Here Is A Model of Health IT Development and Delivery We Should Have a Close Look At.

The following was published overnight.

Tuesday, March 22, 2011

The Direct Project: Accelerating Government Innovation in Health IT

by Richard P. Adler

In February 2011, two pilots of a new standard for sending health information securely over the Internet were launched. The pilots -- one in Minnesota and one in Rhode Island -- are the first tests of the Direct Project, an HHS initiative designed to simplify the exchange of information within the health care industry.

The most noteworthy aspect of this initiative is how quickly it happened. These initial pilots are taking place less than a year after the Direct Project was started.

The project represents an unusual experiment in accelerating the creation of the Nationwide Health Information Network. The project has demonstrated how rapidly a "lightweight" open process can yield useful results compared with typical government-sponsored IT development projects.

Developing NHIN

Development of NHIN began at HHS in 2005. It was intended to provide a robust, comprehensive electronic infrastructure for sharing health-related information among multiple agencies.

The NHIN project grew out of a realization that a great deal of time and effort had been invested in developing standards for the format and structure of medical information (such as the data in health records), but relatively little attention had been paid to how this information could be shared by different parties.

According to Brian Behlendorf -- who served as an adviser to HHS on the Direct Project (and now is the chief technology officer of the World Economic Forum) -- it was as if the creators of the Internet had focused all of their attention on deciding whether HTML or PDF was the best standard for presenting information online but neglected to establish a communications standard like the URL ("uniform resource locater"), the simple address scheme that is the key to allowing information to be easily found anywhere on the World Wide Web.

Development of NHIN was well funded, but it was carried out in a traditional governmental process -- specifications and parameters for the project were carefully defined in advance, a request for proposals was issued and a contractor was selected to carry out the work.

In an effort to increase the usefulness of NHIN, the government decided to use an open-source model for development of the software. This approach did expand participation in the project: an open-source community began to grow around the effort, and several private companies built applications to extend the functionality of NHIN. However, the effort also had significant limitations.

Development was done in Java, an open-source tool that is powerful but relatively difficult to learn. Some parties criticized the effort as being too broad and trying to accomplish too much at one time. Further, actually using NHIN Connect would require a relatively high degree of trust because (much like the Web) information placed in the system would be available to any other party who requested it, an arrangement that was potentially at odds with stringent HIPAA standards designed to protect the privacy of sensitive medical information.

Enter the Direct Project

In response to an HHS advisory panel recommendation, a decision was made in late 2009 to pursue an alternative approach that would be faster and less complicated to implement because it was more limited in scope. This new project, known initially as NHIN Direct, would be more like an e-mail service that allows two parties to directly exchange information between themselves (rather than making it publicly available), which simplified the issue of trust. In addition, the development process for this alternative would be much less structured.

HHS agreed to try using an "organic" process that involved inviting all interested parties to participate. The project leader agreed to serve as the "orchestrator" of an open development process ("air traffic controller"), rather than as a contractor responsible for writing the software. Since funding for the project would end in 2011, the goal was to have a working prototype completed by the end of 2010.

The Direct Project, as it came to be known, was built around:

• A wiki (http://wiki.directproject.org/) that could be accessed and edited by anyone;
• An open code repository (http://code.google.com/p/nhin-d); and
• A blog (http://nhindirect.typepad.com/nhin-direct) maintained by the project leader.

A weekly conference call open to all interested parties was set up to identify issues needing attention and keep everyone informed of the project's progress. Notes from the calls were published on the wiki, where a continuously updated list of current tasks and their status also was available.

When the project was officially launched in March 2010, the expectation was that it would attract perhaps a dozen outside participants. However, within a few months, more than 60 organizations -- including both major software and health care IT companies, as well as much smaller firms -- had gotten involved.

Moving Swiftly

Over the next 11 months, the project progressed from initial discussion of the goals of the project to the development of a model to the creation of a set of prototypes to the launch of the first pilot implementations.

More here and lots of links:

http://www.ihealthbeat.org/perspectives/2011/the-direct-project-accelerating-government-innovation-in-health-it.aspx

What I hope people do is read here and then go on to the iHealthBeat site and read the rest of the article.

It is really hard to imagine a more different process of attempting to deliver Health IT than this when compared with the pathetic efforts of DoHA and NEHTA.

What this effort has is leadership, governance and purpose - all of which are lacking from the Australian efforts in my view.

What is being done in the US is almost certainly not perfect, but there are so many lessons about how to get things done and how to interact with experts and clinicians what is being done deserves careful study.

Enough said, go read and try and control the fury that reading will induce when you compare there with here! Chalk and cheese.

NEHTA and DoHA do not know what openness, consultation and transparency mean. Even worse they don’t get how important they are!

For those who want to follow up the technical details the following which also appeared overnight will help:

Direct Project Specifications Achieving Widespread Adoption: Could Positively Impact Care Coordination Soon for Millions of Americans

March 21, 2011, 9:30 am / Dr. Doug Fridsma / Director Office of Standards and Interoperability

As an internal medicine physician, I know how hard it was to coordinate patient care across diverse health care systems. Primary care providers struggle to keep up with the flow of information coming in and going out of their offices on faxes, couriered documents, and hand carried patient notes. The Direct Project was created to address this problem head-on by creating a simple, secure way to send this information electronically, so that providers can concentrate on what counts: excellent patient care.

Today, The Direct Project announced that over 60 health care and health IT organizations , including many state based and private sector health information exchanges, leading IT vendors, and several leading integrated delivery systems, have planned support for the Direct Project. The broad reach of so many significant national players is helping the project reach its goal of providing health care stakeholders with universal addressing and universal access to secure direct messaging of health information across the U.S. This is quite an accomplishment, given that the Direct Project just started twelve months ago.

This broad swath of support for the Direct Project represents approximately 90% of market share covered by the participating health IT vendors. With over 20 states participating in the project, including many of the largest states in the country, nearly half of the total U.S. population can now benefit from the Direct Project’s growing integration into the national health IT ecosystem. Growing participation with the Direct Project will alleviate a health care system awash in a sea of paper and faxes.

The Office of the National Coordinator for Health Information Technology (ONC) convened the Direct Project to expand the existing specifications incorporated in the Nationwide Health Information Network to be as inclusive as possible for any caregiver regardless of their technology used or the size of the organization. The Direct Project is facilitating “direct” communication patterns, meeting the providers where they are today, with an eye toward approaching more advanced levels of interoperability as they invest in health IT systems.

The result of this groundbreaking public/private collaborative is a set of specifications for simple and directed messages among caregivers and to patients

Widespread Adoption – Up to 160 Million Americans May Soon be Positively Impacted

Many of the country’s largest health IT vendors, most populous states, and robust integrated delivery systems are incorporating Direct Project specifications into their health IT systems. What’s exciting about this growing list of organizations is that over half the country’s population could benefit from the availability of secure, directed health information messaging. The numbers are sure to continue growing in the coming months as more organizations support Direct Project specifications for health information exchange. A complete list of participating organizations, including states, health information exchanges, and health IT vendors, is available on the Direct Project website .

Transport of Coordination of Care Messages

The Direct Project also announced finalization of the Direct Project specifications, including the core Direct Project requirements and a specification which describes how EHRs and other health IT systems can leverage the Direct Project to securely exchange direct messages. Such communication is critical, especially when a primary care doctor in the U.S. on average has to coordinate care with 229 doctors across 117 different practices . The Direct Project helps address the technology interoperability challenge created by needing to coordinate with such a large group of diverse organizations. It does so by fulfilling the promise of a real-time secure electronic transport mechanism for referrals and clinical documentation, integrated into the health care workflows and systems across different settings of care. This has enormous impact on the provider’s ability to keep the patient at the center of care. The Direct Project meets providers where they are today and grows with them as they invest in electronic health records, enabling EHR to EHR direct message transport.

More details here:

http://www.healthit.gov/buzz-blog/meaningful-use/direct-project-specifications-achieving-widespread-adoption-positively-impact-care-coordination-millions-americans/

Enjoy and reflect how much better this could be managed!

David.

Australian Doctor Reviews Some Implications Of the PCEHR Proposal. It Seems The Docs Are Being Alerted to Some Worrying Things Coming!

The following couple of articles appeared in the Australian Doctor last week.

EXCLUSIVE: GPs to be e-record guardians

16-Mar-2011

Paul Smith

GPs will take the key role in “curating” millions of patients’ e-health summaries to ensure they are accurate, safe and clinically relevant, Australian Doctor has been told.

A three-month consultation on the $467 million system is due to start shortly with the patient-controlled e-health records to be launched from July next year. The records will include a patient summary listing medications, diagnoses and allergies, which in most cases will be uploaded from a GP’s own patient summary.

The system will also include records detailing hospital discharge summaries, diagnostic results, event summaries and details on Medicare claims.

Patients will have to decide who can access which parts of their records and they will also choose the health practitioner to manage the information in their summary. In most cases, this is expected to be their usual GP. However, patients will also decide what clinical information appears on their summary record, meaning GPs will have to gain their consent to make changes.

Critics are concerned about the workload impact, but also point out that some people with sensitive conditions — such as mental illness, HIV or epilepsy — may choose to omit clinical information considered medically necessary to ensure safe patient care. It has yet to be decided if it will be clear to other health professionals that clinical information has not been included.

More here:

http://www.australiandoctor.com.au/articles/77/0c06f677.asp

The article is followed by a range of comments many of which were concerned about practicalities which have yet to really be addressed by anyone.

There was also a commentary on the initial report by the same author.

Some big questions remain

16-Mar-2011

Analysis by Paul Smith

The biggest issue in general practice this year is going to be these e-health records. Don’t allow yourself to be befuddled by the painful jargon employed by IT nerds, the meaningless acronyms they spout and the impenetrable way they explain their work to the wider world.

These records are meant to provide the basis for doctors — and others in the health system — to do their work. The core issue is the integrity of the information the records offer and whether that information is in a form that makes it clinically meaningful and usable.

In theory the ability to access summary health records — that list event and discharge summaries, perhaps diagnostic tests, along with medications and diagnosis — has the potential to fill the systemic cracks in modern day healthcare. But this means nothing if the clinicians cannot trust what they are reading. The initial experience of doctors with the UK’s own billion pound e-health experiment is an expensive testament to that.

The big questions facing those leading Australia’s e-health revolution were raised by Professor Enrico Coiera, a health informatics expert at the University of Sydney, in a Medical Journal of Australia article last year — and those questions are not about healthcare identifiers, interoperability issues or terminology domains. Professor Coiera, who is yet to be convinced of the need and value of summary health records, asks: “Who is to decide whether a drug should remain on a patient’s current medications list when they are treated by multiple clinicians? How do old drugs get dropped off the list?

“This synthetic act requires time, access to a wide variety of detailed data sources, clinical knowledge and familiarity with the patient. It might also require team consensus. The quality of a [summary care record] is compromised if crucial data are missing, if old data persist, and if no one is there to ‘join the dots’ across the data.”

Ultimately it will be patients who choose the health professional to “join the dots” but in most cases they will choose their usual GP.

More here:

http://www.australiandoctor.com.au/articles/e5/0c06f6e5.asp

Again we have multiple comments related to the vagueness and lack of practicality of the PCEHR proposals that have managed, thus far, to make their way into the public domain.

What these two articles show is that the PCEHR proponents are not doing a very good job of either communicating their plans or making it clear what the implications will be for those involved. Of course not getting this right will dramatically increase the risk of overall failure of the total project.

If the professional clinical newspapers are pointing out major flaws in what is proposed maybe some form of rethink is needed!

I get the sense those attempting this flawed project really don’t have a clue as to what is required to have any chance of success. They don’t seem to understand that a high level of clinician understanding and support is a binary critical success factor. Low levels of support it is finished - high levels of support are necessary but by no means sufficient for success!

David.

Guess What? You Can Now Leak To This Blog Without Risk That I Will Be Forced to Snitch on You By the Law!

Apparently there has been some really good news come out today from the Parliament!

Journo shield laws now cover bloggers and tweeters

• James Massola
• From: The Australian

BLOGGERS and tweeters will enjoy the same shield law protections as journalists under newly amended laws that passed through federal parliament today.

But the new laws, which aim to give protection against being forced to reveal confidential information or sources, do not extend to those who make anonymous comments on news sites and blogs.

The amendments broaden the definition of journalist to include so-called new media journalists, citizen journalists and independent media organisations.

The original laws proposed by Tasmanian independent Andrew Wilkie had passed through the House of Representatives but were amended in the Senate by the Greens and sent back to the lower house.

Backed by Labor and the cross bench, the amended laws “recognise the rapidly changing face of news, news mediums and the people who deliver it,” Mr Wilkie told parliament.

The broader definition was necessary to keep up with the the “seismic shifts” in news media, he said.

More here:

http://www.theaustralian.com.au/business/media/journo-shield-laws-now-cover-bloggers-and-tweeters/story-e6frg996-1226025441600

What this means is that if you leak to me some crappy NEHTA plan then they cannot demand I tell them who it was who leaked as I have ‘shield law’ protection!

Of course I have never snitched to date - but this protection means I can really say - sorry I am protected and can't say where this came from - and that is the law!

All interesting documents are now welcome! Amazing stuff!

David.

Weekly Australian Health IT Links – 21 March, 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:

It has to be said that e-Health has rather taken a back seat with what is presently going on in both Japan and Libya, to say nothing of the emerging problems in Yemen, Bahrain and Saudi Arabia.

We live in very uncertain times and it seems to me those things we can actually manage and deliver properly we should just get on and do and clearly e-Health falls into that category rather than the external and far more difficult categories.

It would be good to think this might actually happen but I have to say with the shenanigans we are presently seeing from NEHTA and DoHA (with continuing secrecy and lack of leadership, governance and transparency) I sadly am fearful this will not be the case.

I hope the world will look to be a better place in a week’s time (with reactors safe and fighting stopped) when I next contribute a comment. E-Health might take a little longer to look better!

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http://www.theaustralian.com.au/australian-it/nt-leads-in-developing-e-health-platform/story-e6frgakx-1226021389660

NT leads in developing e-health platform

• Karen Dearne
• From: The Australian
• March 15, 2011 12:00AM

THE Northern Territory is first to adopt a jurisdiction-wide e-health platform, selecting InterSystems's enterprise integration hub Ensemble to connect shared medical records and messaging services across the sector.

Northern Territory Health chief information officer Stephen Moo said the aim was to create a robust hub to handle growing volumes of clinical messaging and resolve interoperability issues.

"We've got critical mass in e-health adoption by our clinical community, they're becoming reliant on it and we need a high-calibre service," Mr Moo said.

"This investment will give us an integrated enterprise solution.

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http://www.zdnet.com.au/nt-preps-for-e-health-roll-out-with-hub-339311349.htm

NT preps for e-health roll-out with hub

By Josh Taylor, ZDNet.com.au on March 15th, 2011

The Northern Territory Department of Health has unveiled plans to roll out an e-health communications system across the territory in preparation for the implementation of the Federal Government's e-health agenda.

The e-Health Enterprise Integration Hub being implemented by InterSystems and DWS Advanced Business Solutions will build on the territory's existing secure messaging delivery system that was aligned with the standards proposed by the National E-Health Transition Authority (NEHTA). The system will be able to use individual health identifiers, personally controlled e-health records (PCEHR) and the National Authentication Service for Health.

The current health network provides electronic healthcare records to some 40,000 of the territory's 200,000 residents, NT Department of Health CIO Stephen Moo told ZDNet Australia. The network relies on "system to system" interfaces to connect to 105 sites together processing 60,000 transactions over the network each month.

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http://www.techworld.com.au/article/379798/northern_territory_implements_e-health_hub/

Northern Territory implements e-health hub

Hub will allow connected healthcare applications in the Northern Territory to utilise clinical data from other systems and provide a single point of integration for each application

• Chloe Herrick (CIO)
• 15 March, 2011 15:35

The Northern Territory Department of Health and Families (DHF) has implemented an enterprise grade e-health integration hub across its entire jurisdiction.

The hub, provided by InterSystems, will allow connected healthcare applications in the Northern Territory to utilise clinical data from other systems and provide a single point of integration for each application with an architecture that simplifies the task of creating and maintaining interfaces.

DHF CIO, Stephen Moo, said the agency’s aim was to create an e-health hub to ensure healthcare providers could share clinical information easily and securely for the best healthcare outcomes.

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http://www.newswiretoday.com/news/87170/

myMedirecs Introduces Personal Medical Alert USB Devices - Puts Medical Records Control in the Hands of the Patient

NewswireToday - /newswire/ - Sydney, New South Wales, Australia, 03/15/2011 - myMedirecs Corp has broadened its range of Personal Medical Alert USB devices that carry the award winning myMedirecs Personal Medical Records Management suite, providing immediate access to critical medical information.

myMedirecs, a leading provider of Medical Records Management solutions, has released an enhanced range of USB devices that carry a person’s critical medical information using the myMedirecs software, which can be readily viewed by first responders, hospitals and medical practitioners. The immediate availability of such information can be beneficial to both patient and practitioner as it empowers those who provide emergency and general medical services with current information on which to make informed decisions that could well be life saving.

"Consumers are becoming more aware of the importance and value of maintaining copies of their own personal electronic health records, particularly for emergency situations, and even the more typical of requirement such as travel and relocation." says Karyn Harris, Research Coordinator at myMedirecs. "Your health is one of your most valuable possessions, likewise your medical record information, it’s yours, shouldn’t it be under your control?" asks Harris, adding. “We plan to release further initiatives in support of this objective in the near future.”

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http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=526:msia-taking-shortcuts-will-get-you-lost

MSIA: Taking shortcuts will get you lost

Written by Dr Geoffrey Sayer | 06 March 2011

I spend a lot of time in Auckland. Auckland is a wonderful and beautiful city. I like to think Auckland is well known to me. I know Auckland CBD better than the locals. I know how to get to where I want to go. But because I know Auckland, it doesn’t mean I know the surrounding suburbs of Auckland, the surrounding regions of Auckland, nor the rest of New Zealand.

.....

In the e-health world, we want to move away from where we are to what we believe will be a better place, and indeed a place that we haven’t been to before: the Personally Controlled Electronic Health Record (PCEHR). While slightly longer than a long weekend, there is limited time (July 1, 2012) to connect a considerable number of pieces together to achieve the deadline. We of course have to be careful that we don’t break the pieces in doing so, or we won’t be able to make them fit.

Careful planning and detailed maps will give you the best chance of getting you where you want to go. The beauty of careful planning and detailed maps is you can share these resources with others. Planning and objective setting can also temper overzealous ambition, while still delivering tangible benefits from the journey. Remember the journey itself can bring delights and benefits.”

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http://www.computerworld.com.au/article/380089/medicare_launches_online_cash_claiming_tool/?eid=-6787&uid=25465

Medicare launches online cash claiming tool

Medicare customers are now able to claim doctor's consultations online

• Chloe Herrick (Computerworld)
• 17 March, 2011 11:53

Medicare Australia has launched a new online service enabling customers to claim doctor’s consultation fees online and reduce the time taken to claim benefits manually at their local branch.

Human Services minister, Tanya Plibersek, said in a statement that the new online service would provide convenience to millions of Medicare customers.

“By first signing up to Medicare’s online services, and then entering the required details, customers will receive direct payments into their bank account,” Plibersek said in a statement.

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http://www.zdnet.com.au/thousands-flock-to-medicare-online-claims-339311522.htm

Thousands flock to Medicare online claims

By Luke Hopewell, ZDNet.com.au on March 17th, 2011

Medicare Australia has gone live with a new online claims system that allows customers to submit their bills for refund online.

The new claims system, which has been live for just over two weeks, has already attracted almost 1950 successful claims, Medicare told ZDNet Australia in a statement today.

Customers can access the online claims system using their Medicare Australia Online Services log-in, a system that already has over 2 million registered users.

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http://www.cio.com.au/article/379764/nsw_health_ups_cio_ranks_new_it_support_director/?eid=-601&uid=25465

NSW Health ups CIO ranks with new IT support director

New career follows two recent CIO roles

• Rodney Gedda (CIO)
• 15 March, 2011 10:32

A month after appointing a new CIO for its e-health and IT strategies the NSW Department of Health has appointed a director of strategy and architecture for health support services (HSS) ICT.

Tim Hume has accepted an offer of appointment to the “key position” of director, strategy and architecture with HSS ICT, based in Chatswood, NSW.

Hume will work with HSS ICT CIO, Greg Wells on project planning and implementation of each stage of NSW Health’s ICT Strategy.

New IT leaders will drive the development, implementation and operation of NSW Health’s ICT strategy and network in conjunction with the department’s health networks

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http://www.apo.org.au/research/digital-identity-emerging-legal-concept

Digital identity: an emerging legal concept

• Clare Sullivan
• University of Adelaide Press

Read the full text

PDF Digital identity: an emerging legal concept

10 March 2011This study discusses digital identity in a transactional context under a national identity scheme.

It contrasts the right to identity to the right to privacy in the context of a national identity scheme, and defines identity theft and its consequences.

The analysis and findings are relevant to the one proposed for the United Kingdom, to other countries which have similar schemes, and to countries like Australia who have the long term goal of establishing one.

Under a national identity scheme, being asked to provide ‘ID’ will become as commonplace as being asked one’s name, and the concept of identity will become embedded in processes essential to the national economic and social order.

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http://www.theaustralian.com.au/news/nation/medications-kill-more-than-cancer-or-heart-attacks/story-e6frg6nf-1226022801971

Medications kill more than cancer or heart attacks

• Sue Dunlevy
• From: The Australian
• March 17, 2011 12:00AM

MEDICINE-RELATED deaths are killing more people than heart attacks or cancer.

And one in three prescriptions checked by a medication screening program had an error, according to a new book launched today.

Around half a million Australians experience an adverse effect from their prescription medication every year, says pharmacist Ken Lee, whose study "How Safe is Your Prescription" will be launched at the Australian Pharmacy Professional Conference today.

His research shows about 190,000 hospital admissions a year are associated with medicines and their harmful side effects. And the inappropriate use of medicine is costing Australia about $660 million a year.

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http://www.theaustralian.com.au/australian-it/bionic-eye-project-short-sighted-in-rejecting-us-bid/story-e6frgakx-1226021373923

Bionic eye project short-sighted in rejecting US bid

• Chris Griffith
• From: The Australian
• March 15, 2011 12:00AM

AUSTRALIA lost an opportunity to access state-of-the-art research for creating a bionic eye when it rejected a partnership with a US company trailblazing its development.

This month Los Angeles-based Second Sight Medical Products became the first company granted a commercial licence to sell its bionic eye, Argus II, in the European Union.

Second Sight says its device will be on sale in Europe within months and Australia was "on the radar screen" as a future market.

Australia also has sought to develop and market a bionic eye, but clinical trials here are not due until 2013, and commercial approval may take years.

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http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=524:nps-study-into-gp-clinical-software-shows-room-for-improvement

NPS study into GP clinical software shows room for improvement

Written by Simon James | 10 March 2011

NPS better choices, better health (NPS) has continued its research into Australian clinical software, previewing an as yet unpublished paper in an editorial piece featured in the February 2011 edition of Australian Prescriber.

The editorial overviews a process undertaken by NPS whereby seven general practice clinical software products were selected and assessed against a comprehensive list of desirable features. This list of features was published in 2010 by Sweidan M, Williamson M, Reeve J, Harvey K, O’Neill JA, Schattner P, et al, in their paper: Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process.

In their recent editorial, authors James Reeve and Michelle Sweidan lament the lack of standards guiding the development of general practice clinical software in Australia, stating: “Over 90% of general practitioners use one of the 20 or so commercial systems that are available to write prescriptions, order pathology and other tests, record medical progress notes or communicate with other healthcare providers. Despite the widespread use of e-prescribing systems, there are no clear standards or guidelines for their development. This has led to a variety of systems with markedly different capabilities, particularly in terms of assisting general practitioners to prescribe safely and effectively.”

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http://www.futuregov.asia/articles/2011/mar/11/analytics-enhances-patient-safety-victoria/

Analytics enhances patient safety in Victoria

By Adrienne Valdez | 11 March 2011

Victorian Health Services implemented a new system to deliver greater quality and safety, as well as a depth of reporting into incidents which could potentially result in harm to patients.

The Victorian Health Incident Management System (VHIMS) serves as a tool for collating, analysing and identifying trends and is a useful and important step forward in reporting errors and sentinel events.

In an official statement, Victorian Health Minister David Davis said, “Improving health outcomes for patients is a key focus of the Baillieu Government and we have now made fully operational a new management tool which will help to deliver better safety and higher quality services for Victorian patients.”

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http://www.computerworld.com.au/article/379645/sa_introduce_real-time_reporting_pseudoephedrine_sales/?fp=4&fpid=78268965

SA to introduce real-time reporting on pseudoephedrine sales

Replaces paper-based system, mandatory by July

• Lisa Banks (Computerworld)
• 14 March, 2011 13:48

Mandatory real-time reporting of the sale of pseudoephedrine will be introduced into South Australia, with Project STOP scheduled to be implemented in July.

Minister for health, John Hill, said the system will replace a largely paper-based monitoring system, and will alert pharmacists and authorities to people who are potentially using pseudoephedrine to create illegal drugs.

“The new system will alert pharmacists and the authorities if people are going from one pharmacy to another, accumulating large amounts of medication to be used in the manufacture of illegal drugs,” Hill said in a statement.

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http://www.theaustralian.com.au/australian-it/satellite-not-good-enough-for-outback-broadband/story-e6frgakx-1226021376614

Satellite not good enough for outback broadband

• Karen Dearne
• From: The Australian
• March 15, 2011 12:00AM

RURAL health providers fear the 3 per cent of Australians living in remote areas who would benefit most from broadband access will be further disadvantaged by the satellite services they will end up with under the National Broadband Network.

"We have been frustrated over plans to deliver world-class broadband to 97 per cent of the population," National Rural Health Alliance chairwoman Jennifer May has told an inquiry into the NBN.

"For us, the missing 3 per cent -- those who live in quite remote and poor reception areas -- provide the real test.

"If the small proportion of Australians to whom it is difficult to deliver fast broadband do not receive it, the relative disadvantage of those in rural and remote areas will be further enshrined."

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http://www.smh.com.au/technology/technology-news/telstra-11b-nbn-deal-vote-delayed-20110318-1bzqn.html

Telstra $11b NBN deal vote delayed

Ben Grubb

March 18, 2011 - 12:51PM

Telstra has pushed back a crucial shareholder vote on its $11b financial heads of agreement with NBN Co, the government-owned company charged with building the federal government's national broadband network.

The deal, which requires shareholder approval, was to be put to a vote in the first half of this year.

If approved, the deal will see Telstra hand over millions of customers to the federal government's national broadband network and shut down its ageing copper and cable networks. It will also mean that the rollout of the new network will take a lot less time.

But in a statement to the Australian Stock Echange this morning, Telstra said that it had "now reached the point where a 1 July meeting is no longer practicable".

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http://www.medicalobserver.com.au/news/bitter-split-emerges-in-race-towards-medicare-locals

Bitter split emerges in race towards Medicare Locals

17th Mar 2011

Byron Kaye

GP networks vying to become Medicare Locals (MLs) have been urged to cooperate after a joint bid by three divisions to become Australia’s biggest primary care hub collapsed into a bitter split.

With the 4 April deadline for the first round of ML tenders looming, the Sydney-based General Practice Network Northside (GPNN) unexpectedly broke from neighbouring Northern Sydney General Practice Network (NSGPN) and Manly Warringah Division of General Practice (MWDGP) to prepare a solo bid.

In his division’s newsletter, due to be sent to members this week, NSGPN chair Dr Harry Nespolon suggested he had been “double crossed” and questioned whether GPs could “trust or support such an organisation”.

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http://www.hospitaliteurope.com/article/24690/iSOFT_agrees_%A35.4m_PAS_renewals_with_two_NHS_trusts

iSOFT agrees £5.4m PAS renewals with two NHS trusts

Monday 14th March 2011

Two NHS trusts in Yorkshire have renewed contracts with iSOFT for patient administration systems (PAS) in deals that include new HP hardware and total £5.4 million.

The Leeds Teaching Hospitals NHS Trust has extended its contract for iSOFT’s PatientCentre PAS for three years with the option of a further two years, while Hull and East Yorkshire Hospitals NHS Trust has signed a three-year extension.

Hull has similarly extended its contracts for iSOFT’s radiology information and theatre systems. Under a new managed services agreement, iSOFT will to continue to host Hull’s systems at its data centre at Prestwich for another three years.

Both deals include a move to HP’s latest iTanium hardware for improved performance, extra resilience, and reduced risk. It also provides a platform to introduce other iSOFT clinical applications such as e-prescribing.

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http://www.abnnewswire.net/press/en/66554/iSOFT_Group_Limited_%28ASX:ISF%29_Agrees_New_Five_Year_Deals_With_iSOFT_7_Worth_GBP126M.html

iSOFT Group Limited (ASX:ISF) Agrees New Five-Year Deals With iSOFT 7 Worth GBP12.6M

Sydney, Mar 16, 2011 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) said today that the group of seven NHS trusts in England, known as the iSOFT 7, will extend their agreements for patient and clinical management systems for five years, in deals totalling GBP12.6 million (A$20.2 million).

The contracts are worth GBP4.8 million (A$7.7 million) in licence fees and GBP7.8 million (A$12.5 million) for maintenance and support and run to April 2016.

All seven are to extend contracts for iSOFT's patient administration system (PAS). The four of these trusts that use iSOFT's clinical management solution for order communications, results reporting and prescribing will also extend licenses, maintenance and support for a further five years. The trusts will take control of the contracts from NHS Connecting for Health.

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http://abnnewswire.net/press/en/66552/iSOFT_Group_Limited_%28ASX:ISF%29_Agrees_GBP54M_Patient_Administration_Systems_Renewals_With_Leeds_And_Hull_NHS_Trusts.html

iSOFT Group Limited (ASX:ISF) Agrees GBP5.4M Patient Administration Systems Renewals With Leeds And Hull NHS Trusts

Sydney, Mar 16, 2011 (ABN Newswire) - Two NHS trusts in Yorkshire have renewed contracts with iSOFT Group Limited (ASX:ISF) for patient administration systems (PAS) in deals that include new HP hardware and total GBP5.4 million.

The Leeds Teaching Hospitals NHS Trust has extended its contract for iSOFT's PatientCentre PAS for three years with the option of a further two years, while Hull and East Yorkshire Hospitals NHS Trust has signed a three-year extension.

Hull has similarly extended its contracts for iSOFT's radiology information and theatre systems. Under a new managed services agreement, iSOFT will to continue to host Hull's systems at its data centre at Prestwich for another three years.

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http://www.brisbanetimes.com.au/business/peacock-weighs-up-next-move-on-lloyds-20110314-1bukq.html

iSoft - Hard Landing

March 14, 2011

HARD LANDING

Two years ago iSoft was being added to the local market's benchmark index, the S&P/ASX 200. Last December, Standard & Poor's dropped it from the 200, and this Friday it will scrub the company from the ASX300.

Yesterday the shares fell below 4¢ each during trading, finishing the day down 0.5¢ at 4¢ - a decline of more than 10 per cent.

Not only is iSoft's market worth struggling to hold $40 million, compared to $600 million last May before investors lost faith in its management and direction, a long-contemplated equity issue now becomes even more difficult.

At the end of December iSoft had more than $230 million in debt. Only $33 million was due in the next 12 months (the largest part of which comes from a syndicate that includes NAB's Clydesdale/Yorkshire banks), but unless its bankers remain convinced that the share price is not reflecting iSoft's internal metrics, that timing could change.

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http://www.computerworld.com.au/article/379941/linux_kernel_2_6_38_arrives_desktop_wonder_patch_/?eid=-255&uid=25465

Linux Kernel 2.6.38 arrives with desktop 'wonder patch'

New Kernel brings improvements to the virtual file system, Btrfs compression and memory management

• Rodney Gedda (Techworld Australia)
• 16 March, 2011 13:10

Version 2.6.38 of the Linux kernel was released by Linus Torvalds overnight, including the much-hyped performance improvement patch amid many feature enhancements and bug fixes.

Back in November last year news broke about a 233 line patch to the Linux kernel by developer Mike Galbraith that could noticeably speed up the Linux desktop experience.

The patch to the Linux scheduler can reduce latency by as much as 60 times.

It changes how the process scheduler assigns CPU time to each process so the system will group all processes with the same session ID as a single scheduling entity.

Once kernel 2.6.38 makes its way into the Linux distributions people will begin to experience the patch in their desktop experience.

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Enjoy!

David.

AusHealthIT Poll Number 62 – Results – 21 March, 2011.

The question was:

Do You Believe Clinicians Will Regularly Make Use of User Controlled Information in the PCEHR?

The answers were as follows:

Very Often

- 5 (11%)

Sometimes

- 3 (7%)

Occasionally

- 10 (23%)

Very Rarely

- 24 (57%)

Well that is seems pretty clear with only 20% planning even more than occasional use that we have a looming white elephant on our hands!

Votes : 42

Again, many thanks to those that voted!

David.

Professor Jon Patrick Refines And Expands Publication On Cerner FirstNet Based on ED Director Interviews.

The following announcement appeared this morning.

----- Begin Announcement E-Mail

I've just finished a new critique that I hope you will enjoy.

I have issued a new analysis of the discussions with 7 ED Directors in NSW. The Analysis can be found here

http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=120&Itemid=116

Or it is linked from the main report page, which can be found here

http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146

cheers

jon

Professor Jon Patrick

jon.patrick@sydney.edu.au

Health Information Technologies Research Laboratory: www.it.usyd.edu.au/~hitru

----- End Announcement E-Mail.

This is certainly a very long list of issues Jon was alerted to via the interviews.

I suggest reader browse slowly, consider possible options and form their own view on just what should happen next with this system. It seems pretty clear to me the status quo is probably not an option!

David.

Here Is The Proof DoHA Really Doesn’t Know Where the PCEHR is Heading. It is Still Foilware With No Supporting Detail!

The following e-mail arrived from DoHA a day or so ago. The context is that I asked DoHA for a copy of the RFT for the Provision of National Infrastructure Solution Services relating to the introduction of a Personally Controlled Electronic Health Record (PCEHR).

The tender was issued by the Department of Health and Ageing as RFT No 278/1011

What I have been sent since then have been tweaks and changes to the Tender and this specific one was Addendum Number 7.

As the e-mail was unclassified I assume it is OK to chat about the contents. This is different to the DataPak for the Tender which when I requested it - I was sent a Non-Disclosure Agreement to sign which would have basically demanded I put my first born to death if I divulged any of its contents, ideas or implications. Needless to say I decided not to sign.

The areas of the Addendum I found to be revealing were as follows:

Q7 How does the transition authority propose to ensure a viable take-up of PCEHR?

DOHA and NEHTA are in the process of engaging a national change and adoption partner to assist with this issue.

Q8 How does the transition authority propose to ensure that people are who they say they are when they register for a PCEHR userid and password?

This will be addressed in forthcoming design documents during stage 2

Q9 How does the transition authority propose to standardize the non clinical data that form part of a PCHER deployment i.e. organisation names, department names, gender, title, address, so that they are recognisable to viewers who want the details of people who have contributed to or accessed the record (central clinical register ?)

This will be addressed in forthcoming design documents during stage 2

Q10 What capability will be available for people to prevent access to parts of their PCEHR?

This will be addressed in forthcoming design documents during stage 2

Q11 Is this an opt in/opt out scheme?

As per the draft concept of operations, the PCEHR is an opt-in scheme.

Q12 Who will be the data owner and data custodian with respect to changes made to the data and will changes made by the person on their PCEHR be reflected in the source system where the data originated from?

Changes can only be made in the originating system. The PCEHR is a copy of the originating system information. Stage 2 design documents will provide further clarity.

Q13 What is the expected user experience relating to retrieval of the data (real time vs central repository), as this determines the mechanism used to build the record?

The performance of the system should not hinder the end user experience. Suppliers should provide details on how they will address performance issues.

Non-functional requirements will be established during the course of the program.

Q14 What is the latency allowed for source systems to send changed records to the PCEHR (assuming it is centralized) and how long will the PCEHR have to apply these changes?

Refer to Issue No. 13

Q15 How does the Transition Authority perceive the end-user patient will exercise control over their record and does this differ between bundles and channels? For example do the B2B channel and the indexing service have a dependency on patient approval for information sharing?

All channels will depend on the consumer access control settings recorded in the participation and authorisation service. The way that information is used will vary dependent on the channel. Further details will be provided during stage 2 of the RFT process

Q16 In relation to Bundle 2: How does the Transition Authority perceive the end-user client experience will look in the context of the various methods of personal information administration channels?

We have not described a concept of a personal information administration channel.

Q20 Has the Transition Authority formed a final view on how ‘client authentication’ needs to be performed for individuals accessing the Call Centre?

No, a final view has not yet been formed.

----- End Selective Extract.

So of a total of 26 Questions put we have, ‘we are still thinking about that answers’ to 10 with confirmation that the system is to be opt-in.

What, of course is not mentioned, is whether it will be opt-in by choice, or not, for clinicians.

Read the answers to the questions carefully and it becomes clear that the PCEHR is very little more than a concept and a few slides right now.

Just how one would respond to the RFT for an infrastructure partner in the light of the vagueness regarding just what one is getting into is pretty tricky to say the least. One would certainly offer a fixed price on anything for a very long while yet!

It is amusing to think that DoHA thinks that hiring an adoption and change management partner will address the issues around clinician adoption. It is called wishful thinking I believe!

David.