available nationally and to support the sharing of critical health information when there is no other suitable repository available locally. It is likely that the national repository will be used to store health summaries and discharge summaries.

• Other PCEHR-conformant repositories will be accessible over time. These

repositories will typically be multi-purpose repositories that may have been designed for other purposes and now include new features to allow it to become conformant with the PCEHR system. Potential candidates include, but are not limited to:

– state, territory and regionally operated SEHRs (e.g. NT SEHR, NSW SEHR);

– Medicare Australia operated repository (e.g. for ACIR and Organ Donor Information);

– privately operated diagnostic services (e.g. repositories operated for/by Pathology and Diagnostic imaging companies);

– other sources including Australian Childhood immunisation register (ACIR), Adverse Drug Event Reporting (ADRAC), implant registers, cancer registries, breast screen registries, etc; and

– commercially operated PHRs (although this is subject to further policy review).

----- End Extract.

From other sources we know there will be an record indexing service, access control services and a template service (whatever that actually is).

What is not clear to me are the following:

1. Where are the health summaries and discharge summaries going to be sourced from?

2. Who will be accountable - and presumably paid - for keeping them current even after they have been uploaded?

3. Who will be accountable for errors in the summaries?

4. How will other non-government entities be paid for their time and trouble to populate the proposed repositories?

5. Who will fund the update of all the affected systems?

6. Who will train and support all the new e-Health users?

7. What happens if your GP does not want to share his records with the Government?

8. More important has anyone actually thought about any of this?

I note the RACGP has come out with some suggestions on e-Health Summaries. This is found here:

http://www.racgp.org.au/ehealth/summary

GP e-health summary

The RACGP is working closely with the National e-Health Transition Authority (NEHTA) to further define the core elements of the GP health summary and its application in an electronic health record. This will provide clinicians with key health information when providing care. Health information obtained through an accurate and current health summary will ensure safe and high quality care is delivered through access to the e-health summary in an electronic health record. Software specifications need to be developed to ensure the design is technically robust. The RACGP has established a group of GPs to work with NEHTA to ensure that electronic health records are integral to the management of patient care and the treatment of patients across the health sector.

Related files

Fact sheet - Allergies and adverse reactions (PDF 191KB)

Fact sheet - Health risk factors (PDF 186KB)

Fact sheet - Immunisations (PDF 186KB)

Fact sheet - Medical history (PDF 186KB)

Fact sheet - Medicines list (PDF 186KB)

Fact sheet - Relevant family history (PDF 186KB)

Fact sheet - Social history (PDF 184KB)

These are worth a browse - if only to see just how much information is envisaged in being shared. and the possible risks of sharing any of this information with anyone without explicit patient consent - which does not actually seem to get a major mention.

The College Standards make it clear that clear consent, beyond just consent for treatment, is required for clinical information to be transferred to third parties:

See pages 12, 29 and 93 among others.

The document is found here:

http://www.racgp.org.au/Content/NavigationMenu/PracticeSupport/StandardsforGeneralPractices/Standards4thEdition.pdf

This caution should have been included at the header of these summaries I reckon.

I wonder how this is actually going to managed and signified. In the UK this has been a major issue which is still not actually resolved as far as I know.

It is also clear the College sees some other issues:

http://www.medicalnewstoday.com/articles/215669.php

GP Health Summaries - Clear Guidelines Needed To Ensure Consistency, Australia

04 Feb 2011

A need to clearly define the key elements of the GP health summary and its application in an electronic health record has prompted the Royal Australian College of General Practitioners (RACGP) to develop a set of seven factsheets to provide advice to general practice and their teams.

The 4th edition of the RACGP Standards for general practices requires that practices can demonstrate that at least 75 percent of their active patient health records contain a current health summary (criterion 1.7.2). To meet the requirements for a satisfactory summary, elements such as allergies and adverse reactions, current medicines list, current health problems, relevant past health history, health risk factors, immunisation, relevant family history and relevant social history need to be included. But what does 'current' or 'relevant' mean?

RACGP e-health spokesperson Dr Chris Mitchell said that there is a need to clearly define the core elements of the GP health summary as health information available through an accurate and current health summary will ensure safe and high quality care for patients.

----- End Extract.

There is a good way to go in sorting out content, accuracy, sharing and consent at the very least!

As for paying for all this some of the issues are flagged here!

www.gp10.com.au/slides/thursday/slide30.pdf

If ever there was something that was not yet properly thought through, seems to not have absorbed lessons from overseas and needs a lot more consultation and work this PCEHR is it!

Time to swallow the pride and start really consulting! As the poll that will report tomorrow shows very few reckon this project - as presently conceived - is a goer of any sort.

David.

Here Is A Different Perspective on Person Centred Health Information Management. Might Be A Better Approach Than NEHTA’s - If We Knew What That Was!

The following appeared a few days ago:

Thursday, February 03, 2011

Person-Centered Health Data Management Systems: Key to Sustainable U.S. Health Care

by Mike Critelli and Jacob Sattelmair

The U.S. health care system is a $2.5 trillion industry comprising multiple powerful stakeholder groups, often with competing interests. It is therefore crucial to identify guiding principles and priorities by which all stakeholders may be held accountable. For example, there is broad consensus for the following two mandates:

• The U.S. health care system needs to function to provide the best possible quality of care and service for the patient (i.e. become more patient-centered).
• The U.S. health care system needs to deliver higher value care in order to improve long-term access and achieve financial sustainability.

Engaging individuals as informed and empowered participants in their health, as well as discerning consumers of health care is essential to achieving these goals.

Person-centered ("person" because we are not all patients) health information management systems -- IT solutions that put individuals in control of their health data, allow them to share their data and communicate with anyone who is involved in their health, and provide them with the information and tools they need to improve their health and health care -- will emerge as powerful solutions that will be critical to the long-term performance of the U.S. health care system.

In an era where clinical and non-clinical digital health information is proliferating, the only way to achieve a truly patient-centered health care system is to aggregate and exchange this information at the point of the patient. Doing so will accelerate efforts aimed at achieving comprehensive patient health records, health information exchange and coordinated care, thus improving care quality and eliminating waste.

Why Are Person-Centered Health Information Management Systems Needed?

The prevalence of largely preventable, lifestyle-related chronic conditions continues to soar, now accounting for an estimated three-quarters of health care spending. Americans need to become more informed, engaged and empowered to improve their daily health behaviors, and, in doing so, stem the rising tide of chronic disease-driven demand for care. Person-centered health information management systems that combine clinical and non-clinical data, mobile capabilities, devices that track behaviors and biometrics, and personalized incentives will become a cost-effective method to achieve population wide health behavioral change.

More here with links:

http://www.ihealthbeat.org/perspectives/2011/person-centered-health-data-management-systems-key-to-sustainable-us-health-care.aspx

As I see it this article is talking about a rather different take on the personal involvement in their Health Information that the one outlined by the still secret (and outrageously so) Concept of Operations for the PCEHR.

I am told NEHTA might be about to issue some tenders for the other partners in implementing the PCEHR while the public still does not know what they are actually up to.

Bluntly this is just outrageous and unacceptable.

David.