A Comment That Really Needs Some Close Reading! It Gets To An Important and Unrecognised Barrier to Success For the Planned PCEHR.

The following long and interesting comment appeared a day or so ago.

This comment is in response to an article I published here:

http://aushealthit.blogspot.com/2011/06/draft-blog-for-guest-posting-on.html

The comment suggests a critical missing aspect of the NEHTA PCEHR ConOps. The comment is responding to my ideas on what is needed to have Health IT projects actually succeed.

Anonymous said:

I agree we have a governance problem. And since the pcEHR is the big play in the space (whether it succeeds or fails, it seems likely there won't be anything else national for a long time), it's something we need to take seriously.

It seems to me that the ConOps doesn't quite come to terms with the central problem we face trying to build a national EHR: we need to build distributed trust.

I say this because the national EHR is a grand play to reduce the amount of money - and more importantly, the time of doctors and nurses - to provide the level of care that we are used to. It will do this by reducing the amount of time that these people need to gather information - on the basis that collecting the information is what takes time. But we can only do that if the information that is in the system is trusted by the users (all of them). So the central problem with a really scaled EHR is building that trust.

The ConOps doesn't grasp this issue. This is what is says specifically about trust:

"trust is critical for the success of the rollout and uptake of a PCEHR system"

Great. That's exactly what we need out of the EHR. But what kind of trust does the ConOps talk about?

"Trust is one of the many critical success factors for the PCEHR system, therefore it is essential to ensure that:

• people seeking access to information are whom they claim to be;

• information received from a claimed person is from that person;

• information transmitted across networks is appropriately encrypted andhas arrived at its destination point without being tampered with; and

• access to information is appropriately authorised.

A high level of data quality is another essential ingredient in trust around the PCEHR system. High levels of data quality are required to assist providers and individuals in making safe healthcare decisions."

I agree with all that. And there's real challenges there.

But these technical issues are not the core issue - which is how we get people to trust each other. Because right now, trust is not a scalable asset we can rely on. Patients, Doctors, and Nurses trust each other as individuals - to a degree - but that that trust doesn't scale. These groups don't trust themselves as a group, let alone the other parties.

As long as all the parties insist on being gatekeepers for the pcEHR - so that information can only become part of the EHR if both the source agrees, and the patient agrees, and either can subsequently revoke their permission - this is not a trust based system.

When the ConOps talks about "high quality" - what does it mean? The discussion that follows it is very focused on the quality of the data, not the quality of the participations. There is a shout out at the end of the section to clinical governance, but still, this is about data quality, not about really establishing distributed trust.

The ACHI comments on the pcEHR say that eHealth change is really changing healthcare with a "e", and that's the real thing the ConOps doesn't grasp: that in order to build a system that can leverage trust, we need to build the trust, not only in the system, but also between the participants.

But perhaps this is what the pcEHR is about - it's called "patient controlled", because there's no other way for it to even exist as things are; perhaps it's all we can hope for - better than nothing. And there's certainly an argument that if this is all we can have, then let's have it, and hope that it grows into something useful in the longer term.

It certainly seems that we aren't yet ready for the hard discussions that need to occur in our society in order for us to build distributed trust - and these aren't technical, they're social. So I think that we'll have to watch other countries forge ahead and build working systems that they can leverage, while we squabble about the peripheral issues and whine that we can't have both our trust and our freedom at once.

----- End Extract.

I have to say there is not a single point here I disagree with and I also believe that the challenge of actually achieving the necessary levels of trust will be very, very difficult. I do recognise that there are examples of working professional trust networks (including clinicians) but that trust networks between strangers is a real challenge with only a few examples of success (maybe like eBay)

It seems to me that in the 21^st Century in Australia cynicism, fear (of the future with concerns on a renewed CFG, new taxes, a collapsing environment, ineffective Government and so on) and scepticism are at levels as high as I have experienced in my short 60 years. Establishing trust in a situation where we are told of new cyber-threats and see apparent policy paralysis in everything from what to do about the Murray-Darling Basin to Gay Marriage is going to border on the impossible.

I know many are confident that we will just ‘muddle through’ but I have to say that just recently my faith in muddling has become pretty stretched.

In the situation where bi-partisan action seems to be almost impossible I really wonder where the consensus to undertake major initiatives in areas like e-health will come from?

This said the writer is right. Building trust is a major part of what is needed. It is the how we can do that I am not sure about!

David.

It Seems I Am Not the Only One Concerned About the Current Planned Shape of the PCEHR.

The following appeared today.

Medicos wary of e-health draft concept of operations

• Karen Dearne
• From: The Australian
• June 07, 2011 12:00AM

PEAK information technology, medical and consumer groups have slammed the draft concept of operations for the $500 million personally controlled e-health record (PCEHR) and are demanding an urgent review before work continues.

"If substantial amounts of taxpayers' money are spent (on e-health) with little outcome, future funds will go to other programs," the Australasian College of Health Informatics has warned.

"Therefore, the PCEHR must work and must be sustainable."

The college says the draft does not "consider benefits in any depth nor how they may be practically achieved".

"It is to be hoped the Health Department will (undertake) a comprehensive cost-benefit analysis once the full scope of the PCEHR is determined," it says.

"This should be in conjunction with a review of the detailed planning, including functional and technical specifications."

The college notes that "substantial and critical pieces of work" should be completed before the Gillard government could realistically decide "not only whether to proceed with the PCEHR but whether it is prudent to consider other options", as the costs, complexity and risks likely outweighed any benefits.

The Australian Medical Association has warned that the concept is so flawed, doctors will not use the system. "Many of the problems are due to the decision to make it opt-in," it said.

"Disproportionate emphasis has been given to the concerns of an extreme minority who wish to mask details of their health record. A much simpler design would have resulted from making it opt-out."

Allowing patients to set limits on which healthcare providers can access their records, or to hide certain information, "means doctors will not be able to rely on the clinical information in the records", it said.

The Australian Privacy Foundation said the "lack of a coherent governance framework" lay at the heart of its concerns.

"The draft signals an even more confusing era of access by doctors, health organisations and many authorities than at present," it warned.

"But the governance framework for e-health nationally has not been devised.

"Work on an overarching structure, rather than the much-needed detailed plan, will occur late this year -- after the enabling legislation has been introduced to parliament.

"This draft seems to have been hastily conceived to meet the scheduled start date, rather than to inform people how the system will function in real life."

The Consumers Health Forum also "strongly argues that genuine, rigorous consultation on proposed governance models must occur" prior to the commencement date.

It noted that other contentious issues, such as possible data breaches, an efficient complaints mechanism and secondary use of personal data, had not been addressed.

More here:

http://www.theaustralian.com.au/australian-it/medicos-wary-of-e-health-draft-concept-of-operations/story-e6frgakx-1226070463633

With the range and depth of the comments and suggestions provided what is really important is the way NEHTA responds and re-does the ConOps to address the large range of serious issues raised.

As far as I am concerned we need a new Draft developed in interactive consultation with those who have submitted. The release of a new Draft should be followed by a reasonable period of discussion and review with a second submission round to ensure all the issues raised have been properly addressed.

It will be utterly crucial that the consultation process is seen to result in proper reasoned change to ensure there is no perception that the consultation has been a sham.

Were the various upcoming tenders to be awarded in the absence of finalisation of an essentially agreed ConOps and draft legislation that reflects these outcomes the likelihood of success of the overall program will be much reduced.

NEHTA needs to fully appreciate that unless the response to what is considered and fundamental criticism of the first released draft is satisfactory any claim it may have had to be a consultative organisation will be shredded.

David.

AusHealthIT Poll Number 73 – Results – 6 June, 2011.

The question was:

Is NEHTA Sufficiently Accountable For the Funds it Spends?

The answers were as follows:

For Sure

- 4 (8%)

Possibly

- 4 (8%)

Probably Not

- 4 (8%)

They Are Unacceptably Unaccountable

35 (74%)

Close to the clearest poll yet. NEHTA is just not accountable enough for what is it spends!

Votes : 47

Again, many thanks to those that voted!

David.

Weekly Australian Health IT Links – 06 June, 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

I have to say it seems to have been a week where that has been a lot of State based news and a few little pieces of PCEHR related material.

I found the first article below interesting as it seems some are still trying to work ‘bottom-up’ to improve information flows among clinicians and consumers.

I wonder will we see the occasional report on how this is going!

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http://www.theleader.com.au/news/local/news/general/its-just-for-the-record/2183492.aspx

It's just for the record

BY DEBORAH FIELD

05 Jun, 2011 04:00 AM

MORE than 150 St George and Sutherland Shire residents have enrolled in a world-first study into whether the humble notebook can help save lives.

The Portable Health File project at St George Hospital measures the effectiveness of portable health files in improving the quality and length of a patient's life through improved communication between patients and health professionals.

It involves participants carrying copies of their health information in either a notebook or on a computer memory stick each time they see their GP or health professional, over a four-year period.

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http://www.theaustralian.com.au/australian-it/government/csc-handed-reins-of-troubled-wa-health-project/story-fn4htb9o-1226066638882

CSC handed reins of troubled WA health project

• Karen Dearne
• From: Australian IT
• May 31, 2011 5:06PM

CSC has taken over the troubled West Australian patient administration system (PAS) project under a $6.3 million contract with the Health department.

The project began in mid-2009 when Health paid iSoft a $1.5m licensing fee for its iPatient Manager (iPM) system, and signed a deal for implementation and support services worth $15.4m over five years.

However, the WA government yesterday announced the selection of CSC as the project's new systems integrator.

In addition, CSC will work with iSoft to deploy its webPAS product in two WA hospitals this year.

The Health department has been criticised for its handling of the PAS procurement by WA’s acting auditor-general, Glen Clarke.

"Ten years after recognising that its existing PAS arrangements were a risk to its operations, Health still has not rolled out a replacement though it had initially committed to (one) in 2009," Mr Clarke said in a report last October.

-----

http://www.computerworld.com.au/article/388321/wa_health_deploy_pas_by_year_end/

WA Health to deploy PAS by year's end

The state's health department has inked a $6.3 million deal with global services company CSC for the project

• Chloe Herrick (Computerworld)
• 30 May, 2011 13:32

Western Australia’s Department of Health has signed a $6.3 million contract with CSC for the implementation of a patient administration system (PAS) by the year's end, despite speculation the system would not be replaced until 2014.

Under the deal, CSC will deploy the system to the two hospital campuses as part of the state’s e-health reform project, quashing assumptions the system wouldn’t be in place for another three years.

The PAS is an electronic health record system which stores personal information about patients of public health facilities and helps manage care from admission to discard. Major medical facilities use a PAS to coordinate patient care and guarantee clinical outcomes. The department is aiming for the system to be a single application base across WA Health providing a single source of reference data using common practices.

-----

http://www.zdnet.com.au/csc-snags-63m-wa-health-deal-339315876.htm

CSC snags $6.3m WA Health deal

By Luke Hopewell, ZDNet.com.au on May 30th, 2011

CSC has scored a $6.3 million contract with the Western Australian government as a deployment and integration partner for its new Patient Administration System.

Under the arrangement, CSC will deploy its iSOFT Patient Manager system to two hospital campuses.

CSC is also set to deliver quality management services, testing and training on the new patient management system and develop a learning management system for WA Health.

CSC was chosen due to its experience in integrating iSoft products for the UK's National Health Service (NHS), according to Lisa Pettigrew, CSC's national director of Health Services for CSC Australia.

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http://www.theaustralian.com.au/australian-it/government/ernst-young-bags-1m-pcehr-contract/story-fn4htb9o-1226068453617

Ernst & Young bags $1m PCEHR contract

• Karen Dearne
• From: Australian IT
• June 03, 2011 9:19AM

ERNST & Young has been secured by the Health department for the Gillard government's $467 million personally controlled e-health record program, winning a $990,000 contract to provide "external delivery assurance adviser" services over the next 14 months.

As the external assurance adviser, E&Y will have ongoing oversight of the project and provide independent advice on progress.

A department spokeswoman said the quality control component would include "three discrete, but not mutually exclusive, elements: design assurance; process assurance and benefits assurance".

The deal is the first of four key tenders for private-sector delivery partners, who will work with the National E-Health Transition Authority to build an Australia-wide system.

-----

http://www.cio.com.au/article/388730/emr_success_needs_it_wake_up_nsw_e-health_cio/

EMR success needs IT wake up: NSW e-health CIO

New environment where health IT will involve critical service delivery

• Rodney Gedda (CIO)
• 02 June, 2011 10:30

The success of an electronic medical records (EMR) project will depend on a level of high-velocity, mission-critical ICT not seen before in the sector, says the NSW Department of Health’s director of e-health and ICT strategy branch Ian Rodgers.

Rodgers began in the new role in March[1] and is tasked with strengthening the department’s e-health and ICT strategy and governance.

“Our journey started way back in 2006 when my predecessors established the NSW Health ICT strategic plan from 2006 though to 2011 [and] the key theme was a sustainable future,” Rodgers said.

“To build an EMR system we need to decide what the necessary

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http://www.zdnet.com.au/nsw-govt-mulls-e-health-expansion-339316090.htm

NSW govt mulls e-health expansion

By Luke Hopewell, ZDNet.com.au on June 2nd, 2011

NSW Health has put forward a plan to the state government to extend the reach of its electronic medical record (EMR) program into clinics and intensive care units, underpinned by an ongoing network refresh.

Speaking at the CeBIT 2011 eHealth conference yesterday, Dr Ian Rodgers, director of the NSW e-health strategy branch, said that the second phase of the state's e-health plan is currently being mulled over by the parliament.

Phase two, according to Rodgers, is set to expand the use of the EMR program in NSW to intensive care units, paediatric units and local clinics.

"This system is aimed at extending the reach of the EMR project into those high dependency areas and the scope of the project includes 45 adult and paediatric [intensive care units] and high dependency units," Rodgers said.

-----

http://www.theaustralian.com.au/australian-it/government/medibank-to-manage-after-hours-gp-service/story-fn4htb9o-1226068023638

Medibank to run after-hours GP service

• Karen Dearne
• From: Australian IT
• June 02, 2011 3:20PM

MEDIBANK Private has been tapped to provide the new after-hours GP web- and phone-based hotline from July 1.

Health Minister Nicola Roxon announced the deal today following weeks of negotiations with the government-owned insurer.

The value of the contract has not been revealed.

"One of Australia's must trusted health brands, Medibank Health Solutions, will operate the after-hours helpline with a team of about 100 GPs and more than 240 nurses on staff to answer calls," she said in a statement.

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http://www.australiandoctor.com.au/articles/d1/0c070ed1.asp

100 GPs enlisted for after-hours helpline

2-Jun-2011

More than 100 GPs and 240 nurses have been hired to staff the after-hours helpline, which will start from next month, according to the Federal Health Minister.

Medibank will run the helpline at a cost of $216 million over four years.

GPs will work on-call shifts, covering the hours 6pm to 8am from Monday to Friday, from mid-day Saturday, and all day Sunday and public holidays.

It is understood that patients using the helpline will first talk to a nurse, who can then triage the patient to the GP. If necessary, the patient will then be referred to their nearest after-hours clinic.

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http://www.theaustralian.com.au/australian-it/robot-dispenses-drugs-by-chute/story-e6frgakx-1226066788441

Robot dispenses drugs by chute

• Chris Griffith
• From: The Australian
• June 01, 2011 12:00AM

THE idea of a robot sitting at the back of your local chemist dispensing medicines may seem futuristic.

Nevertheless, Australian-owned Dose Innovations believes it is on a winner with its drug-automated storage and dispensary system, the German developed Rowa Vmax 160.

It consists of a large cubicle occupied by a robot that tirelessly stocks shelves with drugs and dispenses them through a chute as required by prescriptions.

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http://www.theaustralian.com.au/australian-it/government/pcehr-technical-details-to-be-released/story-fn4htb9o-1226068848051

PCEHR technical details to be released

• Karen Dearne
• From: Australian IT
• June 03, 2011 4:54PM

THE Health department will soon issue the technical design details for the $467 million personally controlled e-health records system, deputy secretary Rosemary Huxtable says.

A legal issues paper will also be released shortly for public consultation, she told a Senate estimates hearing this week.

"The legislative discussion paper will go into the regulatory elements, including issues raised in consultations on the PCEHR draft concept of operations," she said.

-----

http://ehealthspace.org/news/doctors-won-t-use-pcehr-ama

Doctors won’t use PCEHR: AMA

Posted Wed, 01/06/2011 - 17:02 by Josh Gliddon

The Australian Medical Association (AMA) has called into question the utility and safety of the federal government’s $467 million personally controlled electronic healthcare record (PCEHR), which is slated to come on stream in July 2012.

The AMA pulls no punches in its submission into the PCEHR, stating that medical practitioners will not use the record in its current format.

The AMA also states the PCEHR will only provide “limited safety benefits” and those benefits will be outweighed by the medico-legal risks posed to medical practitioners. The PCEHR will also impose a significant administrative burden on doctors, it said.

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http://www.computerworld.com.au/article/388694/cebit_2011_clinical_leadership_key_e-health_success_qld_heath_cio/

CeBIT 2011: Clinical leadership is key to e-health success: Qld Heath CIO

Queensland's e-health strategy cannot survive nor produce benefits on funding alone, according to Ray Brown

• Chloe Herrick (CIO)
• 01 June, 2011 16:00

Clinical leadership is key to maximising the benefits and success of e-health projects, according to Queensland Health CIO, Ray Brown.

Brown told attendees of the CeBIT conference in Sydney that Queensland's e-health strategy could not survive nor produce benefits on funding alone.

According to Brown the state government has invested significant time and effort into ensuring the strategy, initially developed in 2005, was a clinically lead initiative.

"Without strong governance and strong clinical leadership and participation in the management of the e-health agenda in particular, there's no hope in succeeding, clinical leadership is absolutely key," Brown said.

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http://www.zdnet.com.au/university-hospital-goes-cashless-339316012.htm

University hospital goes cashless

By Luke Hopewell, ZDNet.com.au on June 1st, 2011

Macquarie University Hospital is rolling out a new cashless payment system to its patients as part of its continuing efforts to eliminate paper.

Speaking with ZDNet Australia at CeBIT 2011's e-Health conference today, chief operating officer Evan Rawstron said that the hospital, which opened its doors to patients almost a year ago, has worked with several technology partners to roll out the cashless system.

Patients will put a pre-pay balance on their card and use it around the hospital to pay for services like food and phone calls, Rawstron said. The pre-paid proximity cards also integrate into the hospital's bedside "cockpit" terminals that serve to track patient care for doctors and nurses.

The cashless payment roll-out is just one of 45 ongoing technology projects going on within Macquarie University Hospital, according to Rawstron. Other technology projects include implementing Citrix access gateways and remote clinical record access, he said.

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http://www.i2p.com.au/article/here-we-are-and-money-goes-to%E2%80%A6

Here we are! And the money goes to….?

Pat Gallagher

The Australian health informatics or e-health development situation is perhaps now at a point of soaring to a bright new world, or not.

Depending on how well ‘we’ spend, between now and June 2012, the $400 million allocated to the Wave 1 and Wave 2 PCEHR development and demonstration sites now under way.

If you are not across what Wave 1 and Wave 2 refer to - then please contact the saintly editor and we will point you to the information.

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http://news.smh.com.au/breaking-news-national/qld-health-workers-owe-62m-in-bungled-pay-20110531-1fdnv.html

Qld health workers owe $62m in bungled pay

Jessica Marszalek

May 31, 2011 - 10:49AM

AAP

Queensland Health workers will be made to pay $62 million back to the Queensland government after it bungled their pay.

But 22,000 workers who were overpaid by up to $200 will not have to give the money back.

Tens of thousands of workers were overpaid, underpaid or not paid at all when a new payroll system was introduced last March.

Now, 38,000 staff who were mistakenly paid too much will have to return the cash, Health Minister Geoff Wilson said on Tuesday.

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http://www.news.com.au/breaking-news/bionic-eye-at-53000-can-be-implanted-in-uk-after-eu-approval/story-e6frfku0-1226065391639

Bionic eye at £53,000 can be implanted in UK after EU approval

• By staff writers
• From: NewsCore
• May 30, 2011 9:01AM

A BIONIC eye that enables blind people to see has been cleared for implantation in British patients after it was granted approval by European regulators.

The artificial retina is the first device of its kind to move from the laboratory to the clinic, after a trial of 30 patients, ten of whom were treated in Britain, has shown that it can safely restore some vision to people who have lost their sight to a genetic disease, The Times of London said today.

Argus II uses a camera on dark glasses to send signals to a network of 60 electrodes implanted in the retina, which relays them to the optic nerve. Patients with no sight who have received the prosthetic retina can see light, motion and colour, discern the outlines of objects, and even read large letters on a computer screen.

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http://www.aph.gov.au/Senate/committee/fapa_ctte/health_practitioner_registration/report/index.htm

Note: This page contains links to PDF files. For more information, see the web page on Accessing files.

The administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA)

3 June 2011

© Commonwealth of Australia 2011

View the report as a single document - (PDF 1836KB)

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http://www.theaustralian.com.au/national-affairs/health/national-medical-registration-body-a-debacle/story-fn59nokw-1226068994363

National medical registration body 'a debacle'

• Milanda Rout
• From: The Australian
• June 04, 2011 12:00AM

THE introduction of a national medical registration body was a "debacle" that resulted in doctors being unknowingly deregistered and losing income and patients being left without healthcare.

A Senate inquiry found the Australian Health Practitioner Regulation Agency failed to notify health practitioners that they needed to renew their licence or that they had been deregistered as a result.

The agency - which took over the registration from 85 different state boards - also spent an "inordinate amount of time" processing applications and did not provide any help to worried doctors who unknowingly had their registration cancelled.

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http://www.theaustralian.com.au/news/health-science/risk-of-brain-tumour-from-mobile-phone-use-is-similar-to-pesticide-ddt-petrol-exhaust-and-coffee/story-e6frg8y6-1226066891966

Risk of brain tumour from mobile phone use is similar to pesticide DDT, petrol exhaust and coffee

• From: AP
• June 01, 2011 6:44AM

A RESPECTED international panel of experts says mobile phones are possible cancer-causing agents, putting them in the same category as the pesticide DDT, petrol engine exhaust and coffee.

The classification was issued last night in Lyon, France, by the International Agency for Research on Cancer after a review of dozens of published studies. The agency is an arm of the World Health Organisation and its assessment now goes to WHO and national health agencies for possible guidance on mobile phone use.

Classifying agents as "possibly carcinogenic" doesn't mean they automatically cause cancer and some experts said the ruling shouldn't change people's mobile phone habits.

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http://www.theage.com.au/national/out-of-sync-with-the-state-of-victoria-20110531-1feid.html

Out of sync with the state of Victoria

Geoff Strong

June 1, 2011

The Australian Synchrotron is in danger of closing and if it does it will be an immeasurable loss to medical researchers trying to find treatments for diseases such as cancer.

'COMING to a drive-in near you,'' the proposed poster was to announce. Its illustration, an enormous circular building, would seem as if it had landed in the middle of suburbia like a flying saucer from a B-grade science-fiction movie. Even as an attempt to capture the public imagination, the poster was dismissed as too frivolous.

Now, the people running the Australian Synchrotron, which coincidentally occupies the site of the former Clayton drive-in cinema, are wondering if a bit of Hollywood magic might not be helpful after all.

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http://www.computerworld.com.au/article/388907/australia_draft_cybersecuity_strategy_paper/

Australia to draft cybersecuity strategy paper

Cyber White Paper to factor in consumer protection, cybersafety, cybercrime, cybersecurity and cyber defence

• Tim Lohman (Computerworld)
• 03 June, 2011 11:56

In a sign of the growing government acceptance of cyber attacks as genuine threats to national security, Australia will develop its first Cyber White Paper.

To date white papers, which are concerned with issues affecting long term Defence planning, have been issued in 2009 (PDF) and prior to that, 2000 (PDF).

According to Federal Attorney-General Robert McClelland, the Cyber White Paper will cover a broad range of areas including consumer protection, cyber safety, cyber crime, cyber security and cyber defence.

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http://www.mja.com.au/public/issues/194_12_200611/man10874_fm.html

Viewpoint

Social media and the medical profession

Sarah J Mansfield, Stewart G Morrison, Hugh O Stephens, Michael A Bonning, Sheng-Hui Wang, Aaron H J Withers, Rob C Olver and Andrew W Perry

MJA Rapid Online Publication — 1 June 2011

Abstract

· Use of social media by doctors and medical students is common and growing.

· Although professional standards and codes of ethics that govern the behaviour of medical practitioners in Australia and New Zealand do not currently encompass social media, these codes need to evolve, because professional standards continue to apply in this setting.

· Inappropriate use of social media can result in harm to patients and the profession, including breaches of confidentiality, defamation of colleagues or employers, and violation of doctor–patient boundaries.

· The professional integrity of doctors and medical students can also be damaged through problematic interprofessional online relationships, and unintended exposure of personal information to the public, employers or universities.

· Doctors need to exercise extreme care in their use of social media to ensure they maintain professional standards.

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http://www.smh.com.au/digital-life/digital-life-news/the-day-my-hard-drive-crashed-20110601-1ffrg.html

The day my hard drive crashed

Katie Cincotta

June 1, 2011 - 2:41PM

Create a back-up system with inbuilt redundancy you can swear by, writes Katie Cincotta.

I never realised just how many expletives I had locked away in my "cuss" cupboard until I lost my hard drive. In my 18 years as a journalist, somehow I'd managed to avoid the menace of random computer termination. Here's a responsible freelance writer who upgrades to shiny new hardware every two years. What could possibly go wrong?

Apparently, when you're that confident, everything could. On a routine morning, the tech gremlins decided to teach me a lesson about the fallibility of bits and bytes.

The stealth operation took just seconds. By the time I realised Windows 7 was reinstalling itself, wiping every trace of data on my new desktop's 1.5-terabyte brain, it was too late. Operation reality check was complete.

-----

Enjoy!

David.

The Last Few Days Bring Some Interesting PCEHR Reporting. None of It All That Encouraging.

First we have this:

PCEHR technical details to be released

• Karen Dearne
• From: Australian IT
• June 03, 2011 4:54PM

THE Health department will soon issue the technical design details for the $467 million personally controlled e-health records system, deputy secretary Rosemary Huxtable says.

A legal issues paper will also be released shortly for public consultation, she told a Senate estimates hearing this week.

"The legislative discussion paper will go into the regulatory elements, including issues raised in consultations on the PCEHR draft concept of operations," she said.

"There is another document that is very close to being finalised which provides yet another layer of detail in terms of the design elements.

"The reality is, yes, this is a complex body of work. It has a strong technical element to it."

Ms Huxtable said there was a tight timetable to create the capability for people to register for an e-health record by July 1 next year, and "to work through the way in which the PCEHR itself is constructed and establish what information will be available on it".

National E-Health Transition Authority chief executive Peter Fleming, in his first appearance before estimates, said that each of the project components "is tracking to its critical path".

"All activities that we expect to be delivered at certain times are being delivered within those time frames," he said.

In response to questions from Queensland Liberal Senator Sue Boyce, Mr Fleming said NEHTA was preparing a business case for Council of Australian Government funding beyond July 2012, when its funding ceases.

"That will be presented to our board within the next two months, but I cannot give you an answer beyond that," he said.

"Most of our staff understand that we have a job to do for the long term, but it is fair to say (this uncertainty) would be a consideration."

Mr Fleming said NEHTA was currently looking to hire another 20 staff, as it ramped up numbers for the PCEHR program.

In the financial year ending April, NEHTA has spent more than $39.7m on consultants, including $16m for Medicare for the healthcare identifiers (HI) service and $8m for IBM for its work on the National Authentication Service for Health.

"Our job is clearly to implement a series of agreed objectives," he said. "We use external parties wherever we believe they will add significant value, whether it be in terms of delivering on time, or quality."

Mr Fleming said Tasmania went live with its HI implementation to the acute care sector, and the HI system and the NEHTA "stack" would be implemented in the 12 e-health early adopter sites.

There is vastly more fun and games here with poor Senator Boyce becoming more confused and incredulous by the moment with the answers she was being given:

http://www.theaustralian.com.au/australian-it/government/pcehr-technical-details-to-be-released/story-fn4htb9o-1226068848051

One has to wonder what soon and technical details actually means when the consultation period for how the PCEHR is actually work is yet to be completed and it is clear there are a range of stakeholders who are less than impressed with just where thing are at present.

It also needs to be noted that report on the Standards base for the PCEHR was given to government recently but it has yet to be released and given its size (300+ pages I am told) it can hardly have been fully digested. Moreover we don’t yet know who is to deliver whatever is to be delivered.

The whole thing is starting to develop a quiet surreal air around it as we watch a Titanic head for that iceberg!

Second we have this - which I have to say looks like a bit of a poison chalice

Ernst & Young bags $1m PCEHR contract

• Karen Dearne
• From: Australian IT
• June 03, 2011 9:19AM

The government has committed to a July 1, 2012 launch of the PCEHR system. Illustration: Mark Wharton Source: The Courier-Mail

ERNST & Young has been secured by the Health department for the Gillard government's $467 million personally controlled e-health record program, winning a $990,000 contract to provide "external delivery assurance adviser" services over the next 14 months.

As the external assurance adviser, E&Y will have ongoing oversight of the project and provide independent advice on progress.

A department spokeswoman said the quality control component would include "three discrete, but not mutually exclusive, elements: design assurance; process assurance and benefits assurance".

The deal is the first of four key tenders for private-sector delivery partners, who will work with the National E-Health Transition Authority to build an Australia-wide system.

The other three contracts are expected to be announced shortly.

More here:

http://www.theaustralian.com.au/australian-it/government/ernst-young-bags-1m-pcehr-contract/story-fn4htb9o-1226068453617

The key paragraph is this one:

“A department spokeswoman said the quality control component would include "three discrete, but not mutually exclusive, elements: design assurance; process assurance and benefits assurance".”

Right now everyone knows the present design is just hopeless, the planned surrounding business processes have anyone who might have to use them less than thrilled and it is utterly improbable we will see any benefits flow to anyone from the PCEHR.

My view is that this contract should recognise the reality and only ask for work to commence when the relevant aspects of the plans are at least close to final. Otherwise gobs of money will just get wasted with junior consultants just spinning their wheels!

Overall, as last week’s poll made pretty clear - once the submission period expires an overall review of this program makes both practical and indeed political sense (let this run on much longer and the politics may very well get ugly).

See the poll here:

http://aushealthit.blogspot.com/2011/05/aushealthit-poll-number-72-results-30.html

We can only hope somehow we can draw back from this increasingly nonsensical proposal and stop the waste of public money on a basically flawed plan.

David.