Now Here Is a Must Not Miss Free Information Session on Australian E-Health!

The following announcement popped into my inbox a day or so ago.

Sydney: AIIA NSW Healthcare Briefing - "The NEHTA Call to Business"

When:

8:00am - 9:30am, Tuesday, 22 February 2011

Where:

Telstra Experience Centre,

Level 4, 400 George Street

Sydney, NSW, 2000, Australia

Cost:

Free of Charge: FREE!

AIIA NSW Healthcare Briefing - "The NEHTA Call to Business"

As the pace of e-health reform gathers momentum, this is a valuable opportunity to explore the latest opportunities emerging out of Australia’s national e-health investment.

To kick off our year of AIIA Healthcare Briefings, we will be joined by Lisa Smith, who has taken on a challenging new role as Head of Implementation for NEHTA.

Lisa’s appointment marks significant progress in Australia’s e-Health agenda as community and political focus moves beyond planning and design to the establishment of ground-breaking ehealth projects.

* Don’t miss this opportunity to learn about NEHTA’s staged approach to implementation and how this will help fast-track the journey towards a Personally-Controlled Electronic Health Record (PCEHR).

* Find out more about the concept behind Wave 1 and Wave 2 project sites and how the vendor panel is assisting the procurement process.

* Hear about the current status of Healthcare Identifiers and their significance as a foundation for PCEHR design.

* Discover how the private sector can help and get involved!

Our briefing moderator, Andrew James will lead our discussions on what companies need to be doing to be business ready to take advantage of the e-health developments.

Please come along to listen, ask questions, and make suggestions.

AIIA is supporting NEHTA in the introduction of better ways of electronically collecting and securely exchanging health information in Australian healthcare.

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The invitation is found here:

http://www.aiia.com.au/event_details.aspx?ID=746a8340-0230-e011-a034-005056b90019

Go to the website to register. Sounds like a fun one to attend.

I wonder whether any actual clarity on this list of important issues will emerge. Certainly those who can attend should to, at the very least, ask a few hard questions!

The slides and transcripts should hopefully turn up pretty quickly on the NEHTA web site!

David.

A Short Review of How Kaiser Permanente Got The Largest Private EHR System in the World Implemented.

Kaiser Permanente, a large Health Maintenance Organisation in the US, based largely in California has installed the largest integrated e-Health system, covering both hospitals and ambulatory care, in the US. They support over 8 million patients - almost ½ the size of Australia!

The following is valuable reading and proof it really can be done!

Lessons Learned From The Largest Civilian EHR System

Implementation can costs hundreds of thousands of dollars, so it's critical to make wise decisions.

By Phil Fasano, InformationWeek
Jan. 29, 2011
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229200032

Implementation of electronic health records continues across the nation as healthcare providers position themselves to take advantage of the federal government's incentive payment program, which begins this year and can yield tens of thousands of dollars to those that demonstrate "meaningful use." But implementation itself, from the acquisition of equipment, software, and services to training and utilization, can cost providers hundreds of thousands of dollars, so it's nonetheless critical to make wise choices.

In choosing and deploying an EHR system, continually remind yourself of what it is you're supposed to bring to your practice: connectivity and better coordination among care teams; improved quality and patient safety; efficiency and reduced care costs. As you make system choices, ask how these goals can be advanced--or hampered--through specific EHR capabilities.

Kaiser Permanente is proud to have implemented the largest civilian EHR system in the world, KP HealthConnect, developed with Epic Systems and incorporating a number of third-party applications. It securely connects 8.6 million Kaiser Permanente patients (the company calls them "members") to their healthcare teams, their personal health information, and the latest medical knowledge.

Following are some of the valuable lessons we've learned through this ongoing journey, lessons that I hope will provide insight for your own process.

A Team Effort

We created a partnership between clinical and IT staff from the outset to make sure the EHR system would work not only on the technology side, but also in real-time application by front-line clinicians. We never treated the implementation of KP HealthConnect as an IT endeavor; we approached it as a quality initiative supported by the highest level of the organization.

Our physicians and other caregivers were instrumental in this journey from the beginning, and the system was built to facilitate and enhance doctor-patient interaction, not replace it.

We also examined our care delivery workflows and care practices to ensure that the move from paper to electronic processes would be a smooth one. This due diligence helped to expedite the rate at which our doctors embraced EHRs. Still, we needed to evolve our approach as we learned how significantly an EHR changes operational workflow.

For the first time, all eight of our regions were operating on a common technology platform. A change of this magnitude required significant IT infrastructure upgrades, as well as a level of collaboration across all of Kaiser Permanente's regions and assets that had not been required previously.

The collaboration of IT staff and clinicians is also important when selecting vendors and products. By sharing as much information as possible about requirements and workflows, you can ensure that system choices match both infrastructure and the needs of caregivers.

Putting paper records into an electronic system isn't enough. Real-time healthcare requires an always-on technology infrastructure that is highly secure and supports interoperability--with the wide range of equipment and applications used within your organization, as well as with external providers with which you must share information.

The full article is at the URL above.

Phil Fasano is the executive VP and CIO at Kaiser Permanente. Write to us at iwletters@techweb.com.

All one can do is congratulate them for sticking with it, given the huge expensive false start they had a number of years ago before this success!

David.

I Wonder What This Says About the Australian E-Health System Providers?

A major contract for the Australian Defence Force’s e-Health was announce a few days ago.

Software group provides healthier outlook for military

Published on Thu Feb 10 12:59:30 GMT 2011

HEALTHCARE software group EMIS has won a major contract to monitor and help improve the health of Australia’s armed forces.

The Leeds-based group, founded by two North Yorkshire GPs in 1987, yesterday revealed it has been appointed by global technology giant CSC to supply a new electronic health information system for the Australian Defence Force (ADF).

Under a five-year contract, CSC Australia use EMIS’s clinical software to deliver a health records system covering all personnel in the ADF, called the Joint e-Health Data and Information (JeHDI) system.

The new system, which will be based on EMIS’s clinical software – will create a detailed electronic health record for each ADF serviceman and woman, featuring data from recruitment to discharge.

EMIS, originally called Egton Medical Information Systems, said JeDHI will support better and more efficient healthcare, and also allow the ADF to map health trends across its three armed forces.

EMIS chief executive Sean Riddell said: “As well as being the UK market leader in primary care systems, EMIS is also highly experienced at providing military healthcare solutions and our systems are already widely deployed across the world.

“This prestigious contract further extends EMIS’ international reach and reinforces our credentials as a world-class provider of e-health information systems.

“We are delighted to partner with CSC Australia on this project and look forward to working together to make a positive difference to the care of thousands of Australian servicemen and women around the globe.”

More here:

http://www.yorkshirepost.co.uk/business/business-news/software_group_provides_healthier_outlook_for_military_1_3066115

It is hard to understand just why a system from the UK would be selected for the ADF.

While I have no problem with EMIS being selected but the fact does rather beg the question about what is going on locally that this gap cannot be filled by an Australian developed system.

It would be interesting to read the evaluation report and to know which Australian providers submitted a tender.

David.

What Is Currently Being Said About What the PCEHR Actually Is? It is Fantastic is the Real Sense of That Word!

I thought it would be useful to provide a summary of what PCEHR Tenderers are being told about what the PCEHR is and what it is intended to do.

This is directly from the Infrastructure Partner Tender released today.

2 PCEHR PROGRAM DESCRIPTION

2.1 Release 1 Outcomes

2.1.1 In executing its responsibilities under the Contract for the provision of Services specified in this RFT pack, the National Infrastructure Partner will work towards an outcome that aligns with the Government’s commitment to eHealth, as defined by the Minister for Health and Ageing on 11 May 2010:

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia. The national e-Health records system will be a key building block of the National Health and Hospitals Network.

This funding will establish a secure system of personally controlled electronic health records that will provide:

· Summaries of patients’ health information – including medications and immunisations and medical test results;

· Secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;

· Rigorous Governance and oversight to maintain privacy; and

· Health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.

A personally controlled electronic heath record will have two key elements:

· a health summary view including conditions, medications, allergies, and vaccinations; and

· an indexed summary of specific healthcare events.

Implementation of personally controlled electronic health records

Personally controlled electronic health records will build on the foundation laid by the introduction of the Individual Health Care Identifiers later this year. Under this, every Australian will be given a 16-digit electronic health number, which will only store a patient’s name, address and date-of-birth. No clinical information will be stored on the number, which is separate to an electronic health record.

Implementation will initially target key groups in the community likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

This investment includes funding for the first two years of the individual electronic health record business case developed in consultation with all states and territories and the National Electronic Health Transition Authority (NEHTA).

Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.

Reforms to take health system into 21st century

A national e-Health records system was identified as a national priority by the National Health and Hospitals Reform Commission and the draft National Primary Health Care Strategy. It was also supported by the National Preventative Health Strategy.

The Government’s reform plans in primary, acute, aged and community care also require a modern e-Health infrastructure. It is a key foundation stone in building a health system for the 21st century.

A personally controlled electronic health record will not be mandatory to receive health care. For those Australians who do choose to opt in, they will be able to register online to establish a personally controlled e-Health record from 2012-13.

2.1.2 The following table specifies the key outcomes and capabilities to be delivered for Release 1 of the PCEHR Program.

Table 1: Key Outcomes and Capabilities for Release 1 of PCEHR Program

Outcome Area

PCEHR Core Infrastructure

Capability

Consumer Portal

Provider Portal

Indexing and Search Service

Outcome Area

Strengthen Consumer Participation

An appropriate system and interface for accessing Personal Health Records is finalised and ready for implementation.

Capability

Portal for Consumers to access their own health information, manage who has visibility of their PCEHR and view an access audit trail.

Outcome Area

Better Assessment and Treatment Selection

Capability

Pathology report summary information available via PCEHR indexed GP summaries.

Radiology report summary information available via PCEHR indexed GP summaries.

Outcome Area

Safer Medication Management

Capability

Pharmaceutical Benefits Scheme information indexed by PCEHR.

Prescription provider information (e.g. GP Prescriptions) indexed by PCEHR Program.

Outcome Area

Improved Continuity of Care

Capability

Discharge summaries electronically sent from participating hospitals to GPs.

Discharge summary indexed by PCEHR Program.

Referrals from GP to Specialists.

Referral indexed by PCEHR Program.

Outcome Area

Enhanced Coordination of Care

Capability

PCEHR populated with initial static health summary view using readily available information (e.g. Medical Benefits Scheme and immunisation).

PCEHR information is available for download to local GP system upon request.

Outcome Area

Health System Intelligence

Capability

Reporting and evaluation framework.

----- End Extract (Note I have left out the level of requirement for each area as most of it is mandatory)

It seems to me that this set of capabilities are utterly ‘pie in the sky’. Given the tender does not close till March 22, 2011 and evaluation has to take a couple of months, to have 12 months to deliver this range of capabilities is just not realistic.

Of course just how all those in GP land, all the pathology and radiology services and all the hospitalsare going to be lined up to record electronically and provide the required information to populate the PCEHR is an utterly unanswerable and clearly impractical question which is not based on any reality.

I feel this is all part of an enormous and very expensive hoax on the public at large!

David.

Weekly Australian Health IT Links – 14 February, 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:

The most important news this week for the whole health sector will be how the Council of Australian Government Meeting on Sunday has played out. See recent blog for comment.

http://aushealthit.blogspot.com/2011/02/at-least-partial-deal-has-been-done-at.html

No mention of e-Health I could spot.

There is a good conversation on the PCEHR found here:

http://aushealthit.blogspot.com/2011/02/draft-person-controlled-electronic.html#comments

The bottom line to me is that we are all being messed around by the secrecy surrounding just what the PCEHR actually is and how it related to all that has gone before - here and elsewhere!

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http://www.theaustralian.com.au/australian-it/government/e-health-project-costs-rise-by-millions/story-fn4htb9o-1226004579907

E-health project costs rise by millions

• Karen Dearne
• From: Australian IT
• February 11, 2011 5:32PM

THE cost of three lead e-health implementations has risen by $2 million to $14.5m before the projects have even begun.

During the 2010 election campaign, Health Minister Nicola Roxon committed $12.5m to hand-picked GP divisions – GP Partners in Brisbane, GP Access in the NSW Hunter Valley and Melbourne East – to act as lead sites for the government’s $467m personally controlled e-health record program.

Health department documents show each site received $4.83m in grant funding on February 2, bringing the total to $14.5m. The projects are due for completion by June 30 2012, when a PCEHR is supposed to be available for every Australian who wants one.

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http://www.medicalobserver.com.au/news/gps-urged-to-be-wary-of-medicine-bought-online

GPs urged to be wary of medicine bought online

10th Feb 2011

Caroline Brettingham-Moore

GPs have been advised to be wary of counterfeit medicines purchased over the Internet as part of the TGA’s latest initiative to reduce the sale and consumption of illegitimate medicines in Australia.

The initiative includes a new reporting function that went live on the watchdog’s website earlier this week. The online reporting portal allows consumers and health professionals to submit information relating to possible breaches of the TGA’s act.

According to figures released by the TGA, the watchdog has received 146 reports of counterfeit medical products over the last 12 months, with the majority of reports relating to lifestyle medications imported by individuals from unknown Internet sites.

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http://www.theage.com.au/digital-life/ipad/health-tech-setback-as-ipad-halted-20110209-1an3d.html

Health tech setback as iPad halted

Julia Medew

February 10, 2011

HOSPITAL staff will have to continue queueing for computers in Victorian hospitals after the new Coalition government dumped a trial of 500 Apple iPads, which it was hoped would improve internet access this year.

In July last year, the former Brumby government said it had allocated $500,000 for 500 iPads to be given to graduate doctors and nurses in January to help them use the internet as they move around hospitals.

But when The Age asked the new government about the trial this week, a spokesman for Health Minister David Davis said the Brumby government had made no budget-level commitment to the program, leaving a ''black hole''. The spokesman said ''core wireless infrastructure'' required for the mobile iPads was also missing from the former government's plan.

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http://www.scoop.co.nz/stories/GE1102/S00042/dunedin-hospital-pilot-uncovers-serious-prescribing-errors.htm

Dunedin Hospital pilot uncovers serious prescribing errors

Wednesday, 9 February 2011, 3:07 pm

Press Release: Pharmacy Guild

MEDIA RELEASE

9 February 2011

Dunedin Hospital pilot uncovers serious prescribing errors

The electronic prescribing pilot involving two wards at Dunedin Hospital may be extended across the entire hospital, and to Wakari Hospital, after the pilot exposed inadequate prescribing and administration practices.

In yesterday’s Otago Daily Times it was reported that from a sample of 100 paper charts, the pilot uncovered 2,623 instances of harm or near misses from medication errors last year - most of which were unreported or unrecognised.

“The Guild has always asserted that there is a serious prescription error problem in primary health care,” says Annabel Young, Pharmacy Guild of New Zealand Chief Executive. “This is both a patient safety issue and a cost issue for health care.

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http://www.arnnet.com.au/article/376049/csc_takes_prime_role_multi-million_dollar_ehealth_defence_deal/

CSC takes prime role in multi-million dollar eHealth Defence deal

Defence is investing more than $55.7 million into its Joint eHealth Data and Information (JeHDI) system

• Julia Talevski (ARN)
• 09 February, 2011 12:56

CSC has been selected as the prime system integrator with the Department of Defence to develop and implement a multi-million dollar eHealth system for the Australian Defence Force (ADF).

Called the Joint eHealth Data and Information (JeHDI) system, it has also been developed inconjunction with Defence and IT services company, Oakton.

The JeHDI system will provide an eHealth record for all personnel, and also give the Department of Defence the ability to map health-related trends of the ADF and derive financial reports on its healthcare costs.

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http://www.techworld.com.au/article/376036/defence_signs_five-year_e-health_deal_csc/

Defence signs five-year e-health deal with CSC

Undertakes e-health records project

• Georgina Swan (Computerworld)
• 09 February, 2011 12:18

The Australian Department of Defence has has signed a five-year information technology contract with CSC to develop and implement an electronic health information system for the Australian Defence Force.

The system, dubbed as Joint eHealth Data and Information (JeHDI), will be one of the first comprehensive e-health records projects in Australia, according to CSC Australia president, Gavin Larkings.

“This project is an important example of a modernised health system optimising the use of e-health technologies to provide the right healthcare at the right time in the right place,” he said in a statement. “JeHDI is a significant project for Defence and we foresee it as a showcase for Australia's e-health evolution."

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http://delimiter.com.au/2011/02/09/csc-core-to-55-7m-defence-ehealth-project/

CSC core to $55.7m Defence eHealth project

The Department of Defence this morning unveiled plans to build a $55.7 million electronic health system to maintain records about armed forces personnel, commissioning IT services companies CSC and Oakton to assist it with the work.

The project has been named the “Joint eHealth Data and Information” (JeHDI) system and will deploy a military specific, primary care solution known as EMIS into the Defence Information Environment.

In a statement, Defence said it was spending more than $55 million to develop and deliver the JeHDI, which is predicted to be completed by 2014. Gaving Larkings, president of CSC in Australia, said JeHDI was a significant project for Defence and would support the modernisation of the whole organisation.

“This project is an important example of a modernised health system optimising the use of eHealth technologies, to provide the right healthcare at the right time in the right place,” he said.

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http://www.zdnet.com.au/defence-touts-55m-e-health-system-339309075.htm

Defence touts $55m e-health system

By Luke Hopewell, ZDNet.com.au on February 9th, 2011

Australian Defence Force (ADF) personnel has officially kick started work on a new multimillion-dollar, web-based e-health records management platform.

Announced by Minister for Veterans' Affairs Warren Snowdon in Canberra this morning, the Joint e-Health Data and Information system (JeHDI) will hold an ADF member's e-health record, containing medical information from recruitment right through to discharge and is, according to the minister, set to improve the quality of healthcare provided to ADF personnel.

"JeHDI is a web-based system which can be accessed wherever internet is available, while still maintaining confidentiality and data integrity, JeHDI will simplify record management and provide immediate access to patients' medical records and other healthcare information," Snowdon said.

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http://www.yorkshirepost.co.uk/business/business-news/software_group_provides_healthier_outlook_for_military_1_3066115

Software group provides healthier outlook for military

Published on Thu Feb 10 12:59:30 GMT 2011

HEALTHCARE software group EMIS has won a major contract to monitor and help improve the health of Australia’s armed forces.

The Leeds-based group, founded by two North Yorkshire GPs in 1987, yesterday revealed it has been appointed by global technology giant CSC to supply a new electronic health information system for the Australian Defence Force (ADF).

Under a five-year contract, CSC Australia use EMIS’s clinical software to deliver a health records system covering all personnel in the ADF, called the Joint e-Health Data and Information (JeHDI) system.

The new system, which will be based on EMIS’s clinical software – will create a detailed electronic health record for each ADF serviceman and woman, featuring data from recruitment to discharge.

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http://www.theaustralian.com.au/news/health-science/registration-bungle-stops-nurses-working/story-e6frg8y6-1226004019491

Registration bungle stops nurses working

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

NURSE graduates due to start their first day on the job were turned away at the hospital door this week because the new national health registration agency failed to process their registration on time.

The Australian Health Practitioner Registration Agency confirmed it was unable to register more than 10 NSW nurse graduates before they started their first nursing job.

Nurse graduate Penny Foy says she saw four nurses turned away from her new workplace, Gosford Hospital. "We know of 20 that were not registered at the end of last week," she says.

Foy tells Weekend Health her registration arrived a week ago Tuesday, but only after she phoned the agency twice a day and asked opposition health spokesman Peter Dutton to intervene on her behalf.

A spokeswoman for AHPRA says up to 60 NSW nurses turned up at the agency's office on Friday because their registration hadn't come through and agency staff had worked through the weekend to get most of them registered.

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http://idm.net.au/article/008225-dca-secures-nt-messaging-tender

DCA secures NT messaging tender

02.09.11

The Northern Territory department of Health and Families has awarded DCA the tender to provide a territory-wide infrastructure to support secure exchange of health records based on the NEHTA Secure Message Delivery (SMD) specification.

The infrastructure will enable existing software products residing in hospital, community health and aboriginal medical centres to send and receive secure messages amongst each other using a common protocol. The project is a collaboration between DCA, NTDHF, NEHTA, and the major existing software vendors Ascribe and Communicare.

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http://www.techworld.com.au/article/376040/toughbooks_take_precedence_sydney_adventist_hospital_cio/

Toughbooks take precedence at Sydney Adventist Hospital: CIO

Paperless environment a long-term strategy

• Hamish Barwick (CIO)
• 09 February, 2011 11:42

The Sydney Adventist Hospital has made the decision to adopt the Panasonic Toughbook H1 Health mobile clinical assistant for its pharmacists, after literally weighing up the benefits of the device.

The hospital’s CIO, Chris Williams, told CIO Australia that after weighing up the large amounts of documents each pharmacist had to lug around compared to the weight of the Toughbook H1, the hospital decided to purchase eight of the device for its pharmacy.

In addition, other benefits of the device include pharmacists being able to continually update discharge notes and modify them as a doctor prescribes drugs, and patients will receive printed, instead of hand written, prescriptions when they leave the private hospital.

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http://www.theaustralian.com.au/australian-it/victorian-department-of-human-services-extends-reach-of-the-cloud/story-e6frgakx-1226001684516

Victorian Department of Human Services extends reach of the cloud

• Jennifer Foreshew
• From: The Australian
• February 08, 2011 12:00AM

THE Victorian Department of Human Services is planning to put more sensitive systems into the cloud after a US enterprise software service provider began using a local data centre.

Oracle has set up a dedicated CRM On Demand package at its new Sydney Data Centre for the department's 350 users accessing the Victorian Bush Fire Recovery case management system, which supports Black Saturday victims.

The department took possession of the Oracle software in February 2009, when it was run out of Oracle's data centre in Austin, Texas.

CRM On Demand went live at the Sydney data centre in October last year.

Plans for establishing the centre were revealed in September, including a deal with hosting company HarbourMSP.

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http://www.ehi.co.uk/news/acute-care/6629/isoft_wins_double_kiosk_deal

ISoft wins double kiosk deal

10 February 2011 Sarah Bruce

West Hertfordshire Hospitals NHS Trust and North Cumbria University Hospitals NHS Trust have signed a contract for iSoft’s patient check-in kiosks in a deal worth £275,000.

West Hertfordshire is taking eight of the Savience kiosks for its outpatient departments at Watford General, Hemel Hempstead, and St Albans City hospitals.

The trust, which deals with 374,000 outpatient appointments a year, has signed for a fully managed service over five years, which includes six plasma screens and audio equipment for patient calling.

North Cumbria has ordered two kiosks initially, for the West Cumberland Hospital at Whitehaven, under a proof-of-concept project.

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http://www.ehi.co.uk/news/acute-care/6626/two_trusts_use_isoft_pathology_tool

Two trusts use iSoft pathology tool

9 February 2011 Lyn Whitfield

ISoft has announced the first UK sales of its CorVu laboratory management reporting tool.

North Cumbria University Hospitals NHS Trust and St George’s Healthcare NHS Trust have both taken the system, which iSoft has been able to introduce to the UK because of a partnership with US based developers Rocket Software.

The two companies formed a strategic partnership in 2009 to develop Business Intelligence and strategic management applications across iSoft’s portfolio.

North Cumbria University Hospitals NHS Trust will use CorVu to analyse department statistics to improve its turnaround times for pathology tests at the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven.

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

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.

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

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.

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http://www.computerworld.com.au/article/375689/clear_it_vision_ahead_mater_health_services/?eid=-255&uid=25465

Clear IT vision ahead for Mater Health Services

Application development leads to department integration

• Hamish Barwick (CIO)
• 07 February, 2011 12:28

Doubling the rate of eye tissue donations is just one of many positive outcomes for Mater Health Services following the introduction of a new application development platform, InterSystems Ensemble.

Since implementation in March 2010 by the Brisbane-based health provider, a total of 15 applications have been developed including data quality checking, discharge summaries, outpatient appointments and test results acknowledgment, with work for a general practitioner (GP) portal in development.

Ensemble also provides message translation for Healthcare Seven (HL7), an health industry standard which supports structured messages containing complex clinical and administrative data. More than 100,000 HL7 messages are generated by Mater Health Service’s systems daily.

One of the major new apps to be created on the new platform is an eye tissue donation system monitors HL7 messages captured by the electronic patient record from Mater’s patient administration system. After a potential eye donor dies and the death is registered in the system, it generates an email which is converted into an SMS message and sent to Queensland Health which lets the tissue banks know of an incoming donation.

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http://www.cfoworld.com.au/news/533868/global-health-secures-e-health-contract/

Global Health secures e-health contract

18:29, 7th February 2011

By Dylan Bushell-Embling (CFO World)

Australian e-health solutions provider Global Health (ASX:GLH) has revealed it has secured a contract to deploy two of its suites at 40 youth mental health centres.

National youth mental health foundation headspace will deploy Global Health's MasterCare Clinician platform and ReferralNet Secure Messaging suite across its centres nationwide.

The foundation has 30 centres across Australia, with another 10 due to be opened in the second half of 2011.

Under the terms of the deal, Global Health will update the MHAGIC mental health case management system it had previously provided for headspace with the shared electronic medical records provided through MasterCare, while implementing some specific customisations.

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Enjoy!

David.

AusHealthIT Poll Number 57 – Results – 14 February, 2011.

The question was:

On Balance Has NEHTA Been A Good or Bad Thing For E-Health In Australia?

The answers were as follows:

A Very Good Thing

- 9 (21%)

Slightly Better than Neutral

- 5 (11%)

Neutral

- 3 (7%)

Slightly Worse Than Neutral

- 5 (11%)

A Very Bad Thing

- 20 (47%)

Well that is seems pretty clear with 58% suggesting a bad thing and 32% saying NEHTA is a good thing!

Votes : 42

Again, many thanks to those that voted!

David.

At Least A Partial Deal Has Been Done At the COAG Meeting on Health Reform. A Long Way From The Initial Vision or What Is Needed I Believe.

The following report appeared a little while ago on the ABC.

Deal done at COAG health meeting

Prime Minister Julia Gillard has emerged from a tough day of negotiations with state and territory leaders with a national agreement in place on health reform.

After more than seven hours of talks at the Council of Australian Governments (COAG) meeting at Parliament House in Canberra, the leaders finally put pen to paper on a heads of agreement for a health reform plan that Ms Gillard described as a "huge step forward".

Ms Gillard said with the heads of agreement in place, the technical details would now be worked through.

It is understood the deal, which was put forward last week, was held up as the leaders argued over Ms Gillard's proposed national health funding pool, which the Prime Minister said would boost transparency.

Ms Gillard said leaders have agreed to have one body distribute the money instead of having separate bodies for each State and Territory, and stressed the federal, state and territory governments would now be 'equal partners in growth'.

"It [multiple distributing bodies] would have risked over time that information was not truly comparable nationally," she said.

"As a result of today's agreement we are sweeping away those eight separate bureaucracies for one national funding body.

"While this has been a very long day, it has been a very successful outcome.

More here:

http://www.abc.net.au/news/stories/2011/02/13/3137595.htm

At least we have got some of the reforms now hopefully in place - but it is a long way from the objective of fixing the ‘blame game’ as far as I can tell. You have to say this was pretty predictable despite the huffing and puffing from the Premiers etc.

It is worth noting that the SMH is reporting that the 'final deal' will be finalised by COAG at a mid-year meeting so this may not be exactly as final as initial reporting suggests.

That the details of actually how funding will flow is still to be sorted leaves a fair bit of room for later problems before the final agreement as Colin Barnett has already said.

Prof John Dwyer put it will on ABC redio pointing out that this was actually a hospital fundinding reform deal and not actually a health system reform deal that shifted the emphasis and model of care to the proper emphasis on prevention, integration and primary care.

No mention of e-Health in the ABC report.

David.

NEHTA Releases A Set of Documents Describing Integration of the Health Identifier Service With the HealthSMART Program in Victoria. Not There Yet!

The most interesting to me is this document of the release is this one:

Vic IHI Integration Clinical Risk Assessment Report v1.1

The document is one of a series of specifications and so on produced as part of a IHI Pre-Implementation Project between NEHTA and HealthSMART.

An overview is found here:

Vic IHI Integration Project Deliverable Release Note 1.0

Overall the project is to deliver the following we are told:

“Project deliverables include:

• Business Requirements

• IHI Integration Functional Design

• IHI Clinical Risk Assessment

• IHI Best Practice Guide

• IHI Integration Technical Design

• IHI Integration Solution Architecture.”

Interestingly the IHI Solution Architecture itself was held back for a later release as it was not ready yet (as of 11-02-2011).

As mentioned, I was especially interested to read this document. Interestingly the risks around the use of the CDMS as the source data for the HI Service seem to not get much discussion or review as far as I can tell.

2.2 Clinical Risk Assessment

This document provided an important input to the Vic IHI Integration Design, and much of the design exists to address the risk areas identified. This document was prepared by the project team with input from health service and other staff well versed in evaluating and mitigating clinical risks.

This document is user and clinician focussed, but may also be of interest to designers and architects of health IT systems.

This is the Table of Contents:

Table of Contents

1. Document Overview

1.1 PURPOSE

1.2 INTENDED AUDIENCE

1.3 REFERENCES

2. Introduction

3. Scope

4. Risk Assessment Report Summary

4.1 APPROACH

4.2 IMPLEMENTATION ASSUMPTIONS

4.3 RESULTS OVERVIEW

4.4 DISCUSSION OF THE HAZARDS ASSESSED AS MEDIUM

4.5 DISCUSSION OF THE HAZARDS ASSESSED AS LOW

5. Detailed Hazards Assessment and Recommended Controls

5.1 HAZARD 001: MISIDENTIFICATION OF THE PATIENT ASSOCIATED WITH AN IHI

5.2 HAZARD 002: INABILITY TO IDENTIFY PATIENT BY IHI IN CLINICAL CARE SETTING

5.3 HAZARD 003: PRIVACY OF PATIENT INFORMATION IS BREACHED

5.4 HAZARD 004:WHOLE OF PART OF THE SYSTEM IS UNAVAILABLE OR ACCESS IS INAPPROPRIATELY DENIED

6. Appendix: NEHTA Sentry Clinical Safety Risk Assessment Criteria

6.1 CLINICAL RISK SEVERITY CATEGORIES

6.2 LIKELIHOOD CATEGORIES

6.3 CLINICAL RISK CLASSIFICATION MATRIX

7. Glossary.

Just a few comments:

First just why is this the first time we have heard of this document?

NEHTA Hazard Assessment Report – Health Identifiers Release 1, v 1.0 , Feb, 2010

Second on page 6 we read:

“A constraint upon this review was that specialist training in NEHTA Clinical Safety Management methodology, and NEHTA Clinical Risk Assessment of Release 3 HI Service functionality was not available at the time of this Risk Assessment. Capacity to participate in Jurisdictional Clinical Safety Management was identified during this project as a gap in NEHTA support. The NHCIOF have subsequently sponsored a Gap Analysis and Clinical Safety Management Model to be delivered by NEHTA in January 2011.”

Translation from bureaucratese - The team were not ready and not trained to undertake the review!

Further on we read:

”The introduction of healthcare identifiers, whilst designed to improve quality and safety in clinical communication and electronic identification of patients to support clinical care can also increase risk of harm to patients.

The Australian Commission on Safety and Quality in Health Care, Report ‘Review of Technology Solutions to Patient Misidentification’ (2008) notes that:

Throughout the healthcare sector, the failure to identify patients correctly and to correlate that information to an intended clinical intervention continues to result in wrong person, wrong site procedures, medication errors, transfusion errors and diagnostic testing errors.

In examining the potential for technology to assist in solving this problem, the Commission’s key finding noted:

· Diligent execution of appropriate process/workflow remains the key aspect of patient identification. Technology is an enabler, not a sole solution.

· To be successful in the long term, implementation implies ubiquitous deployment of the technology throughout the patient journey.

· The importance of formally developed corporate implementation strategies, planning, and process scoping should not be underestimated.”

So this implementation all needs to happen pretty carefully - or some big issues can flow!

Third on page 8 we then read:

The preferred architecture for the IHI capture in the Victorian health service is as an alternate identifier. The local URN will not be replaced in the short term by the IHI in Victorian health services.

This Risk Assessment did not consider the obtaining and use of healthcare identifiers beyond the individual healthcare identifier (IHI), i.e. the scope does not include Provider Healthcare Identifiers, HPI-I and HPI-O.

This leads one to ask just when the system will actually be trusted in use. Not soon would seem to be the answer.

It seems to me the real ‘guts’ of the assessment is here. On Page 10.

4.3 Results Overview

“Assessment of the level of Clinical Risk associated with the introduction and use of the IHI was seen to be mitigated internally for health services through its use in conjunction with a local UR number. The effect of not relying solely on the IHI was that it reduced overall risk levels. Therefore it is important to realise that the ratings noted in the following review would have been assessed as higher in a situation where the IHI is used singularly to identify a patient.

Where the IHI is used singularly at the point of exchange between health services, ie the sending or receiving a patient referral with an IHI, increased checking of patient demographics with the HI Service to verify the IHI has been included in the controls.

There were two key Clinical Hazards reviewed where the clinical risk was assessed as Medium, however only where the IHI is used in conjunction with a local UR number. If the IHI is used in isolation then these Clinical Hazards would result in High risks.

The identified Hazards were:

· Misidentification of the patient associated with an IHI.

· Inability to identify the patient by IHI in a clinical care setting.

The rating of Medium defines that the clinical risk is of moderate severity and that it may create a situation that is serious and potentially life threatening, however the clinical risk may also be avoided/prevented by a Clinician. This level risk requires that stakeholders be notified of the risk as soon as practicable and appropriate mitigating actions agreed.

If the IHI is used singularly these Clinical Hazards would be considered High risk. High Risk signifies major or catastrophic severity risks that create a situation that is inherently and immediately threatening to a patient’s life. The clinical Hazard may results in permanent harm and/or death to a patient. Harm is unlikely to be prevented by a Clinician in these circumstances. This category will also apply to a Clinical Hazard that causes many occurrences of Moderate or Major Severity.”

This really seems to be saying that, at present, relying on the IHI alone is not recommended and hence the decision to go with both the URN and IHI.

If ever there was a case for staged careful implementation of this service this assessment seems to make it pretty strongly.

It also seems to me that developing a PCEHR service to rely on the HI Service, with unproven work practices and flows, until we are sure all the wrinkles of the foundation are fully managed would be very silly indeed. The technology really does not matter unless the HI Service is a real improvement on what is happening now - and it is not obvious that is true.

We won’t even mention that the overall situation of the HealthSMART Program also seems to be under review!

David.