The Federal Budget Has Some Interesting Revelations in E-Health. As Always the Devil is in the Detail!

There is really quite a large amount regarding e-Health in the detailed papers.

The full Commonwealth Health Budget for 2011/12 is found here.

http://www.health.gov.au/internet/budget/publishing.nsf/Content/2011-2012_Health_PBS

Of main interest is this section.

Outcome 10:

Health System Capacity and Quality (PDF 332 KB)
Health System Capacity and Quality (Word 533 KB)

Here is the text summary of the key section

Program 10.2: e-Health implementation

Program Objectives

Through Program 10.2, the Australian Government aims to:

· provide national leadership in electronic health (eHealth) to improve health system standards and infrastructure;

· promote the use of Healthcare Identifiers and Authentication Services to improve safety and quality outcomes for patients and support improved management of health information by health care providers; and

· support the design and development of a personally controlled electronic health record system to increase the availability of health care information for consumers and health care providers when and where it is needed across the health care system.

Major Activities

National eHealth leadership

The Australian Government will demonstrate the benefits of eHealth to the community in terms of improved health care safety, quality and efficiency. The importance of eHealth is recognised around the world as an opportunity to fundamentally reshape and improve health service delivery. eHealth has the capacity to change the way practitioners interact with each other and with patients, leading to more efficient and effective patient-centred health care.

The department, in partnership with state and territory governments, will continue to fund the National E-Health Transition Authority (NEHTA) to develop the specifications, infrastructure, software and systems required to support electronic health systems nationally.

NEHTA is responsible for the delivery of key eHealth components, including the Healthcare Identifiers (HI) service, the National Authentication Service for Health (NASH), standard clinical terminologies and secure messaging to support the safe and secure electronic exchange of patient information. NEHTA, along with Standards Australia, plays a crucial role in the development of the eHealth standards necessary to guide the implementation and take-up of the Government’s eHealth initiative nationally.

Standards Australia is an independent, not for profit organisation, recognised by the Government as the peak non-government body in Australia for the development of rigorous, internationally aligned standards. In 2011-12, the department will actively participate in stakeholder discussions, led by NEHTA and Standards Australia, to inform the development of national eHealth standards. The development of national standards is critical to ensure an information technology system which will allow for the sharing of health care information.

The department will promote the use of eHealth standards, particularly the foundation standards for clinical terminology and secure messaging, to ensure efficient, effective and consistent implementation of eHealth nationally. In addition, the department will lead discussions with states and territories to develop funding options for national eHealth work for 2012-13 onwards.

The department will fund early implementation of standard clinical terminology into emergency departments during 2011-12 and collaborate with Therapeutic Goods Administration, pathology companies, community pharmacies and diagnostic imaging companies to adopt the Australian Medicines Terminology.

In 2011-12, the department will continue to provide incentives to general practices, through the Practice Incentives Program, to promote the use of eHealth tools and systems. The department, through the Fifth Community Pharmacy Agreement, will also provide funding to pharmacies for dispensing prescriptions that are generated electronically by prescribers. Through these activities, general practitioners and pharmacists will able to send and receive crucial information faster and more securely.

The department will also continue to lead nationally focussed stakeholder engagement, consultation and associated communication to ensure that national eHealth programs are deployed and implemented effectively. The department will continue to consult with various stakeholder groups, including the community, clinicians and the information and communications technology vendor industry, to promote collaboration across the health sectors around the national eHealth agenda. With privacy being a key consideration for consumers, the department’s eHealth leadership includes working collaboratively with states and territories on the national health information regulatory framework.

Promote the use of Healthcare Identifiers and Authentication Services

In 2011-12, the department will continue to promote the use of Healthcare Identifiers (HI). HIs are unique reference numbers allocated to individuals receiving health care, individual health care providers and health care provider organisations involved in providing patient care. HIs ensure that individuals and providers can have confidence that health information accessed through eHealth technologies is linked with the correct individual at the point of care.

The department will work with NEHTA and Medicare Australia, as the HI service operator, to support the adoption of HIs in health care provider information management systems.

The Healthcare Identifiers Act 2010 and the Healthcare Identifiers (Consequential Amendments) Act 2010 set out the governance arrangements as well as permitted uses and privacy safeguards related to HIs. The department, through Medicare Australia, NEHTA and the Office of the Australian Information Commissioner, will provide consumers and health care providers with information and assistance about the benefits of HIs, legal compliance and how the HI service works. Further information is available from Medicare Australia website.

A key challenge for the department is building the public’s confidence in the use of the HIs. In 2011-12, the department will continue to support the development and implementation of HI adoption plans focussed on specific health care sectors, including primary care, aged care and private hospitals. The department will fund the development of lead implementation sites in two waves to demonstrate the benefits of HIs, the National Authentication Service for Health (NASH), secure electronic communication and the personally controlled electronic health records (PCEHRs). Wave One lead sites are targeted around general practice and Wave Two sites will expand upon existing work to cover a broader range of settings including pharmacies, hospitals, aged-care homes and Indigenous health care providers. The lead sites will implement eHealth infrastructure and standards in real world settings. These sites will provide a foundation for secure electronic communications such as referrals and sharing of summary health information to support continuity of care between health care providers.

In 2011-12, the department, through NEHTA will continue to develop the NASH. The NASH will support secure electronic communication of health information between health care providers and the adoption of PCEHR by issuing digital certificates to health care providers across the Australian health system. In combination with frameworks for their management and use, these digital certificates will provide assurance about the identity of health care providers when they send electronic communications or access electronic health information systems. From 30 June 2012, health care providers will be able to obtain a digital certificate on a range of tokens, such as a smartcard, that they can then use to authenticate who they are when accessing eHealth systems or communicating electronically with other health care providers. The NASH will enable secure access control and audit logging mechanisms in readiness for when the PCEHR system is put in place. This will allow patients to have greater certainty over which health care providers have access to their information. During 2011-12, the department will progressively update information about the PCEHR on the yourhealth website. The website will also provide an access channel for the community to provide their comment on the design and implementation of the PCEHR system.

Support the design and development of a personally controlled electronic health record system

The Australian Government is committed to strengthening Australia’s ability to share health care information. Through the development of a PCEHR system, the Government will encourage greater participation by individuals in their own health care, improve the efficiency of the health care system by reducing the time taken to locate relevant information, reduce duplication of services and provision of inappropriate treatments.

The department will continue to provide governance and oversight for the rollout of PCEHR system.

This includes establishing the infrastructure, standards and tools needed to enable an individual’s key health information to be secure and available when and where it is required across the health and hospital system. These system components will be delivered by a National Infrastructure Solutions Partner and NEHTA through a tripartite agreement with the department. All Australians who wish to participate in the system will be able to register for their own PCEHR, which will provide a summary of the individual’s health information drawn from information systems distributed across the health system. The PCEHR system which is now being established will enable patients to access their PCEHR regardless of where it is physically located, and will enable Australians and authorised health care providers to securely access patient’s PCEHRs via the internet. The PCEHR system will be complemented by the introduction of the national HIs for individuals, health care providers and health care organisations, as well as authentication services and standard clinical terminologies.

In 2011-12, the department will work with National Infrastructure Solutions Partners and the information and communications technology vendor industry to design and develop the IT architecture and national infrastructure components to enable patients and clinicians to register for use of the PCEHR system commencing from 1 July 2012. This will include sourcing of information from existing health care systems ready to connect to the PCEHR system to provide high priority health information, such as GP health summaries, hospital discharge summaries, referrals and medications. eHealth lead implementation sites will be used to implement national eHealth infrastructure and standards in health care settings, and be able to demonstrate outcomes and benefits.

In 2011-12, the department will evaluate the benefits and capabilities of the system. In addition, the department will develop a national change management framework providing communication, training and support services to health care providers, tailored to meet local community needs. These national communication and management programs aim to ensure the PHECR system is established and adopted effectively. Strategic engagement across consumers, clinicians, industry, and state and territory governments will be ongoing to encourage Australians to register for a PCEHR from July 2012.

Program 10.2 is linked as follows:

· The Department of Human Services (Medicare Australia) to administer the Healthcare Identifiers service and promote the use of Healthcare Identifiers, under its Delivery of other Benefits and Services (Program 1.3).

----- End Extract.

The figures then follow and it seems that it is planned to spend $432,667,000 in 2011-12 after spending $137,678,000 in the current year.

At present it all stops after that with all if $34,675,000 coming in 2012-13.

Seems like a lot of money to spend with no plan to continue on!

The major deliverable targets seem to be:

E-Health Leadership.

• National eHealth standards for electronic transfer of prescriptions completed by June 2012
• Fund early implementation of standard clinical terminology into emergency departments during 2011-12 and work with the various organisations on implementation projects to adopt the Australian Medicines Terminology in the health sector during 2011‑12

Health Identifier Service

• HIs and implementation guidance available to providers, software developers and patients in a timely manner
• Implementation plans for up to 12 lead implementation sites which will focus on the adoption of HIs as a first step completed in a timely manner

PCEHR Implementation.

• Undertake awareness-raising campaigns to inform the Australian public of their ability to register for a personally controlled electronic health record from 1 July 2012
• Implementation plans for up to 12 lead implementation sites which will focus on the adoption of PCEHRs as a first step completed in a timely manner
• 500,000 Australians registered for a PCEHR before the national launch of eHealth records in 2012-13

The last bullet is interesting as it suggest the PCEHR launch will not be by June 30, 2012 but in the following year! Overall the papers make it pretty clear progress is going to be a good deal more stately than might otherwise be suggested.

Note all the comments on NASH - but the lack of any consumer authentication plans.

The documents are worth a close read! At least e-Health gets a few pages!

By the way, if you want to read about the telehealth program it is found under Outcome 3.

David.

An Initial Draft of My Submission to DoHA on the PCEHR ConOps. Comments and Suggestions Encouraged!

Here is a first cut for comment.

Submission to the Commonwealth Department of Health and Ageing.

Topic: The NEHTA developed Personally controlled electronic health record (PCEHR) Draft Concept of Operations (ConOps for Short)

Date May, 2011

Submissions Due May, 31, 2011

Address for submissions:

E-mail

ehealth@health.gov.au

Postal Mail

PCEHR Feedback
MDP 1005
GPO Box 9848
Canberra ACT 2606

Submission Author:

Dr David G More BSc, MB, BS, PhD, FANZCA, FCICM, FACHI.

Author’s Background. The author of this submission is an experienced specialist clinician who has been working in the field of e-Health for over 20 years. I have undertaken major consulting and advisory work for many private and public sector organisations including both DoHA and NEHTA.

Previous Submission

I previously provided a Submission on the PCEHR proposal to NHHRC in May, 2009 and the views expressed in that submission remain my position despite the work undertaken by DoHA and NEHTA since.

This submission is available here:

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/309-interim/$FILE/309%20-%20Submission%20-%20Dr%20David%20More.pdf

Executive Summary of Submission.

The ConOps proposal provided by NEHTA is an utterly flawed and disastrously conceived document which has taken NEHTA’s earlier Shared or Individual EHR proposals and seen the ideas contained within distorted to create a proposal which at once does not achieve the possible benefits of the earlier proposals while being essentially useless at a clinical level.

I believe that in the presently proposed form the PCEHR is doomed to not be adopted or used by either consumers or clinicians and will become a very expensive failed ‘white-elephant’.

A total re-consideration of virtually all aspects of this current ConOps offers the only chance to claim success from an otherwise doomed set of proposals.

Background to the PCEHR Proposal.

As a consequence of a series of recommendations in the Final Report to Government of National Health and Hospitals Reform Commission (NHHRC) in 2009 the subsequent Commonwealth Budget allocated almost half a billion dollars over two years to make a PCEHR available to all citizens who wanted one by July 2012.

As the PCEHR has evolved - largely away from the public gaze and in secret - it has morphed into a conceptual Health Summary and then a series of Event Summaries. The Health Summary contents are intended to be the basic individual demographic details and the information that is normally held - either electronically or on paper - in the General Practitioners Summary Record. This would include allergies, regular medications, key elements of history and current diagnoses. The Event Summaries are envisaged to be such things as a set of pathology results, referral letters and so on.

The idea is that the patient will be in control of this information and will, if they agree and consent, make the information held in this record available to clinicians caring for the patient.

The patient PCEHR record is to be held by a PCEHR system - presumably run by the Commonwealth Government - which will be accessible via a web portal for a clinician, with permission, to review. At a later date the patient will also be able to contribute their personal information and comments should they choose. The system is apparently intended to be a lifelong record which will be accumulated over time.

At present the system is intended to be available for patients who choose to have a PCEHR to register for access by July 2012 - now just 14 months away. The system is presently planned to operate in an ‘opt-in’ fashion where an individual takes a positive decision to register for and establish a PCEHR.

Key Topics Addressed in This Submission.

1. Proposed System Architecture

As described in the section on the background to this proposal what is being created in this system is a system which will operate in parallel to the systems used by professional care providers and will contain a partial sub-set of the information held in their systems.

As currently envisaged it is neither fish nor fowl, by which I am saying it is not a highly refined abstract of that clinical information which is needed for emergency care nor a complete longitudinal record which replace what is currently used by those providers who use electronic records.

By falling in an inconclusive middle ground the planned record has no clear user audience and does not seem to have any real place. The proposal brings with it some almost insurmountable issues around the currency, reliability, and quality of the information held within the PCEHR system and this situation will mean it will be poorly used. Legal liability and related issues around the possible erroneous interpretation of data held within the system will also mean a lack of trust and adoption of the system by many clinicians.

2. Sustainability of Proposal

It was never likely that a two year half billion dollar national e-Health program initiated from what was essentially a ‘standing start’ would be able to demonstrate useful outcome in the time allocated - as has been demanded by Minister Roxon. Every other national program has taken at least 3 times that period to even begin to show results.

The application of such politically driven deadlines, with no commitment to continued investment and funding adds substantially to the risks of the program as it distorts quite unreasonably what is being attempted and what would be planned - and have a higher chance of success - in more realistic circumstances.

3. The Politics of Names and Actual Reality.

The issue here is that Shared EHRs (as described on Page 108 and 109 of the Conops) are not PCEHR systems in any sense of the word. Each of these initiatives are, in fact, Shared EHR systems intended to be used by clinicians and not by patients. There is NO experience anywhere in the world with the model proposed in the ConOps.

The statements made at the top of page 108 are deliberately distorting of the reality that the NEHTA proposed IEHR and the earlier HealthConnect Shared EHR are very different from what is proposed with the PCEHR:

“The Strategy identified a national Individual Electronic Health Record (IEHR) System as a high priority. The Strategy envisaged the IEHR as:

A secure, private electronic record of an individual’s key health history and care information. The record would provide a consolidated and summarised record of an individual’s health information for consumers to access and for use as a mechanism for improving care coordination between care provider teams. [AHMC2008]

Since the Strategy was originally developed, the term ‘PCEHR’ is now preferred as it better aligns with the recommendations from the National Health and Hospitals Reform Commission which recommended that a national approach to electronic health records should be driven by ‘the principle of striving to achieve a person-centred health system.’ [NHRR2009].

In 2010, the Government has invested 466.7 million in the first release of a PCEHR System.”

To suggest they are the same or even quite similar is just dishonest. Equally it is dishonest to claim the IEHR was a high priority in the National Strategy - it simply was not.

It is also quite surprising to see NEHTA claim consultations on HealthConnect which were conducted 5+ years ago and many of the other consultation processes cited on Page 103 bear any relevance to the PCEHR proposal.

4. Lack of Evidence Regarding Benefits.

Again this is an area where both NEHTA and the Department of Health have been less than frank with the public.

All the modelling undertaken by NEHTA and DoHA has indicated that it is providing clinicians with reliable information at the point of care (for medication management and so on) and providing clinical decision support is where the major benefits from e-Health can be obtained. However what we see in the ConOps, buried on page 18, is :

“2.8.1 Clinical decision support

The PCEHR System will not provide clinical decision support services. It is intended that the PCEHR System will provide information to help drive clinical decision support algorithms and the industry and healthcare professions will take the lead on delivering clinical decision support services.”

No business case exists to justify the PCEHR. (NEHTA did develop one a year or so back for the IEHR, but that is not really in any way comparable as it is quite different in architecture and intent.) This alone should cause some alarm. At best we have very sloppy thinking, at worse we have downright deception.

5. Consent Model.

At present it is proposed that consumers will have the option of signing up at a PCEHR for the proposed electronic record as of July 1, 2012. Signing up will be totally voluntary i.e. the system is conceived as an ‘opt-in’ system. Additionally, at any point the consumer will be able to inactivate their PCEHR as well as decide with parts of the PCEHR will be accessible to whom. As an example a spouse might have complete access to the others record but the same consumer may choose to make some sections of the record inaccessible to their GP. Equally the consumer can make quite the reverse decision. These decision can be changed at any point.

The problem with this ‘opt-in’ approach is that it is only successful if there is sufficient utility and value provided by the PHR to stimulate adoption. The functionality that has been found to be most valued by consumers include being able to arrange appointments, request prescription repeats and access a secure e-mail messaging system to seek information and explanations related to their care. Consumers also find it useful to have access to test results and other information sources.

Sadly the first mentioned three functions are not planned in any proposed release of the PCEHR and provision of results information is likely to be a number of years off. The net result of this approach would seem to suggest a very low adoption and use of the PCEHR system is highly likely.

Additionally there seem to be a very limited number of circumstances when a practitioner would want to access an individual’s PCEHR given that most of the information held in the PCEHR, other than the consumer contributed material, will already be held in the provider’s clinical system.

The convoluted plans for the consent model and the potential incompleteness of what may be there when access is granted will greatly limit clinician’s interest in obtaining access to the consumer PCEHR.

Overall, at best, significant usage of the PCEHR will take many years to evolve and the potentially transformative benefits of other architecture and consent models will come very late if at all.

6. The Lack of Appropriate National Governance and Leadership in Australian E-Health.

In order for any National E-Health Program - such as the PCEHR - to be successful there are a number of critical success factors that appear to need to be in place based on international experience. These include top level political commitment at Cabinet level, stability of long term and adequate funding, expert national leadership, appropriate consultative and governance frameworks and an agreed national vision and consensus on the way forward.

I would contend that Australia is presently lacking most of these critical success factor with but 2 years funding agreed, division of responsibility for the PCEHR between NEHTA and the Commonwealth Department of Health, no single point accountability for PCEHR delivery and a forward plan which essentially ignores the agreed National E-Health Strategy which was approved in 2008.

7. The Lack of A Trained Workforce and Plans To Develop Such Capability.

In July 2009 the Department of Health and Ageing received a Review of the Australian Health Informatics Workforce. This report said we did not have enough staff capability in the domain and that there was no apparent plan in place to correct the deficiency. As far as is presently know there has really been no significant progress in the two years since the report was produced, and the skills and capability gap remains and is probably worsening if the number of job vacancies advertised by NEHTA is any guide.

As for supporting a major national implementation of the scale of the PCEHR this is simply not possible.

8. Information Sources and Lack of Clinician Incentives

The ConOps document seems throughout to have as an underpinning assumption the belief that clinicians (and diagnostic service providers) will be so excited by the prospect of what is to be offered by the planned PCEHR that they will spend their own resources to provide the technology and work effort involved to populate the PCEHR with their in-house information on individual patients at their (the providers) expense.

With the ongoing financial pressure on diagnostic service providers and clinicians currently being applied by the Commonwealth Government such altruism in the context of such unproven and potentially time consuming technology is simply not going to happen without substantial financial carrots being provided.

It needs to be clearly appreciated that without enthusiastic co-operation of the clinical community the PCEHR will be simply a useless empty vessel which will be of no use to either consumer or clinician.

9. Privacy and Security Concerns

It is unnecessary for this document to rehearse the potential privacy and security issues that surround the creation of a national EHR system.

It is enough to say that a range of technical and privacy experts have expressed significant concerns that have yet to be properly addressed and that until such experts are reasonably satisfied appropriate controls are in place there is likely to be major resistance to the PCEHR proposal from such sections of the community.

An example of the sort of issue that has been rather ‘swept under the carpet’ in the ConOps are the arrangements to ensure that, with the PCEHR accessible over the Internet, that it is possible to definitively identify the consumer who is accessing their PCEHR, and that access is not being achieved by another, possibly malevolent citizen here or overseas via identity theft or the like.

NEHTA simply admits they have not worked out how this is to be managed and so have no idea of the potential cost and effort involved - which may be very substantial indeed.

10. Clear Medico Political Rejection of The Present PCEHR Plans.

The following recent article from Computerworld - and many other similar remarks from both the key GP representative organisations make it clear they are not at all satisfied with the present approaches and plans. If these key stakeholders are anything less than very enthusiastic the likelihood of success with the PCEHR program is essentially zero.

Budget 2011: E-health communication trumps spending

Peak health groups have called for greater focus on standards, rather than spending, for effective e-health implementationg

• Chloe Herrick (Computerworld)
• 10 May, 2011 11:54

Australia’s peak health industry bodies have warned of the Federal Government’s e-health solutions becoming “siloed” without greater attention to standards surrounding implementation of technology for doctors and practitioners.

Both the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP) expect there to be little in the way of further funding for e-health initiatives in Tuesday’s federal budget, following the government’s $467 million pour in to personally controlled electronic health records (PCEHR) last year. The government has also committed nearly $400 million to subsidising telehealth services from 1 July next year.

Any health funding announced by federal treasurer, Wayne Swan, is expected to be put toward mental health schemes.

However, AMA federal vice president, Dr. Steve Hambleton, told Computerworld Australia that even without additional funding, the industry required a greater, whole-of-sector approach to the looming initiatives.

“E-health has grown up in isolation, we’ve got to start talking about protocols we can communicate to each other nationally,” he said. “NEHTA [National E-Health Transition Authority] is trying to do that, but hospitals have different software in each state and only recently have we started getting a single unique healthcare identifier.

“GP [general practioner] software, which we’re all going to rely on ultimately to communicate, is all different and the way GPs use the same software is different so standards are really important otherwise we can’t get up and running.”

E-consultations with GPs were particularly important, as they required standardised software and hardware at both ends.

Royal College of General Practitioners (RACGP) e-health spokesperson, Dr. Nathan Pinskier, said standards were also required for implementation, change and adoption of the technology required. He warned a lack of protocols could ultimately silo e-health outcomes.

“Medicare Australia for example struggled to roll out its initiatives for a number of years until it adopted a more broad focus on a whole sector approach,” he said.

For the PCEHR program to have utility it must be embedded into existing software programs, Pinskier said, even once technical requirements have been locked down.

“If it requires practitioners to log out of one system and into another and then copy and paste information or transcribe information it’s not going to fly, if it’s embedded into existing technology so it’s one push at the end of a consultation subject to the patient consent we’re much more likely to have uptake.”

The full article is here:

http://www.computerworld.com.au/article/385928/budget_2011_e-health_communication_trumps_spending/

Concluding Remarks

I had planned to address the specific areas that NEHTA’s ConOps document suggested needed further review but after working through the ten points above there did not seem to be a great deal left to say.

The PCEHR proposal needs an insightful and pragmatic review and major revision to address the issues raised above. If this is not done the outcome is likely to be very bad indeed.

Weekly Australian Health IT Links – 09 May, 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 been a pretty quiet week, with the work released by the National Prescribing Service probably being the highlight.

Also important is the reporting of the Victorian Privacy Commissioner starting to explore the security issues surrounding use of the cloud.

Additionally there seems to be increasing notice being taken of the security of personal information. This debate clearly has implications for public attitudes to the PCEHR and e-Health in general.

Clearly the HealthSMART program is also still rather in limbo given the Victorian Budget last week.

It will be interesting to see if the Budget - released tomorrow night - has any extension of funding for the PCEHR. If it is not in this Budget next May will loom as a rather close ‘drop dead’ date!

-----

http://www.6minutes.com.au/news/standards-needed-to-address-practice-software-flaw

Standards needed to address practice software flaws

• By Gemma Collins on 3 May 2011

National standards are needed for prescribing software in general practice because current systems have “noteworthy flaws”, according to the National Prescribing Service.

The NPS is calling for national guidelines and standards to ensure better support for doctors using the electronic systems, following its own review of the current software.

A review of seven commonly-used prescribing systems found “little or no support” for doctors on harmful dosages or safety issues relating to specific drugs and no indications of recent warning from the TGA.

-----

Evaluation of features to support safety and quality in general practice clinical software.

Just wanted to let you know that the second and final part of the NPS Evaluation of Prescribing Systems study has now been published.

Evaluation of features to support safety and quality in general practice clinical software.

Sweidan M, Williamson M, Reeve JF, Harvey K, O’Neill JA, Schattner P, Snowdon T.

BMC Medical Informatics and Decision Making 2011, 11:27 doi:10.1186/1472-6947-11-27

http://www.biomedcentral.com/1472-6947/11/27

If you are interested, the study report can be downloaded on the NPS website, here: http://www.nps.org.au/research_and_evaluation/current_research/evaluation_of_electronic_prescribing_systems

-----

http://www.theaustralian.com.au/australian-it/government/victorias-warning-on-cloud-computing/story-fn4htb9o-1226049270403

Victoria Privacy Commissioner issues cloud computing guidelines

• Karen Dearne
• From: Australian IT
• May 03, 2011 4:49PM

VICTORIA'S Privacy Commissioner Helen Versey has warned that the cost of addressing privacy and security issues may outweigh expected capital and operational savings for agencies wanting to shift to cloud computing.

Ms Versey has told state government organisations they should only use cloud service providers that agree to comply with Victoria's information privacy laws, and preferably have locally-based data centres.

"Where the provider is located offshore, or even outside of Victoria, taking reasonable steps to protect personal information from misuse, loss, unauthorised access, modification or disclosure may be difficult or even impossible," she said in a statement.

"By using a cloud service, the government agency is relinquishing some -- if not all -- control over their data.

-----

http://www.theaustralian.com.au/australian-it/government/victorian-agencies-urged-to-secure-private-data/story-fn4htb9o-1226051027628

Victorian agencies urged to secure private data

• Karen Dearne
• From: Australian IT
• May 06, 2011 10:41AM

FRESH from warning agencies of the costs of using cloud computing, the Victorian Privacy Commissioner has reminded state organisations they cannot relinquish responsibility for securing personal information.

Helen Versey says agencies are increasingly using external people and organisations to carry out functions on behalf of the state government.

"This means that a lot of personal information about individuals, which would normally be collected by government, is now collected and handled by external providers," she said.

"People expect the same information privacy protection when they are dealing with a service provider which is handling their personal information on behalf of a government agency as they would if they were dealing with the agency itself."

-----

http://blogs.computerworlduk.com/the-tony-collins-blog/2011/05/pm-to-be-questioned-next-week-on-cscs-nhs-it-deal/

Prime Minister to be questioned next week on CSC's NHS IT deal

David Cameron to be asked about his talks with Andrew Lansley and Francis Maude on CSC's £3bn NPfIT contracts

Published 13:12, 06 May 11

David Cameron will be asked at Prime Minister's Questions in the House of Commons next week about his discussions on the performance of CSC as supplier of the "Lorenzo" software under the NHS IT scheme.

CSC has NHS IT contracts worth about £3.2bn, as a local service provider under the NPfIT.

-----

http://www.global-health.com/uploadedFiles/CONTENT/NEWS/2011/Gemini_ASX%20Release_3%20May%202011.pdf

Global Health forms strategic alliance with Gemini Consulting

Global Health Limited (ASX:GLH) has today announced it has formed a strategic alliance with Gemini Consulting Pty Ltd (Gemini) - a change management consultancy specialising in sales strategy, organisational change and market development Gemini has agreed to pay GLH a licence commitment fee of $500,000 in the current financial year to become GLH's exclusive channel partner for the Company's consumer health-related products in Australia.

Under this agreement, Gemini will assume responsibility for the sales, delivery and support of all GLH's products, as well as identifying and developing new market segments for both current and proposed new products in Australia.

-----

http://www.computerworld.com.au/article/385223/efa_apf_call_greater_access_personal_information/

EFA, APF call for greater access to personal information

Privacy group cites Facebook as top privacy culprit

• Hamish Barwick (Computerworld)
• 04 May, 2011 12:22

Electronic Frontiers Australia (EFA) and the Australian Privacy Foundation (APF) have highlighted the need to strengthen the Privacy Act 1988 and make information held by a company available to end users.

EFA spokesperson, Stephen Collins, told Computerworld Australia that the current Privacy Act was "problematic" because in some cases, it was difficult for people to get hold of information about themselves.

“In light of some recent breaches of privacy that we have seen take place, the EFA would love to see some teeth with respect to penalties for those who breach privacy," he said.

.....

Vaile was also concerned by the planned introduction of an individual health identifier number as part of the Personally Controlled Electronic Health Records (PCEHR) announced in April.

The $466.7 million project aims to increase online access to records with proposals, such as consumer information via Web portal (to be developed by Medibank Private), advanced care directives and connection with Medicare data.

"A lot of critics have said it is getting introduced without a proper public consultation about the privacy and information security regime around it," Collins said.

-----

http://www.computerworld.com.au/article/385356/identity_theft_e-fraud_top_australian_security_concerns_unisys/?eid=-255&uid=25465

Identity theft, e-fraud top Australian security concerns: Unisys

Data loss also more of an issue than terrorist attacks

• Hamish Barwick (Computerworld)
• 05 May, 2011 08:29

Financial fraud, identity theft and environmental disasters lean more heavily on Australians’ minds than national security threats, according to a Unisys report.

The biannual Unisys Security Index report, conducted in February 2011 by Newspoll, surveyed 1200 people what security risks they were concerned about compared to 10 years ago in the wake of the September 11 World Trade Centre attacks.

76 per cent of those surveyed said they were worried about credit card data being stolen, while 66 per cent cited environmental disasters as a threat. Companies losing personal details came in at 59 per cent while 56 per cent mentioned cyber attacks on national computer networks.

-----

http://www.nehta.gov.au/media-centre/feature-story/863-oct-2011

SNOMED CT Implementation Showcase a feature of October 2011 IHTSDO meetings

For the first time the International Health Terminology Standards Development Organization (IHTSDO) conference will feature an Implementation Showcase.

The IHTSDO Working Sessions and Implementation Showcase will take place in Sydney, Australia on October 10 – 14. In line with this years theme 'Implementing SNOMED CT: Realizing the Benefits', the Showcase will allow attendees to interact with SNOMED CT implementers from around the world who will share their first hand knowledge about the challenges, benefits and lessons learned of implementation. Workshops and education sessions will focus on approaches to implementing SNOMED CT for beginners as well as for advanced users. Session attendees will also have an opportunity to visit vendors in the vendor exhibit area.

-----

http://news.theage.com.au/breaking-news-national/ahpra-shaky-start-but-getting-better-20110505-1e9cc.html

AHPRA shaky start but getting better

May 5, 2011 - 12:14PM

AAP

The federal government's new register of health professionals has had a shaky start but is now well on its way to overcoming teething problems.

The old scheme, involving 10 groups of health professionals registered through 85 separate state and territory bodies, wound up on June 30 last year with the new scheme starting on July 1.

Under the national scheme launched a year ago, health professionals register just once through the national body and practice anywhere in Australia.

Australian Health Practitioner Regulation Agency (AHPRA) chairman Peter Allen said it was a shaky start to the new scheme, but problems are being bedded down.

-----

http://www.6minutes.com.au/news/ahpra-warning-on-e-health-consults

AHPRA warning on e-health consults

• By Gemma Collins on 5 May 2011

GPs could face reprimands for doing unstructured ‘electronic’ consultations with patients, following plans by AHPRA to introduce stricter standards.

The Medical Board of Australia (see link) is warning GPs about the use of “technology-based consultations” as it announces plans to consult on specific guidelines in the months ahead.

With the Federal government saying earlier this year that telehealth consultations in rural and remote areas would be eligible for an MBS rebate from July 1, the use of online and video consultations are expected to increase.

-----

http://www.nit.com.au/News/story.aspx?id=21729

Territory to lead the nation in e-health reform project

Residents of the Northern Territory will be one of the first groups of Australians to have access to e-health records thanks to a new national health reform e-health project announced by the Federal Government.

Aboriginal and Torres Strait Islander Australians will benefit from e-health records as they will reduce the chance of medical errors and save patients from having to repeat their health history every time they visit a new doctor.

-----

http://www.computerworld.com.au/article/385551/nt_makes_first_e-health_contributions/?eid=-6787&uid=25465

NT makes first e-health contributions

First lot of funding allocated to territory's Health eTowns project, despite government announcement a year ago

• James Hutchinson (Computerworld)
• 06 May, 2011 12:44

The Northern Territory has allocated $6.6 million toward telehealth services at 17 remote towns in the territory, marking its first financial contribution since the initiative was announced a year ago.

The allocation, announced in the 2011/2012 budget released this week, will form part of a $16.4 million funding package over three years to establish video conferencing sites, telehealth capabilities and e-learning capabilities for students at 17 of 20 towns marked as growth sites by the territory government.

The funding will also help to further establish the territory’s shared e-health record project, which handles records for close to 40,000 indigenous consumers, as well as improvements to fibre optic bandwidth at the earmarked towns.

-----

http://www.brisbanetimes.com.au/opinion/politics/coalition-caught-between-saving-and-spending-promises-20110502-1e4ly.html

Coalition caught between saving and spending promises

David Hayward

May 2, 2011 - 5:14PM

Victorian Treasurer Kim Wells brings down his first state budget tomorrow amid mixed messages about what to expect from such an important occasion.

The government was elected on a centrist platform, and there was no suggestion of a budget crisis. A progressive Premier was endorsed by a range of people including those who would not normally be expected to cast their vote his way. For the past five months, he has remained true to form as a calm and progressive leader.

His ministers, on the other hand, have often seemed indecisive. In transport and health for example ministers have damned Labor's IT legacy at every opportunity, yet we still don't know if a tainted myki and Healthsmart are gone or are set to be given a reprieve because on balance it would be the sensible thing to do.

-----

http://www.smh.com.au/opinion/politics/throwing-good-money-after-bad-is-no-way-to-run-a-government-20110502-1e4m2.html

Throwing good money after bad is no way to run a government

Ted Baillieu

May 2, 2011 - 4:32PM

It is clear that a new level of financial discipline from the Coalition government will be necessary for Victoria's future sustainability so the mistakes and waste of the past are not repeated.

The ruinous legacy of the former government is plain to see, most recently exposed in the Interim Report of the Independent Review of State Finances released this week.

This follows the Victorian Ombudsman's clear advice to government last week that "a new and more disciplined approach is required if governments are to avoid being faced with continuing blowouts and failure to deliver owing to mismanagement".

-----

http://www.cio.com.au/article/385231/aiia_commends_victorian_budget/

AIIA commends Victorian budget

Straight ICT figures don't reveal the whole story, says Birks

• Chloe Herrick (Computerworld)
• 04 May, 2011 12:48

The Australia Information Industry Association (AIIA) has commended the Victorian Government’s proposed budget despite the document’s lack of focus on information technology spending.

AIIA chief executive, Ian Birks, told Computerworld Australia that while the outlined budget appeared to contain less spending on ICT than previous budgets, the government has maintained focus on improving the industry.

“AIIA has met a number of times with Minister [for Technology] Rich Phillips... and we’ve talked to him about the ICT industry agenda,” Birks said. “I think he and the government are very focused on productivity within the Victorian Government and there’s a very strong linkage between productivity improvement and ultimately increased or improved investment in ICT.”

-----

http://www.zdnet.com.au/healthsmart-myki-cop-vic-budget-bashing-339314376.htm

HealthSMART, myki cop Vic budget bashing

By Luke Hopewell, ZDNet.com.au on May 4th, 2011

Victorian State Treasurer Kim Wells last night released the state's budget, and blamed costly projects such as myki and HealthSMART for the budget's $7 billion debt figures.

"Major projects inherited by this government — including myki … and HealthSMART — face significant cost overruns which total around $2 billion and have further contributed to the run-up of debt," the treasurer said.

As a result of the myki and HealthSMART blowouts, among other things, Victoria is set to carry a debt of $7.5 billion — higher than previously forecast. HealthSMART will receive $6.7 million worth of funding in this year's budget, with future funding riding on a report yet to be handed down by the state's auditor-general.

The treasurer also put the boot into Victoria's troubled smart meter program in his speech.

-----

http://www.smh.com.au/digital-life/games/playstation-hack-15m-aussie-accounts-exposed-20110502-1e3pc.html

PlayStation hack: 1.5m Aussie accounts exposed

Asher Moses

May 2, 2011 - 10:44AM

Sony has revealed more than 1.5 million Australian user accounts including potentially 280,000 credit card numbers are in the hands of hackers as it struggles to contain the reputational damage caused by one of the world's biggest privacy breaches.

Over the weekend, Sony executives bowed in apology for the security breach in the company's PlayStation Network, promising to improve security, compensate users and get the service back online within a month.

The number of Australian accounts affected, which make up a small fraction of the 77 million total accounts exposed worldwide, is far higher than initial estimates.

-----

http://www.smh.com.au/technology/security/privacy-laws-to-be-beefed-up-following-sony-attack-20110502-1e578.html

Privacy laws to be beefed up following Sony attack

Asher Moses

May 3, 2011

THE federal government will introduce laws forcing companies to disclose privacy breaches after Sony revealed that more than 1.5 million Australian user accounts were compromised in the recent attack on its PlayStation Network.

The stolen information include names, addresses, birthdays, email addresses and log-in passwords. Of the 1,560,791 Australian accounts that were affected, 280,000 had credit card details, but these were encrypted and there had been no reports of fraudulent activity, Sony said.

The Privacy Minister, Brendan O'Connor, said he was ''very concerned'' about the theft of personal information and expressed disappointment that Sony took ''several days'' to inform customers about the breach. This meant a mandatory ''data breach notification'' system now ''appears necessary'', he said.

------

http://www.canberratimes.com.au/news/national/national/general/controlled-drug-sales-to-be-tracked/2149495.aspx

Controlled drug sales to be tracked

BY BIANCA HALL

02 May, 2011 07:28 AM

People buying controlled drugs at pharmacies will be electronically tracked across the country in a world-first scheme being rolled out by the Federal Government.

The Department of Health and Ageing has called for tenders for a new electronic program to monitor drug use and to prevent drug abuse.

Pharmacy Guild of Australia national director Kos Sclavos said the new ''electronic recording and reporting of controlled drugs'' initiative would target drug users exploiting gaps in the system by ''doctor shopping'' and ''pharmacy shopping''.

It would introduce an electronic system used by all Australian pharmacies to record and report the purchase of controlled narcotic prescription drugs.

-----

http://www.technologyreview.com/printer_friendly_article.aspx?id=37525

Unthinking Machines

Artificial intelligence needs a reboot, say experts.

By Stephen Cass

Some of the founders and leading lights in the fields of artificial intelligence and cognitive science gave a harsh assessment last night of the lack of progress in AI over the last few decades.

During a panel discussion—moderated by linguist and cognitive scientist Steven Pinker—that kicked off MIT's Brains, Minds, and Machines symposium, panelists called for a return to the style of research that marked the early years of the field, one driven more by curiosity rather than narrow applications.

"You might wonder why aren't there any robots that you can send in to fix the Japanese reactors," said Marvin Minsky, who pioneered neural networks in the 1950s and went on to make significant early advances in AI and robotics. "The answer is that there was a lot of progress in the 1960s and 1970s. Then something went wrong. [Today] you'll find students excited over robots that play basketball or soccer or dance or make funny faces at you. [But] they're not making them smarter."

-----

http://www.computerworld.com.au/article/385175/natty_narwhal_first_linux_newbies_/?eid=-219&uid=25465

Natty Narwhal: The first Linux for newbies?

With its new Unity interface, Ubuntu 11.04 taps the mobile world for a way to help Windows users across the divide.

• Katherine Noyes (PC World (US online))
• 04 May, 2011 04:15

Whenever a new version of an operating system is released, it's common to see a wave of reviews following on its heels, assessing how the software compares with what came before it and weighing its new pros and cons.

That's certainly been the case with Canonical's Ubuntu 11.04, or "Natty Narwhal," which was officially released last week. This time, however, it seems fair to say the scrutiny has been more intense than usual.

For those who haven't been following it closely, Natty Narwhal is the first desktop Ubuntu Linux release to use the Unity desktop shell by default -- a major, ground-shaking departure from the software's traditional use of GNOME. It's also the place several other significant decisions for the free and open source operating system can be seen, such as the adoption of the Compiz window manager.

-----

Enjoy!

David.

AusHealthIT Poll Number 69 – Results – 09 May, 2011.

The question was:

Should Australia adopt some of the US meaningful use criteria to encourage an international market for health software?

The answers were as follows:

For Sure

- 17 (50%)

Possibly

- 4 (11%)

Maybe

- 3 (8%)

No

- 5 (14%)

Meaningful Use. What's That?

- 5 (14)

Good to see a level of support for giving the approach a close look!

Votes : 34

Again, many thanks to those that voted!

David.

Medication Management is Put Under the Microscope and Looks Good - But More Work to Do!

The following appeared a week or so ago and really deserves a blog all to itself.

http://www.ahrq.gov/clinic/tp/medmgttp.htm

Medication Management & Health IT

Full Title: Enabling Medication Management Through Health Information Technology (Health IT)

April 2011

View or download Report

Structured Abstract

Objective: The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research.

Data sources: We searched peer-reviewed electronic databases, grey literature, and performed hand searches. Databases searched included MEDLINE®, Embase, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Compendex, Inspec (which includes IEEE Xplore), Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete. Grey literature searching involved Internet searching, reviewing relevant Web sites, and searching electronic databases of grey literatures. AHRQ also provided all references in their e-Prescribing, bar coding, and CPOE knowledge libraries.

Methods: Paired reviewers looked at citations to identify studies on a range of health IT used to assist in the medication management process (MMIT) during multiple levels of screening (titles and abstracts, full text and final review for assignment of questions and data abstrction). Randomized controlled trials and cohort, case-control, and case series studies were independently assessed for quality. All data were abstracted by one reviewer and examined by one of two different reviewers with content and methods expertise.

Results: 40,582 articles were retrieved. After duplicates were removed, 32,785 articles were screened at the title and abstract phase. 4,578 full text articles were assessed and 789 articles were included in the final report. Of these, 361 met only content criteria and were listed without further abstraction. The final report included data from 428 articles across the seven key questions. Study quality varied according to phase of medication management. Substantially more studies, and studies with stronger comparative methods, evaluated prescribing and monitoring. Clinical decision support systems (CDSS) and computerized provider order entry (CPOE) systems were studied more than any other application of MMIT. Physicians were more often the subject of evaluation than other participants. Other health care professionals, patients, and families are important but not studied as thoroughly as physicians. These nonphysicians groups often value different aspects of MMIT, have diverse needs, and use systems differently. Hospitals and ambulatory clinics were well-represented in the literature with less emphasis placed on long-term care facilities, communities, homes, and nonhospital pharmacies. Most studies evaluated changes in process and outcomes of use, usability, and knowledge, skills, and attitudes. Most showed moderate to substantial improvement with implementation of MMIT. Economics studies and those with clinical outcomes were less frequently studied. Those articles that did address economics and clinical outcomes often showed equivocal findings on the effectiveness and cost-effectiveness of MMIT systems. Qualitative studies provided evidence of strong perceptions, both positive and negative, of the effects of MMIT and unintended consequences. We found little data on the effects of forms of medications, conformity, standards, and open source status. Much descriptive literature discusses implementation issues but little strong evidence exists. Interest is strong in MMIT and more groups and institutions will implement systems in the next decades, especially with the Federal Government's push toward more health IT to support better and more cost-effective health care.

Conclusions: MMIT is well-studied, although on closer examination of the literature the evidence is not uniform across phases of medication management, groups of people involved, or types of MMIT. MMIT holds the promise of improved processes; clinical and economics studies and the understanding of sustainability issues are lacking.

Download Report

Enabling Medication Management Through Health Information Technology (Health IT)

• Executive Summary (Publication No. 11-E008-1)
• Evidence Report (Publication No. 11-E008-EF): (PDF File, 8.6 MB) PDF Help.

Evidence-based Practice Center: McMaster University

Current as of April 2011

Internet Citation:

Enabling Medication Management Through Health Information Technology (Health IT), Structured Abstract. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/medmgttp.htm

----- End Abstract.

On the web site there is a much longer Executive Summary and then a really huge paper reviewing the information that was assessed.

To me this is a very important piece of work that does two key things. First it makes it clear that intervention with clinicians using interactive decision support does appear to make a positive difference and as such should be adopted as a priority - Not that the idiots at NEHTA and DoHA have got the message with Clinical Decision Support being dismissed in one paragraph (Paragraph 2.8.1) in the PCEHR Conops saying the PCEHR will not provide it and it is hoped someone else will!

This is just more evidence of how disconnected from the evidence the present PCEHR proposal in its present form is.

Second it lays out a large array of areas that still need further clarification and investigation. It seems to me the most important it to once and for all nail that using these systems actually not only reduces errors - which we know - but overall provides improved clinical outcomes in the broader sense - which we a pretty sure of but do not have the full picture clarified as yet.

Obviously the economic, financial and sustainability issues are also well worth sorting out.

I would hope to see an update from the EPC at McMaster University every couple of years, or so, and would hope the present issues will be fully clarified over time.

Well worth a download and careful review.

David.