A Brand New Review Confirms The View PHRs are Still Not Demonstrated To Make a Clinical Difference.

The following article appeared in the current issue of the Journal of the American Medical Informatics Association.

J Am Med Inform Assoc. 2011 July; 18(4): 515–522.

doi: 10.1136/amiajnl-2011-000105

Personal health records: a scoping review

N Archer,¹ U Fevrier-Thomas,¹ C Lokker,² K A McKibbon,² and S E Straus³

¹DeGroote School of Business, McMaster University, Ontario, Canada

²Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada

³Keenan Research Centre, University of Toronto, Ontario, Canada

Corresponding author.

Correspondence to Norm Archer, DeGroote School of Business, McMaster University, 1280 Main St West, Hamilton, ON L8S 4M4, Canada; Email: archer@mcmaster.ca

Received January 13, 2011; Accepted April 30, 2011.

Abstract

Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients, thus assisting patients in health self-management. We reviewed the literature on PHRs including design, functionality, implementation, applications, outcomes, and benefits. We found that, because primary care physicians play a key role in patient health, PHRs are likely to be linked to physician electronic medical record systems, so PHR adoption is dependent on growth in electronic medical record adoption. Many PHR systems are physician-oriented, and do not include patient-oriented functionalities. These must be provided to support self-management and disease prevention if improvements in health outcomes are to be expected. Differences in patient motivation to use PHRs exist, but an overall low adoption rate is to be expected, except for the disabled, chronically ill, or caregivers for the elderly. Finally, trials of PHR effectiveness and sustainability for patient self-management are needed.

Here is the discussion and conclusion:

Discussion

Our scoping review has found that a significant amount of research is being done on PHR adoption, use, and satisfaction for various groups of users, with the main focus on providers. There is some evidence for the inclusion of certain functionalities in PHR systems, especially from the patient perspective, as gleaned from the utilities they use most. However, the clinical effectiveness and cost effectiveness of PHR interventions has not been adequately confirmed. From the limited and heterogeneous literature that was synthesized, the following themes emerged:

1. Primary care physicians play a key role in the management of their patients' health. Based on our review, we believe that sharing some proportion of their EMR records with patient PHRs can provide patients with useful information that allows them to be positively engaged in health self-management. A key to PHR adoption in North America is therefore rapid and continuing growth in physician adoption of EMRs from its current relatively low rate. In 2008, EMR adoption by primary care physicians was in the range of 24–28% in the USA, and 20–23% in Canada.⁹⁹ Primary care EMR adoption is likely to have grown considerably since then in both countries, due to provincial subsidies for EMR adoption in Canada, and the implementation of meaningful use requirements and significant allocations to healthcare information technology in the American Recovery and Reinvestment Act of 2009 in the USA.
2. Although a number of good quality studies of PHRs have produced interesting results, many of these studies have been physician-oriented. Patients in the studies had access to their information through their doctors' or hospital EMRs (tethered PHRs). EMRs are designed to provide doctors with the functionality and information they need, and their use for patients does not necessarily meet patient needs. Some studies^{9 12 29 47 74 76 100} included certain considerations of patient-oriented support such as the ability to join communities of interest, general information from high quality internet sites, information from healthcare professionals and internet sites on treatment programs for lifestyle, weight management, support for self-monitoring programs for chronic conditions, etc. But many did not. Until such integrated support is made available to patients, PHRs are not likely to demonstrate their full potential for supporting tangible or intangible improvements in patient health outcomes.
3. People with serious chronic conditions, individuals with disabilities, parents with small children, people with a strong interest in maintaining healthy lifestyles, and the elderly or their caregivers are more likely to adopt PHRs. Therefore, although a low overall PHR sustainable adoption rate can be expected, steps need to be taken by developers to improve the performance of PHRs and their long-term benefits for the people most likely to use them. This includes involving potential user groups with specific health self-management needs directly in requirement specification, design, and testing, to ensure that the PHRs match the cognitive abilities of their intended users and thereby support health self-management and disease prevention.
4. In a recent review of consumer health informatics, Gibbons et al¹⁰¹ report that applications that provided individual tailoring, personalization, and behavioral feedback had the most significant impact on patient health outcomes. However, research is needed to develop a more detailed understanding of what motivates people to not only adopt but to continue using PHRs. Long-term sustainability of PHR use by patients was an issue that was not mentioned in any of the literature we examined. Sustainability involves not just positive results from factors such as adoption, use, acceptance, satisfaction, and usability, but favorable individual and organizational impacts. This is extremely important if healthcare systems are to avoid the specter of financing apparently successful PHR innovations that are abandoned or under-utilized by patients after an initial flurry of use.
5. RCTs are needed to test assumptions about the comparative effectiveness of PHRs on outcomes for various patient populations, using systems designed specifically for patient health self-management and disease prevention.

Conclusions

The objective of this study was to describe existing electronic and paper-based PHR research and to determine whether PHRs can provide benefits to consumers/patients. We found many relevant papers, indicating a generally growing interest in PHR use, but there is much more to be done in tailoring PHRs for patient health self-management and sustainability. Although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of PHR benefits and satisfaction for patients, more research is needed that gathers evidence to evaluate the results of PHR implementations in the context of works such as the Delone and McLean model of information systems success.⁹⁸ At this point there is little solid evidence from RCTs or other studies of proven effectiveness in improved patient health outcomes through the use of PHRs. More research is also needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting self-managed healthcare.

----- End Extracts.

The full article is accessible (for free) here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128401/

This is a very useful review indeed and should be read by all interested in the PCEHR.

As I read this what these experts are saying is that “right now evidence that PHR’s make a difference is pretty thin on the ground”.

It also seems pretty clear that when success has been looking like it is happening there has been a EHR with the PHR as an extension of that system.

This is NOT what is planned in Australia and so one can only conclude the PCEHR is a half billion dollar experiment lacking any real evidence base.

Pretty silly that!

David.

It Seems SNOMED CT Has A Few Issues That Need to Be Addressed. Right Now It Is Apparently Broken And Needs to Be Fixed!

The following paper was formally released a few weeks ago.

J Am Med Inform Assoc. 2011 July; 18(4): 432–440.

Published online 2011 April 21. doi: 10.1136/amiajnl-2010-000045 PMCID: PMC3128394

Getting the foot out of the pelvis: modeling problems affecting use of SNOMED CT hierarchies in practical applications

Alan L Rector,¹ Sam Brandt,² and Thomas Schneider¹

¹School of Computer Science, University of Manchester, Manchester, UK

²Siemens Health Services, Malvern, Pennsylvania, USA

Correspondence to Alan L Rector, School of Computer Science, University of Manchester, Manchester M13 9PL, UK; Email: rector@cs.manchester.ac.uk

Received December 13, 2010; Accepted December 30, 2010.

Abstract

Objectives

(a) To determine the extent and range of errors and issues in the Systematised Nomenclature of Medicine – Clinical Terms (SNOMED CT) hierarchies as they affect two practical projects. (b) To determine the origin of issues raised and propose methods to address them.

Methods

The hierarchies for concepts in the Core Problem List Subset published by the Unified Medical Language System were examined for their appropriateness in two applications. Anomalies were traced to their source to determine whether they were simple local errors, systematic inferences propagated by SNOMED's classification process, or the result of problems with SNOMED's schemas. Conclusions were confirmed by showing that altering the root cause and reclassifying had the intended effects, and not others.

Main results

Major problems were encountered, involving concepts central to medicine including myocardial infarction, diabetes, and hypertension. Most of the issues raised were systematic. Some exposed fundamental errors in SNOMED's schemas, particularly with regards to anatomy. In many cases, the root cause could only be identified and corrected with the aid of a classifier.

Limitations

This is a preliminary ‘experiment of opportunity.’ The results are not exhaustive; nor is consensus on all points definitive.

Conclusions

The SNOMED CT hierarchies cannot be relied upon in their present state in our applications. However, systematic quality assurance and correction are possible and practical but require sound techniques analogous to software engineering and combined lexical and semantic techniques. Until this is done, anyone using SNOMED codes should exercise caution. Errors in the hierarchies, or attempts to compensate for them, are likely to compromise interoperability and meaningful use.

Keywords: Knowledge bases, knowledge representations, methods for integration of information from disparate sources, knowledge acquisition and knowledge management, developing and refining EHR data standards (including image standards), data models, data exchange, controlled terminologies and vocabularies, communication, integration across care settings (inter- and intraenterprise), ontologies, terminology, EHRs

The full free text is available here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128394/?tool=pubmed

This paper needs to be carefully considered as it is written by an internationally recognised authority in the area of clinical terminology deployment.

Here is a link to his home page:

http://www.cs.man.ac.uk/~rector/home_page_rector/

The range of issues and problems identified included the following:

• Errors and omissions with propagation and helter-skelter modelling
• Incomplete modeling: myocardial infarction and ischemic heart disease
• Issues with sites of systemic disorders
• Errors in modeling anatomy: Structure-Entire-Part (SEP) triples and the ankle in the abdomen
• Overgeneralized concepts with underspecified ‘fully specified names’
• Lack of distinction between structure and function
• Inconsistent modeling of complications: hypertensive disorders

Detailed examples of each of these are found in the text.

The full text of the conclusions is as follows:

“This study has five classes of outcome:

• On the SNOMED hierarchies. There are sufficient anomalies in the hierarchies that they cannot be used without significant modification in our applications. More generally, we question whether clinicians entering codes or researchers retrieving information understand their implications. As postcoordination relies on accurate classification, it is doubtful that applications using postcoordination will behave predictably.
• On the use of description logic in SNOMED. Using a description logic is both part of the problem and part of the solution. The response to the issues raised here is not to abandon SNOMED's description logic but to use it more effectively. Using a description logic means that the correcting root errors found in modules will usually repair analogous problems throughout SNOMED.
• On the possibility of quality assurance of SNOMED. Given modern tooling and computer power, the barriers quality assurance of SNOMED can now be overcome, although no well-integrated toolset is yet available.
• On practicality of quality assurance of SNOMED. This was a preliminary study and not exhaustive, but it required less than three person-months using poorly integrated tools. Given an integrated toolset, we estimate that a thorough quality assurance of the Core Problem List Subset would require a small team under 2 years, probably less. This would cover a high fraction of all uses of SNOMED. Most changes would be propagated automatically by the description logic into the full SNOMED corpus. Applying these methods to the remainder of the SNOMED findings would require further resources, but they would be minor by comparison with the effort already devoted to SNOMED's development, let alone to those that will be required for its implementations.^lvii
• On methods required. Using a description logic requires staff who understand both medical content and description logics. It requires adapting the techniques of software engineering to tracing and managing errors. Space does not permit setting out a detailed methodology.^lviii However, key maxims should include:
• Start from clinically important concepts—use clinical intuition.
• Focus on the classified hierarchies—reclassify after every change.
• Work in small modules—so that reclassification is quick.
• Look upwards first and then downwards—there are fewer ancestors than descendants.
• Trace all errors to their root cause—avoid local ‘kluging.’
• Look for analogous errors and repair using consistent patterns—for example, complications and sites.
• Reformulate problematic sections systematically rather than attempting to repair them—for example, head injury and branches in anatomy.
• Use a combination of lexical and semantic methods—as first suggested by Campbell et al¹⁹ and now made straightforward using Ontology Patterns Preprocessing Language (OPPL).²⁰
• Test systematically—maintain a suite of ‘unit tests’ covering all issues identified; include tests for unintended consequences of changes; run test suite after every major set of changes and before each release.

Some might argue that many of the erroneous classifications reported here are several steps removed from the original concept in the hierarchies and would be ignored by clinicians. However, the semantics of the description logic underpinning SNOMED is unambiguous. Software and queries must follow them literally. Likewise, the reliability of postcoordination is a function of the reliability of the classifier, which is best determined by its manifestation in the hierarchies.

Until comprehensive quality assurance has been undertaken, anyone using, or mandating, SNOMED should be aware that the hierarchies contain serious anomalies. Should a ‘Reference terminology’ classify diabetes as a disease of the abdomen; fail to classify myocardial infarction as ischemic heart disease; place the arteries of the foot in the abdomen?

Without further quality assurance, clinicians may not realize the implications of what they are saying; researchers may not realize what their queries should retrieve, and postcoordination cannot be expected to be reliable. Interoperability, and therefore meaningful use, will be limited.”

I suggest anyone who is interested in the area read the whole paper carefully and then e-mail NEHTA (terminologies@nehta.gov.au) asking them just when the work recommended here will be undertaken and finalised. A decision to deploy SNOMED CT was made by NEHTA about 4 years ago and the very limited use so far also suggests there are some significant implementation problems.

It seems that while SNOMED is the best available choice for a clinical terminology there is a real effort to be undertaken to make it fully ‘fit for purpose’. Right now is seems it isn’t. It is especially worrying that there seem to be some clear patient safety issues.

Again we seem to be seeing that NEHTA has over promised and under delivered. They need to get weaving and push for the changes Prof. Rector is suggesting with IHTSDO - the international maintainers of SNOMED.

David.

Weekly Australian Health IT Links – 18 July, 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

A pretty quiet week with the story linked to in the first two articles being a bit of a worry having had a security breach in an SA Health Government entity which was denied, then admitted and then not really fixed promptly. Health Departments really do need to take these issues seriously as there is nothing like a few bad headlines to potentially erode trust in things like e-Health.

Privacy was also in the news with the release by the Federal Privacy Commissioner of a quite substantial document on the privacy aspects of the PCEHR.

Also we have seen iSoft pretty much gone and Qld Health still having a few issues with its payroll.

On the hopeful side we have some ideas for bionic eyes and clever pill reminder systems. I think a focus on the positive will help relieve the gloom so many seem to be feeling.

See here:

http://www.smh.com.au/business/the-global-glums-are-here-to-stay-20110715-1hhy5.html

The global glums are here to stay

Clancy Yeates

July 16, 2011

If we ignore the euro-zone crises, they won't go away; they may even land on our doorstep, at least according to some observers. Clancy Yeates reports.

IF YOU thought the mining boom would bring good cheer to households and businesses around the country, think again. Every day it's clearer that for all our good fortune, Australians have a case of the economic blues.

On paper, we've arguably never had it better. Household wealth is near record highs, debt levels have been slashed, and our unemployment rate of 4.9 per cent is the envy of the Western world. Yet the economy is suffering from a shortage of a crucial ingredient - confidence.

-----

http://www.theaustralian.com.au/news/health-science/dna-test-names-exposed-online/story-e6frg8y6-1226095576596

DNA test names exposed online

• EXCLUSIVE: Hedley Thomas
• From: The Australian
• July 16, 2011 12:00AM

AUSTRALIANS seeking confidential DNA paternity tests to establish the parentage of their children have been outed online in a major privacy breach at Australia's largest drug and alcohol testing company.

Other sensitive data accidentally disclosed by the national company, Medvet, also compromise the privacy of hundreds of people who have confidentially ordered kits to test themselves or family and friends for illicit drugs and alcohol in their urine and saliva.

An investigation by The Weekend Australian has revealed that the complete home and work addresses of customers and others who ordered paternity test kits, drug and alcohol test kits and other products this year and last year are published and accessible on Google.

-----

http://www.theaustralian.com.au/news/health-science/promise-of-privacy-carried-little-weight/story-e6frg8y6-1226095573209

Promise of privacy carried little weight

• Hedley Thomas
• From: The Australian
• July 16, 2011 12:00AM

THE details are excruciatingly private and leave little to the imagination.

The "self-collect paternity test", for example, will be sought by someone who might harbour doubts about the parentage of a child. The customer could be a parent, a grandparent, a sibling or a grown-up child with concern over his or her genetic make-up.

Those who seek such tests do so having been assured their confidentiality is taken seriously by Medvet, Australia's largest company for drug and alcohol testing. Paternity testing is a burgeoning part of the South Australian-government owned venture with close ties to SA Health.

Alternatively, you could be concerned that a drug addiction might compromise your job and buy a test kit for private analysis.

-----

http://www.6minutes.com.au/news/gp-face-pcehr-non-compliance-fines

GP face PCEHR non-compliance fines

• By Michael Woodhead on 12 July 2011

GPs will be subject to new regulations, disciplinary offences and fines in regard to the management of the Personally Controlled E-Health Record (PCEHR) system, under new government proposals.

In proposals (link) for the legal framework for the PCEHR released last week, the Department of Health and Ageing is seeking input on new legislation to handle issues such as e-health privacy, record retention and audit trails.

According to the consultation document, some issues such as age of consent and privacy provisions for accessing medical records may be guided by current laws and requirements.

-----

http://www.itnews.com.au/News/263561,65279-commissioner-eyes-tough-e-health-privacy-laws.aspx

Commissioner eyes tough e-health privacy laws

By John Hilvert on Jul 14, 2011 6:55 AM (1 hour ago)

NEHTA chided for restricted community consultations.

Privacy Commissioner Timothy Pilgrim has proposed laws around e-health records in Australia that would tighten use and disclosure of data and penalise any privacy breaches.

Pilgrim also proposed laws that would keep e-health record storage in Australia to combat data security concerns.

The Privacy Commissioner made 32 recommendations in total on the operation of the Government's planned $467 million personally-controlled electronic health record (PCEHR) system, which was to be implemented by the National E-Health Transition Authority (NEHTA).

While some recommendations were of a technical or housekeeping nature, others required legislation to clarify responsibility for the management of the PCEHR and the health information held in it.

-----

http://ehealthspace.org/news/feds-call-pcehr-legislative-input

Feds call for PCEHR legislative input

Posted Tue, 12/07/2011 - 14:21 by Josh Gliddon

The federal government has called for submissions into the legislative framework associated with the introduction of the personally controlled electronic healthcare record (PCEHR) in July 2012.

In order to stimulate discussion, the Department of Health and Ageing together with the National E-Health Transition Authority (NEHTA) has released a Legislation Issues Paper which addresses five key aspects of the PCEHR system.

The first aspect, participation, identifies those individuals and organisations eligible to take part in the PCEHR system. It states all citizens will be eligible, along with healthcare organisations, the PCEHR system operator, data repository operators, and portal providers.

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http://www.australiandoctor.com.au/articles/b1/0c0719b1.asp

Coupons spark boom in unneeded treatments

14-Jul-2011

David Brill

The new craze for bargain coupon websites is fuelling a boom in unnecessary medical procedures and encouraging beauty treatment companies to flout advertising regulations, doctors warn.

The Cosmetic Physicians Society of Australia this morning hit out at websites like Scoopon and Jump On It, claiming they raise legal and ethical problems by promoting discounted cosmetic procedures.

Society president Dr Gabrielle Caswell said “an alarming number” of companies offer botulinum toxin (Botox) treatment via the sites, despite this being a prescription-only medicine that cannot be advertised direct to consumers.

-----

http://www.nehta.gov.au/about-us/strategy

The National E-Health Transition Authority Strategic Plan Refresh

The NEHTA Board has endorsed the strategic plan refresh which articulates how the National E-Health Transition Authority (NEHTA) will continue to develop and progress the national infrastructure and adoption support required for eHealth in Australia, as mandated and funded by the Council of Australian Governments (COAG).

NEHTA's Strategic Plan describes the COAG funded milestones achieved to date, the work planned to progress the key eHealth foundations and initiatives for the remaining period of NEHTA’s current COAG funding, the targets and activities required to deliver components of the PCEHR, and NEHTA’s role in accelerating the adoption and further progression of eHealth in Australia into the future.

-----

http://blog.healthbase.info/?p=289

Building on the RIGHT foundations

2011-July-16 | 14:40 By: eric Filed in: engineering | pcehr

I have, on a number of occasions over the past decade, tried to explain the importance of building software, systems, national infrastructure, etc. on the right foundations. Other people who do this in the e-health arena often talk purely about the importance of standards and the analogy with the ‘rail gauge problem’ experienced in Australia since the states built their own rail infrastructure in isolation of the rest of the country. Yet others often talk about the need for open, non-proprietary software and systems that can evolve to meet peoples needs without ‘vendor lock-in’.

However, for me, the most important criterion is an engineering one – that of ensuring that a system’s infrastructure is based on solid foundations. First and foremost, any system infrastructure must perform its intended role, and do so safely, reliably and efficiently. This is often ignored or given a lower prominence than standards or openness. Particularly the former.

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http://www.computerworld.com.au/article/393397/nsw_health_calls_time_groupwise_preps_exchange_move/

NSW Health calls time on GroupWise, preps Exchange move

All existing messages to be copied to and stored in the permanent archive

• Rodney Gedda (CIO)
• 13 July, 2011 11:02

NSW Health has started preparing the consolidation of all its disparate e-mail systems into one Microsoft Exchange environment for some 200,000 end-users across the state government department with the big loser being Novell’s GroupWise.

To prepare for the migration, the health support services (HSS) infrastructure office within NSW Health is installing a centralised e-mail archiving system based on Quest Archive Manager specifically for the GroupWise environments.

The new archiving solution will address “pressing GroupWise storage capacity concerns” and allow the historical GroupWise e-mail to be centrally stored and accessed without a dependency on GroupWise itself.

-----

http://www.theage.com.au/business/anz-tosses-the-dice-with-oceania-share-sale-20110711-1hap2.html

ANZ tosses the dice with Oceania share sale

Ian McIlwraith

July 12, 2011

ANZ has put the former Allco Equity Partners, Oceania Capital, in play by selling enough shares to South African listed conglomerate Hosken Consolidated Investments enough shares for a takeover springboard.

ANZ ended up owning 24 per cent of Oceania in late 2008 as a result of an investment company belonging to Melbourne's Liberman family, LJCB Investments, defaulting on a loan.

At the time it was reported that ANZ needed to sell the stake for $112 million if it was to recover all the money owed by LJCB under a collapsed put and call option arrangement with Allco Finance.

-----

http://www.zdnet.com.au/csc-bid-for-isoft-gets-shareholder-tick-339318648.htm

CSC bid for iSoft gets shareholder tick

By Suzanne Tindal, ZDNet.com.au on July 15th, 2011

iSoft shareholders have voted in favour of CSC's acquisition of the troubled e-Health company in two separate votes today.

The company had to split the vote on the acquisition by share scheme arrangement after a Federal Court ruling, which attempted to settle a spat that had arisen in court over the value that CSC was set to pay for iSoft's convertible notes.

Previously, a company controlled by former iSoft executive chairman and founder Gary Cohen had been reported as saying that he'd seen better offers for the firm than those put forward by CSC.

-----

http://phx.corporate-ir.net/External.File?item=UGFyZW50SUQ9MTAwMTg0fENoaWxkSUQ9LTF8VHlwZT0z&t=1

RESULTS OF SCHEME MEETINGS AND NOTICE OF SECOND COURT HEARING

Sydney – Friday, 15 July 2011 – iSOFT Group Limited (ASX: ISF) is pleased to advise that iSOFT shareholders have today approved the scheme of arrangement by which CSC Computer Sciences Australia Holdings Pty Ltd will acquire all of the issued shares in iSOFT ("Share Scheme").

-----

http://www.theaustralian.com.au/business/opinion/stokes-safe-on-100m-westrac-payout-pledge/story-fn7rgef9-1226092650564

Stokes safe on $100m WesTrac payout pledge

• ABACUS: Nabila Ahmed
• From: The Australian
• July 12, 2011 12:00AM

Primary asset sale not in peak health

AS Primary Health Care's Ed Bateman sifts through bids for its Health Communication Network business, and awaits a few more proposals, the indication is the company may struggle to get to the $300 million price tag it is said to be hoping for.

While interest from private equity late last year was one of the reasons Mr Bateman decided to test the market for the asset, private equity is seen as an unlikely owner of the GP software business, which will continue to serve Primary as a client after any change of ownership. Global IT groups such as Computer Sciences Corporation, which is awaiting approval on a $188m offer for iSoft, and Cerner are said to be among logical buyers. One local buyer is said to have expressed an interest, with speculation centering on Computershare. It's understood a few bidders have asked for an extension of last week's deadline for offers.

-----

http://www.6minutes.com.au/news/medical-board-has-ten-tips-for-telehealth--1

Medical Board has ten tips for telehealth

• By Gemma Collins on 14 July 2011

GPs are being advised on how they should be treating patients during telehealth consultations under draft guidelines released by AHPRA.

Following the new Medicare rebates for video consultations, the Medical Board of Australia has come up with a list of guidelines for medical practitioners carrying out “technology-based consultations”, which are open to consultation (see link).

AHPRA says the consultations are not just restricted to video-conferencing, but include any alternative to face-to-face consultations.

-----

http://www.computerworld.com.au/article/393713/qld_nurses_still_seeking_payroll_answers/

Qld nurses still seeking payroll answers

Queensland Health must regain the trust of its nurses as the bungled payroll saga continues

• AAP (AAP)
• 15 July, 2011 08:43

Queensland Health must regain the trust of its nurses as the bungled payroll saga continues, the nurses union says.

Queensland Nurses Union (QNU) secretary Beth Mohle told reporters on Thursday that thousands of nurses were still being underpaid or overpaid each fortnight.

In Brisbane for the QNU annual conference, Ms Mohle also revealed Queensland Health had accused nine victims of its bungled payroll of fraud.

-----

http://www.cio.com.au/article/393545/queensland_health_staff_can_dispute_overpayments

Queensland Health staff can dispute overpayments

Queensland Health's troubled payroll system will need an extra $10 million on top of the $209 million it's already cost to fix.

• AAP (AAP)
• 14 July, 2011 09:00

Queensland Health's troubled payroll system will need an extra $10 million on top of the $209 million it's already cost to fix.

Queensland Health's (QH) acting director general, Tony O'Connell, admitted the extra cost during questioning by a parliamentary estimates committee on Wednesday.

He told MPs $209 million had funded measures to improve the system like extra payroll staff since its disastrous launch in March 2010.

But more money was needed for more staff and staff support.

-----

http://www.computerworld.com.au/article/393203/no_rush_health_overpayments_says_bligh/

No rush on health overpayments, says Bligh

Queensland health workers are being given as much time as possible to make sure calculations of overpayments by Queensland Health are correct

• AAP (AAP)
• 12 July, 2011 08:46

Queensland health workers are being given as much time as possible to make sure calculations of overpayments by Queensland Health are correct, Premier Anna Bligh says.

Ms Bligh announced a moratorium on repayments on Sunday to give health workers some breathing space on making the repayments and to begin the process of restoring staff confidence in Queensland Health.

"I don't want people to feel rushed about this," she told reporters in Brisbane on Monday.

-----

http://www.6minutes.com.au/news/a-glowing-reminder-to-take-your-tablets

A glowing reminder to take your tablets

• By Gemma Collins on 8 July 2011

A medicine bottle top that lights up, makes noises, and then texts and calls when it’s time to take the tablets could mean the end of poor compliance, its makers say.

GlowCaps, which fit on standard medication bottles, come with a plug-in unit that connects to a database through the wireless network and knows the patient’s particular dosage requirements.

The bottle top and the plug-in unit light up at the time the patient needs to take their medication.

----

http://www.theage.com.au/national/bionic-glasses-give-blind-hope-20110713-1he18.html

Bionic glasses give blind hope

Nicky Phillips

July 14, 2011

AN AUSTRALIAN scientist has developed the world's first pair of bionic glasses that could help thousands of legally blind people navigate the world.

The glasses, which utilise tiny cameras and software technology from video games, alert the wearer to objects around them using small flashing lights.

Neuroscientist Stephen Hicks said bionic glasses had an advantage over the bionic eye or retinal implants because they were cheap, non-invasive, and more affordable than training a guide dog. ''Essentially they are just an iPhone and a pair of glasses,'' said Dr Hicks, who presented his invention at The Royal Society's Summer Science Exhibition in London last week.

-----

Enjoy!

David.

AusHealthIT Poll Number 79 – Results – 18 July, 2011.

The question was:

Will The Federal E-Health Program Become An Election Issue At the Next National Election?

The answers were as follows:

No Way

- 5 (11%)

Probably Not

- 28 (62%)

Neutral

- 0 (0%)

It Really Could

- 9 (20%)

For Sure

- 3 (6%)

A reasonably clear poll. Most thought it would not become political. We will see from now until the next election if we are right or wrong.

Votes : 45

Again, many thanks to those that voted!

David.

Eric Browne Has Done a Very Good Thing!

Dr Eric Browne has assembled as many of the Public PCEHR Submissions as he can.

Please let him know about others via his blog - on the list on the left pane of the blog.

See here:

http://blog.healthbase.info/

Here is the current list.

http://www.healthbase.info/pcehr/page5/page5.html

That ordinary citizens need to do this speaks volumes about the 'bad' government we are all labouring under at present.

David.

Here Is A Relatively New Document Describing NEHTA’s View of the Current PCEHR ConOps. Interesting Stuff!

The .pdf file is dated 5^th July, 2011.

Key points

Draft Concept of Operations: Relating to the introduction of a personally controlled electronic health record (PCEHR) system.

This document is a summary of key points. You can find the full Draft Concept of Operations: Relating to the introduction of a PCEHR at:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr-document

1. Overview

eHealth is an important part of the Australian Government’s health reform agenda which aims to deliver a better deal for patients and secure the long-term sustainability of Australia’s health system.

To provide better access to health information, the Australian Government is developing the Personally Controlled Electronic Health Record (PCEHR). This system will enable the secure sharing of health information between an individual’s healthcare providers, while giving the individual control over who can access their ehealth record.

The Government has invested $466.7 million to develop the basic functionality required to establish the PCEHR System that will grow over time. This first release will give all Australians from July 2012 the option to sign up for a PCEHR.

The PCEHR System will build on the foundation laid by the introduction of the National Healthcare Identifiers for individuals, healthcare providers and healthcare organisations as well as the National Authentication Service for Health, standard clinical terminologies and methods for communicating health information between healthcare providers such as discharge summaries and electronic referrals.

1.1 The need for a PCEHR System

One of the many challenges faced by the Australian health system is that health information is held in dispersed records across the country. In many healthcare situations, quick access to key health information about an individual is not always possible. Limited access to health information at the point of care results in:

• A greater risk to patient safety.
• Increased costs of care and time wasted in collecting or finding information.
• Unnecessary or duplicated treatment activities.
• Additional pressure on the health workforce.
• Reduced participation by individuals in their own healthcare information management.

The PCEHR System will enable better access to important health information, allowing individuals to view their important health information when and where they need it. They will also be able to share this information securely to healthcare providers involved in their care.

This will result in:

• Improved continuity of care for individuals accessing multiple healthcare providers by enabling key health information to be available where and when it is needed.
• Access to consolidated information about an individual’s medicines, leading to safer and more effective medication management and reductions in avoidable medication-related adverse events.
• Enabling individuals to participate more actively in their healthcare by improved access to their health information.
• Improved diagnostic and treatment capabilities through better access to health information.
• Improved care coordination for individuals with chronic or complex conditions by enabling the individual’s healthcare team to make better-informed decisions at the point of care.

1.2 The PCEHR System

The PCEHR System aims to place the individual at the centre of their own healthcare by enabling access to important health information when and where it is needed by individuals and their healthcare providers. Individuals will be able to choose whether or not to have a PCEHR, and if they choose to participate, they will be able to set their own access controls. With the individual’s permission, key pieces of health information may be viewed by participating healthcare providers across different locations and healthcare settings.

1.3 Participation

1.3.1 Individuals

Individuals will be able to register for a PCEHR from July 2012. Those who choose to participate will have the opportunity to experience the following benefits:

• Access to their health information
• Receive improved healthcare
• Be more informed about their healthcare choices

Individuals may also nominate representatives (such as family members and carers) to help manage their PCEHR. Authorised representatives (such as parents and guardians), will also be able to register individuals in their care and access their PCEHR. Additional processes will be put into place to manage access when the child becomes older and is able to manage their own PCEHR.

Individuals will be able to withdraw at any time from the PCEHR System. A PCEHR is not mandatory for receiving healthcare services.

1.3.2 Healthcare providers and organisations

Healthcare organisations will be able to access the PCEHR System from July 2012. Healthcare organisations that choose to participate will have the opportunity to:

• Access health information more efficiently
• Ensure safer healthcare
• Deliver more effective healthcare

1.4 Personal control

Central to the PCEHR System is the concept of personal control. Participating individuals can have control over their PCEHR in the following ways:

• Decide whether or not to have an active PCEHR: The PCEHR System operates on an opt-in model, where individuals elect to register and create a PCEHR. At the point of registration, individuals establish their PCEHR by consenting to the terms and conditions of the PCEHR and set their access controls. Individuals may de-activate their PCEHR at any time.
• Access information in their PCEHR: Individuals will be able to view any health information contained in their PCEHR.
• Set controls around healthcare provider access: Individuals can determine and change settings around access to their PCEHR to participating healthcare organisations involved in their healthcare. Individuals may choose from a range of approaches to setting and managing these controls. Where the individual requires emergency care access controls may be overridden.
• Authorise others to access their PCEHR: Individuals can nominate other persons (such as carers and family members) to access health information in their PCEHR.
• Choose which information is published to and accessible through their PCEHR: Individuals can request healthcare providers to not send information to their PCEHR. There will be optional advanced mechanisms to more closely manage access to certain information.
• View an activity history for their PCEHR: The PCEHR System will provide an audit trail where individuals can view a history of actions on their PCEHR.
• Make enquiries and complaints: Individuals can make enquiries and complaints in relation to the management of personal information in their PCEHR and the PCEHR System.

1.5 Privacy and security

Health information within the PCEHR System will be protected through a combination of legislation, governance arrangements and security and technology measures. Some of the technical and non-technical controls include:

· Accurate authentication of users accessing the PCEHR System.

· Robust audit trails.

· Proactive monitoring of access to the PCEHR System to detect suspicious and inappropriate behaviour.

· Rigorous security testing, to be conducted both before and after the implementation of the PCEHR.

· Education and training of users of the system.

· Requirements that healthcare providers and organisations comply with specific PCEHR System business rules and other relevant legislation.

Individuals will be able to make enquiries and lodge complaints regarding suspicious or unauthorised access to their PCEHR.

1.6 Governance

There will be the establishment of appropriate governance structures and mechanisms to manage the national PCEHR program and its operation. During the PCEHR planning phase to June 2012, the primary accountability for the PCEHR system is with the Minister for Health and Ageing. Planning responsibility for the PCEHR system’s implementation into the broader health sector, and its strategic fit with state and territory health policies, is with the Australian Health Ministers’ Conference.

More information on the eHealth agenda

Please visit our new eHealth Information site at: http://www.ehealthinfo.gov.au/ . This website provides information on the PCEHR, healthcare identifiers, eHealth sites, as well as more general ehealth information through the form of text, interactive diagrams and videos. It is a resource which we will be updating regularly.

You can also find relevant video links below:

http://www.youtube.com/watch?v=3IOoUMwSGMI&feature=relmfu

http://www.youtube.com/watch?v=usTGPRQVZ0A&NR=1

----- End Document.

I find this a useful summary of just what NEHTA is thinking and to possibly get a handle on what is coming down the pike. The key points to me are:

1. While the need for the PCEHR (Section 1.1) identifies all sorts of substantive issues with the present situation it really does not show just how the PCEHR (as proposed) will actually solve the problem of easy access to point of care information for the clinical decision makers. There is also no reference provided to anything in the way of evidence that the PCEHR would make any form of clinical or outcome diference.

2. Section 1.3 on Participation really does not provide much in the way of ‘how’ to the bullet points provided. Mainly I suspect because it has not been worked out yet.

3. Section 1.4 on Personal Control really just ensures that no clinician would be bothered using the PCEHR as a resource for the reason that its completeness is dubious and anyway it has not been designed for them as I pointed out yesterday.

4. The provided authentication controls have really neither been developed or finalised (given NASH is not operational yet) to what is said in Section 1.5 is just motherhood blurb at this point.

4.Section 1.6 shows Governance is still a work in progress.

Overall a flawed idea that is not really much advanced and probably never will be.

David.

It Looks Like The Disappearance of the Submissions on the PCEHR ConOps Was Not An Accident.

Here is the current Government page on the PCEHR.

PCEHR Draft Concept of Operations Consultation

Submissions on the Draft Concept of Operations - Relating to the introduction of a PCEHR system have now closed.

All submissions received by the closing date (7 June 2011) will be reviewed and this feedback will inform the final personally controlled electronic health record (PCEHR) system Concept of Operations document scheduled for release in August 2011.

In the interim, the Draft Concept of Operations - Relating to the introduction of a PCEHR system can still be viewed.

This document provides details on how the personally controlled electronic health record (PCEHR) system may look, what information it might contain, and how it will function and connect with existing clinical systems.

It also covers participation issues, information management, privacy and security, and matters of implementation, evaluation and consultation.

The content was shaped by the wide range of consultations which the Department of Health and Ageing (the Department) and the National E-Health Transition Authority (NEHTA) have held with stakeholders — consumer groups, health professionals, the Information and Communications Technology (ICT) industry and state and territory governments.

The PCEHR consumer booklet, e-health - have your say, describes key elements of the proposed PCEHR system, and the impact it will have on health care in the future.

You can also find out more about the PCEHR Concept of Operations process by reading the fact sheet.

Although the consultation period on the Concept of Operations has closed, it is planned that a PCEHR Legislation Issues Paper will shortly be available for public comment. The PCEHR Legislation Issues Paper identifies the legal issues which flow from the Concept of Operations and explores how these issues might be addressed within a legal framework. Watch the yourHealth website for information about the consultation process for legislation issues.

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The page is found here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr

No mention of submissions. They were available and now they have vanisthed!

The Google Cache has not been updated in 10 days:

See here:

http://webcache.googleusercontent.com/search?q=cache:8gLG3k7S3GgJ:www.health.gov.au/internet/yourhealth/publishing.nsf/Content/PCEHRSubmissionsReceived+Submissions+%22PCEHR%22&cd=9&hl=en&ct=clnk&gl=au&source=www.google.com.au

Looks like a sudden change of mind. I wonder why?

Maybe the public were being nasty or just not compliant enough?

It is all pretty dodgy as far as I am concerned!

David.