Health Information Exchange - A US Status Report With Lessons for Australia I Suspect.

Both the eHealth Initiative and the National eHealth Collaborative have provided recent updates and ideas about the state of play of Health Information Exchange (HIE) in the US.

This has provoked a number of articles

First we have

6 Secrets To A Successful Health Information Exchange

Many health information exchanges have had a hard time remaining in business, but a new report from the National eHealth Collaborative spotlights winning strategies.

By Marianne Kolbasuk McGee, InformationWeek

August 04, 2011

Health information exchanges have yet to become the darlings of most hospitals and medical practices, but despite their frostly reception, two recent studies suggest you can launch and maintain a viable HIE.

These health data sharing organizations will undoubtedly play an important role as the HITECH Act's Meaningful Use programs continue to take shape. So it's time to take a closer look at lessons learned from such success stories.

A new report released this week by the National eHealth Collaborative (NeCH), a public-private cooperative funded by the Office of National Coordinator for Health IT, outlined some of the" secrets" uncovered by 12 successful HIEs.

Many HIEs can learn from these lessons--especially considering that there are at least 255 HIEs in the U.S. right now, a 9% increase from 234 HIEs last year, and up significantly from only a few dozen in 2004, according to the eHealth Initiative, another coalition that studies HIEs and which recently completed its own annual report.

For those of us that have been following HIEs over the last decade or so, it's been pretty clear that success--and sustainability--has been elusive for many of these organizations. There have been failures along the way, most notably the once promising Santa Barbara County Care Data Exchange in California, which launched in 1999 and lasted only a few difficult years before shutting down in 2006.

I would argue that the Santa Barbara effort was a visionary for its time--and that proved to be one of its biggest problems. Unfortunately their effort was launched several years before the HITECH Act was signed into law--meaning before EHRs appeared on the radar screens of large numbers of healthcare providers in the region. When the Santa Barbara exchange launched, few healthcare providers were open to the idea of using and sharing digitized patient data--especially among competing doctors and hospitals.

Of course, most of the 12 successful HIEs studied by NeHC in its "Secrets of HIE Success Revealed, Lessons from The Leaders" report have also been around for quite some time, launching pre-HITECH Act, but none as early as the Santa Barbara effort.

Although most of them have no doubt struggled with their own stumbling blocks--big and small--they've been able to recover. That's evident from the "secrets" revealed by the National eHealth Collaboratives report.

Here are some of keys to success among top HIEs:

1 -- An HIE needs to make sure stakeholders see the value of participating in the HIE--and then make sure they deliver on those promised services. That value includes reduced data distribution costs and increased staff productivity, which are "the major reasons why participants are willing to pay for the services offered by these HIEs," according to the NeHC report.

2 -- HIEs must collaborate and align with stakeholders about their priorities for the group. Because stakeholders of an HIE are diverse--they can include payers, competing hospitals, doctor groups and solo practices--their needs differ. So, successful HIEs need to engage the stakeholders in coming up with "win-win" collaborations.

"Once the major two competing [healthcare provider] entities joined from a data sharing perspective, it was easy to get the other hospitals and providers in the area" to join, said Mike Smyly, chief business development officer of Inland Northwest Health Services [INHS], a HIE based in Washington state and one of the 12 organizations spotlighted by NeHC.

Having the two big competing entities finally feel comfortable about sharing data made it easier for others in the region to see value in joining INHS, said Smyly during a NeHC webinar this week discussing the NeHC report. "It became more of a value equation for new folks joining," he said. "Once we got over the hump, it was great."

4 more tips for success are here:

http://www.informationweek.com/news/healthcare/interoperability/231300241

For more insights and "secrets" to running an HIE, be sure to read the full NeHC report.

Second we have a long review for those planning to move down the HIE path.

5 Considerations on Health Information Exchanges: What Your Hospital or Health System Needs to Know

Written by Bob Herman | August 01, 2011

Hospitals and health systems are scrambling to become meaningful users of certified electronic health record technology within their own entities, but what's the next step to share health information after that step? The answer for many organizations will be health information exchanges.

HIEs mobilize patient healthcare information electronically across multiple member organizations, hospitals and other stakeholders. In many ways, it's like an EHR for an entire geographical region or, on a smaller scale, a health system that gives physicians and other healthcare professionals secure access to patient data when it might be needed in critical moments. The following five considerations can give hospitals and health systems more insight on what a HIE is and what the benefits and drawbacks of joining or creating one are.

1. Nuts and bolts. For a HIE to work, hospitals and health systems must first have functioning EHR systems, preferably ones that satisfy the Office of the National Coordinator for Health Information Technology's requirements for meaningful use. Federal grants through the HITECH Act are helping hospitals and health systems adopt EHRs, and the ONC has been funding states to implement HIEs. The State HIE Cooperative Agreement Program has awarded more than $547 million to 56 states, eligible territories and qualified state designated entities, according to the ONC website. Providers wanting to join a HIE look for a basic starting point: where is there a HIE geographically closest? Health systems wanting to create their own must decide if it is financially and logistically feasible to interlink member hospitals.

With EHRs in place, the HIE organization can recruit different providers, hospitals and health systems to join the exchange in order to share patient information. For example, Tom Penno, chief operating officer of the Indiana Health Information Exchange, says patients can go to a physician, have blood work completed and that information can be uploaded if they see other physicians or specialists within the HIE. This gives the provider a new way to obtain patient information quickly and securely at crucial points of care, he says. Joy Grosser, vice president and chief information officer of Iowa Health System, says HIEs make it possible for clinicians and physicians to have all the information they need to give the best possible care to patients, be it in a clinical, ambulatory or hospital setting.

"HIEs are really an infrastructure necessity to change the way we're doing healthcare across regions, states and the nation," Ms. Grosser says. "Most people don't spend their entire life at one hospital or one physician. It's integral to help manage the healthcare of a population to be able to share this info. We're on the first step of a stairway through this process."

2. Implications of health IT vendors. According to a recent eHealth Initiative survey, HIE initiatives are up nine percent from last year, so there is a demand when it comes to HIEs and vendors to build their infrastructures. Consequently, hospitals wanting to join a HIE or build their own are at a time of both early adoption but, as the survey shows, a growing demand. There are dozens of HIE vendors, many of which are similar to a hospital's EHR vendor, but John Hendricks, IT director for interoperability and web programming for Iowa Health System, says knowing the right certified system within the HIE is key. The HL7 Clinical Document Architecture is a standard that all lays out the specific structures and meanings for clinical documents to be exchanged. The Continuity of Care Document is the main document within the HIE and EHR systems, and some include different subject areas of patient health, such as allergies, family history, results, vital signs, payor details and others. Hospitals entering or creating HIEs must be cognizant of the information that is actually being shared and how a vendor handles the sensitivity of the information. Mr. Hendricks notes that not all vendors support the different subject areas and CCDs, and there is not complete interoperability among all different hospital EHR systems.

Ms. Grosser adds that choosing vendors and implementing HIEs is still very new and proprietary for each organization's core IT systems. However, putting certified systems and coding in place is one of the best practices an organization can do, she says. Standardizing those systems with certified nomenclature will lead to less overall confusion between participating providers while sharing information.

Lots more here:

http://www.beckershospitalreview.com/healthcare-information-technology/5-considerations-on-health-information-exchanges-what-your-hospital-or-health-system-needs-to-know.html

and last we have a discussion or a quite advanced HIE here:

Mature HIEs build trust to share data, IT

August 03, 2011 | Mary Mosquera

Oklahoma health information exchange SMRTNET has managed to build a network of seven networks and has attracted a broad range of 3,000 providers in 2011 that share data between hospitals, Native American tribes, community health centers, labs, universities and private physicians.

The individual networks exchange data statewide using a shared set of common resources and privacy policies.

The Secure Medical Records Transfer Network (SMRTNET), a statewide non-profit organization, is one of the examples that the National eHealth Collaborative (NeHC) highlighted in its report of case studies of 12 sustainable and mature health information exchange (HIE) organizations across a variety of geographic regions.

The HIEs follow a number of business and marketing models, according to NeHC, which is a public/private partnership that promotes secure health information exchange, in “Secrets of HIE Success Revealed: Lessons from the Leaders,” released Aug. 2.

Exchange efforts are emerging around the country in order to meet requirements for meaningful use of electronic health records (EHRs) and to improve care coordination.

“While every HIE project is unique, they all share the same problems of participation, value, security, growth and especially sustainability,” said Mark Jones, COO and principal investigator of SMRTNET.

The report extracts critical characteristics that are common to all of the exchanges and offers real-world success stories that may “contribute to a cohesive national roadmap for nationwide HIE” so others can learn from them, said Kate Berry, CEO of NeHC, in an announcement.

For SMRTNET, broad representation in the HIE planning in the beginning was important for future expansion. “Then every potential participant knows that there has been ‘someone like you’ at the table from the beginning,” Jones said in the report.

Among steps the report listed as important for an HIE’s success:

• Bring together many interested organizations that represent industry, health care, technology, consumers and public sectors and other local interests who will agree on shared objectives to foster trust and learning.

• Establish and maintain a consistent set of policies and procedures for data use and data integrity so that “no stakeholder gains a competitive advantage at the expense of others.”

• Sharing IT infrastructure and patient information benefits outweigh risks for HIE provider participants who compete with each other in service area markets, especially in rural areas, where health IT resources are often sparse.

• To identify revenue streams, many HIEs are evolving from just data exchange to application solution providers. SMRTNET offers a master patient index and access to a community record through an online portal. The community record includes demographics, diagnoses visits, medications, provider, labs and data to support meaningful use, such as electronic prescribing and secure messaging, such as the ability to forward reports.

• HIE technical and training personnel work with physicians and office staff to understand and even integrate exchange applications into their workflow to get them online quickly and improve operations.

More here:

http://govhealthit.com/news/mature-hies-build-trust-share-data-it

A key reason for raising these reports it that I have a feeling that when we see when the Infrastructure Partner for the PCEHR announced what we will actually be seeing is a US HIE system provider working with a systems integrator to deliver some custom code to provide a log-in and links to the Health Identifier Service and then the HIE components used to deliver a range of linkages to various information sources - starting with Medicare information and then slowly (over years) creating something very much like a national Health Information Exchange for Australia.

You can all see how close I am in due course, but I suggest close reading of the two reports linked in these articles.

Of course a key issue is that all these HIEs are designed to facilitate provider to provider exchange and not provider to consumer or provider under the control of the consumer to provider exchange. It will be fun to see whatever is selected be ‘shoe horned’ into working in Australia.

Another small issue is that no-one has ever tried an HIE of the proposed size of the National PCEHR. It is planned to be very, very big!

David.

Health Computing in the Cloud Promise and Risks. There Are All Sorts of Wrinkles To Be Aware Of!

The following very useful article on the place of the cloud in Health IT appeared a few days ago.

Health Care in the Cloud

James M. Kunick

Health Data Management Magazine, 08/01/2011

According to a recent Gartner Group study, annual spending on cloud-related transactions may grow to almost $150 billion worldwide by 2014. Although health care is a market segment that has generally resisted jumping into the technology explosion taking place "in the cloud," according to the CDW 2011 Cloud Computing Tracking Poll, 30 percent of health care organizations are now either implementing cloud-based solutions or are already operating such solutions.

In addition, the poll projects that current cloud users will spend more than one-third of their 2016 I.T. budget on cloud resources and applications. This ever-growing movement is driven by the flexibility, cost savings and convenience that cloud-based solutions can offer. At the same time, there are significant downsides to making the move-including the loss of control over critical I.T. systems and sensitive data. However, there are a number of ways health care organizations can manage the risks and reap the rewards of the cloud.

Benefits and risks of the cloud

The term "cloud computing" generally refers to a "public" cloud, in which users have the ability to access I.T. resources and data, on demand, from a third-party provider over the Internet. By effectively outsourcing software hosting, maintenance and support to a cloud services provider, local and regional health care organizations can obtain reliable, scalable, secure and easily available technology solutions that might otherwise be out of reach.

Health care organizations can derive substantial benefits by moving their I.T. systems and data to the cloud. According to the CDW survey, 88 percent of health care organizations that are cloud users have reduced the cost of software applications by moving them into the cloud, with an average annual savings of 20 percent.

Despite the clear cost savings, health care organizations should carefully monitor tax regulations as states begin to formulate positions on the taxability of cloud-based services. Several states have already issued administrative rulings that such services may be subject to state sales tax, and providers are certain to pass these taxes on to their customers.

Other benefits of a cloud solution include (1) fast and easy access to patient data as compared to paper files; (2) best practices data security; and (3) transaction-based pricing for access to state-of-the-art hardware and software. (Cloud users typically pay a monthly or annual subscription fee to the cloud service provider for hosting the software and data and providing Internet-based access, as well as the maintenance and support services that keep the application running.)

There are also a number of unique cloud-based solutions that can specifically benefit health care organizations, including:

* Access to encrypted EMR and EHR;

* Storage of de-identified patient data and practice guidelines in centralized databases;

* Home monitoring apps for patients; and

* Real-time collaboration by professionals using encrypted or de-identified patient data.

A cloud-based solution will, however, require health care organizations to turn over sensitive information-such as the personal health information of its patients and customers-to the provider. If an unauthorized disclosure of such sensitive information occurs, it can have particularly severe consequences for health care organizations, including significant costs of recovering/restoring the data and of notifying affected individuals of the disclosure.

Lots more here - with topics like termination from the use of the cloud, security and compliance management among other things discussed:

http://www.healthdatamanagement.com/issues/19_8/health-care-in-the-cloud-42884-1.html?zkPrintable=true

I believe we will see increasing use of the cloud in Health IT and it would seem obvious that using the cloud as a platform for a basic emergency care shared record for example - for those who wanted one - might be quite an interesting idea. Obviously most of the major Personal Health Record providers are already using the cloud and this could be just a small extension to that environment for those who what it.

Interesting times indeed.

David.

Medico Legal Issues, EHRs and the PCEHR. It Is Pretty Messy and Complicated.

The following appeared a little while ago.

How Will EHRs Impact Medical Liability?

Widespread use of clinical decision support may establish new legal standards of care

By David Raths

Moving from paper to electronic data is expected to have widespread patient safety benefits, but could the use of electronic health records actually heighten the liability risks clinicians and hospitals face? And does the existence of the technology change what is legally expected of physicians?

At least in the initial phase of implementation, the answer to both questions may be yes, according to Michelle Mello, JD, PhD, a professor of law and public health in the Harvard School of Public Health.

Mello is the author of more than 100 articles and book chapters on the medical malpractice system, medical errors and patient safety, research ethics, clinical ethics, and other topics.

Speaking at the World Congress 3rd Annual Leadership Summit on Mobile Health in Cambridge, Mass., on July 28, she noted that as systems mature, there will be clear opportunities to avoid errors, but providers should recognize the potential for new kinds of errors to develop.

“There’s the potential for the failure of clinicians to use the technology consistently,” she said. “There may be bugs, defective applications and system crashes.”

In the transition to an all-electronic environment, there can be documentation gaps in the interface between paper and electronic records.

Before courts have weighed in on new legal standards of care, newer modes of treatment may be problematic. For example, she said, the use of e-mail has the potential to improve communication between providers and patients and improve patient satisfaction. But the use of e-mail with patients may allow for arguments that clinicians are being less thorough. “Not seeing a patient in person might be considered negligent in some circumstances,” Mello said. Also, patients may develop expectations about what defines a reasonable response time to e-mail correspondence.

Clinical decision support (CDS) can transform and improve care and can catch errors before they harm patients.

But Mello said a significant change in malpractice law could involve CDS features. Widespread use of CDS may establish new standards of care. The existence of EHR systems means there is more documentation of clinical decisions and activity and more discoverable evidence, including metadata such as time stamps. Departures from CDS guidelines could bolster a plaintiff’s case, she added.

“Systems document when providers choose to deviate from the algorithms in CDS, and the onus will be on clinicians to legally justify why they did,” Mello said. Several chief medical information officers in the audience expressed their concerns about this topic, and said they have struggled to determine which alerts have the most value in their system and which are just having an “information overload” effect on clinicians.

More here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6E9DCE0AA66443409DF3D03C35EB06D7

This article adds a whole new dimension to the responsibility of clinicians in using any form of electronic health record.

We already know the Australian Medical Association has concerns about liability associated with the PCEHR. See here:

http://aushealthit.blogspot.com/2011/06/australian-medical-association-wants.html

It is time, in thinking about all this to go back to basics. Essentially a patient medical record has three main functions.

The first is to record in reasonable detail the clinician’s assessment and diagnosis(es) of a patient along with the supporting evidence (test results, images etc.). This record is then able to be referred to in the future to ensure follow-on assessments and therapy to do not overlook previous and possibly unresolved issues. It also allows the clinician to build a picture of the patient over time and to ensure proactive prevention and screening are undertaken.

The second function is for the record to facilitate transfer of care or to facilitate collaborative care by members of a practice (e.g. GP and Nurse Assistant or GP and another GP).

The third and less important function of the clinical record is as a record of what assessments and investigations were done by the practitioner to confirm that the care provided has been in a competent way and to a standard that would be expected from peer practitioners (this means that in a specialist area there are higher standards expected from the specialist than a GP).

To ensure legal acceptability, should there be major problems, the each entry should be signed and dated when completed. The record should never be altered - but it is perfectly acceptable to add a later comment or information as long as it is also signed and dated.

Moving to the electronic domain it is ideal that at least the same, if not more complete information is recorded at each encounter, and that the system be designed to record relevant user, date and time stamps to provide an audit trail of the activity within the record. The electronic form also needs to be able to produce a ‘dump’ of the record onto paper or into a human readable file for storage and review.

To me there are two issues that critically need to be addressed - besides the obvious one of the clinical quality of what is recorded electronically. I am also assuming appropriate information integrity and security from change and revelation which seems obvious Also, of course, there is the expectation of system IT quality and ‘bug freeness’ - which can’t be assumed.

Less obvious in the electronic world is to easily be able to discover the provenance of a record. Who wrote the record, when it was written, who are they and what qualifications do they have - as well as under what circumstances was the record created. It is well known in clinical circles that a complete and contemporaneous clinical note is the best defence there is against any medical negligence charge and as such a practitioner needs to be able to fully rely on the completeness and integrity of the electronic record - should the worst come about.

Second there is also the issue raised in the lead article about how clinical decision support (CDS) is implemented, what it is based on, its reliability and so on. No good following CDS if it will mislead or only provide half the picture.

Making all this work in provider systems is a very big ask. In the shared record environment like the PCEHR is may just be too much, as the AMA seems to think.

It is worth pointing out that these issues are not new and that lots of thought has been given to most of these issues a within the GEHR project in Europe which then led to the openEHR work among other efforts. There is a lot of valuable material found on their web site:

www.openehr.org

This page especially on the early work and GEHR those interested will find interesting in following up.

http://www.openehr.org/about/origins.html

(Note: this blog studiously ignores many of the non medico-legal aspects of GEHR and openEHR which are important but not easily covered in this blog format)

David.

Where Is the Risk Management in the PCEHR Program? I Think We Need A Lot More!

We have just run a poll on the blog asking the following question:

Should There Be One Or Two Large Scale Pilots Of the Full PCEHR System Before National Implementation Is Attempted?

70% or respondents say absolutely and a good number more are saying ‘probably’.

The point of the question was to highlight the rather absurd approach NEHTA and DoHA are adopting to managing the risk of what is a pretty large IT project.

If you think the PCEHR is conceptually a reasonable and practical idea, which I emphatically don’t, then at the least, when implementing you should mitigate all foreseeable risks as fully as you reasonably can.

Right now we have the Wave 1 and 2 sites all beavering away on various little bits of what is planned to ultimately a completed PCEHR in the absence, as far as I know, of even an agreed standards framework for implementation - let alone a unifying technical architecture.

What we have is some high level box diagrams linked with some lines and some three minute conceptual videos explaining how it is all to work.

All this can be accessed here:

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

It seems to me there are a large number of unmitigated risks with all this right now. These include:

1. The absence of any Council of Australian Governments agreement to the shape of and continued funding of the PCEHR (or NEHTA for that matter).

2. The lack of any evidence base on the PCEHR approach to guide decision making.

3. The lack of a fully developed Governance Framework that has community understanding and support.

4. The lack of any reasonable scaled pilots of a complete working system so that the inevitable issues that arise during implementation can be addressed early and at reasonable cost. Just steaming ahead with a national implementation is both grandiose and stupid.

5. The lack of any real analysis of just what sort of adoption levels can be expected so proper provisioning of technical systems and services can be planned

6. The lack of much in the way of provider support in the absence of substantial incentives to cover the additional costs that will be borne by practitioners, State Health Systems and information providers.

7. The present lack of readiness of many of the proposed NEHTA infrastructure components and the lack of, at scale, testing of these components.

8. A lack of E-Health literate staff on a national basis to support the over-scaled national implementation.

9. A lack of any approach to the proper curation of health information in a shared, updateable clinical record environment.

10. Some considerable concerns held by some State Governments - see article from two days ago here:

http://aushealthit.blogspot.com/2011/08/victorian-government-is-not-thrilled.html

I wonder does a risk mitigation plan that addresses these issues exist? I doubt it.

I could go on for pages - but the bottom line is that you need to have implemented a full solution at modest scale to discover what works, what doesn’t and what mid-course correction might be needed.

To just rush on ahead with all this is really very unwise and potentially very wasteful.

David.

Weekly Australian Health IT Links – 08 August, 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

Seems that it is all happening this week. I hope it means some progress but there is a bit of a feeling that there is more than a little activity but not in any really clear direction. I would hope the big picture becomes clear, and successful soon.

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http://www.rustreport.com.au/issues/latestissue/australian-healthcare-it-spend-to-hit-us2-4-billion/

Australian healthcare IT spend to hit $US2.4 billion

August 5, 2011

Spending on healthcare IT in Australia will hit US$2.4 billion in 2016, a cumulated annual growth rate (CAGR) of almost 10 per cent from 2010, predicts Ovum in its latest healthcare IT market forecast.

The independent technology analyst finds that Australia’s investment in healthcare IT is driven by the need to cut costs in the sector as well as to improve patient outcome. The Australian government is trying to remedy the enormous cost pressures by launching initiatives to adopt the deployment of IT. Cornelia Wels-Maug, Ovum’s healthcare technology analyst, commented: “Investment in IT healthcare is increasing in Australia, mainly driven by the public health reforms and state-funded development of technology infrastructure.

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http://www.smh.com.au/national/online-health-records-face-uphill-battle-20110806-1igfk.html

Online health records face uphill battle

Jim O'Rourke

August 7, 2011

A NEW online medical records system is doomed to failure because not enough people will sign up for it, the Australian Medical Association has warned.

From July 1 next year, patients will have to volunteer to ''opt in'' to the system, which stores all their health details, including test results and prescriptions, in a national database. It's the first time patients will be able to access their medical information.

The AMA believes inclusion in the federal government's Personally Controlled Electronic Health Record system should be automatic unless patients choose to ''opt out''. Otherwise, many patients in nursing homes, the elderly or others who are not ''technically savvy'' will miss out, the group's national president, Steve Hambleton, said.

See also here:

http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_Health_OptInOptOut.pdf

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http://www.itnews.com.au/News/265915,analysis-e-healths-consumer-conundrum.aspx

Analysis: E-health's consumer conundrum

By James Hutchinson on Aug 5, 2011 7:00 AM
Filed under Strategy

Patients key to national e-health record launch.

With less than a year until the launch of the much-vaunted personally controlled electronic health record, government and industry have questioned how they might convince Australians to want an identifiable record of medical histories, prescriptions, allergies and discharge summaries.

Where July 1 2012 had once been seen as the coming of a technology some viewed as greater than the telephone for healthcare, talk at two informatics conferences this week turned instead to what the day would foreshadow, rather than what it would bring.

Rome wasn't build in a day, after all.

Australians will be able to register for their own personally controlled electronic health records (PECHR) under an opt-in proces that is expected to bring control over the minutiae of how much data one's doctor or hospital can access and in what context.

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http://www.theage.com.au/victoria/medical-data-mixup-major-system-error-20110804-1idht.html

Medical data mix-up, major system error

Kate Hagan

August 5, 2011

MELBOURNE hospitals have sent incorrect patient records to GPs due to an error with Victoria's troubled health technology program over the past two months.

The discharge summaries from Eastern Health and the Royal Victorian Eye and Ear Hospital mixed patients' names with other patient data, including test results and diagnoses.

The data was faxed to GPs under the HealthSMART program, which Health Minister David Davis has described as ''the myki of health''.

Mr Davis yesterday said: ''This latest error raises further concerns about [former health minister] Daniel Andrews's judgment when designing the HealthSMART system.''

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http://www.itnews.com.au/News/265617,nsw-health-to-act-on-firstnet-issues.aspx

NSW Health to act on FirstNet issues

By Liz Tay on Aug 3, 2011 6:34 AM

Filed under Software

Deloitte review sparks 'comprehensive program'.

NSW Health has identified issues with configuration, training and support of its FirstNet clinical information system (CIS) following a government-commissioned independent review.

Implementation of the Cerner FirstNet CIS began in 2008, and was expected to improve information management in more than 200 emergency departments across the state.

But clinicians resisted the change, leading NSW Health Minister Jillian Skinner to engage Deloitte consultants earlier this year for an independent review.

A NSW Health spokesman this week said that the Director-General was currently considering a draft report from the review.

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http://www.mja.com.au/public/issues/195_03_010811/kay10941_fm.html

Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: a randomised controlled trial

Frances J Kay-Lambkin, Amanda L Baker, Brian Kelly and Terry J Lewin

MJA 2011; 195 (3): S44-S50

Abstract

Objective:

To compare computer-delivered and therapist-delivered treatments for people with depression and comorbid addictive disorders.

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http://www.computerworld.com.au/article/396197/wa_health_advancing_health_identifiers/

WA Health advancing Health Identifiers

WA Health is to purchase a major chunk of the underlying software and services to facilitate the delivery of the national Health Identifiers initiative being managed by the National e-Health Transition Authority (NeHTA)

• Tim Lohman (Computerworld)
• 05 August, 2011 12:00

WA Health is to purchase a major chunk of the underlying software and services to facilitate the delivery of the national Health Identifiers initiative being managed by the National e-Health Transition Authority (NeHTA).

According to WA Health documents the agency will shortly procure software to provide an Enterprise Master Patient Index and an Enterprise Provider Index. Services include implementation and integration with other healthcare systems and data cleansing.

“The rollout of the [Health Identifiers] HI Solution will focus initially on public health providers,” the documents read. “The project will provide the technology, organisational capability and policy support to extend the solution subsequently to private providers.

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http://www.theaustralian.com.au/australian-it/clean-bill-of-health-for-streamlined-invoicing/story-e6frgakx-1226106175593

Clean bill of health for Barwon Health's streamlined invoicing

• Fran Foo
• From: The Australian
• August 02, 2011 12:00AM

VICTORIAN regional health service Barwon Health has embarked on a major overhaul of its electronic billing system that processes about $100 million in revenue each year.

Barwon Health has selected LRS Health's MediBILL as its e-billing platform to replace six disparate billing systems that fall under the umbrella of iSoft's HOMER.

HOMER is a 25-year-old system widely used in the public health sector. Its owner, iSoft -- recently acquired by CSC -- stopped providing support for the legacy platform many years ago.

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http://www.theaustralian.com.au/australian-it/csc-warns-of-hard-times-ahead-but-believes-it-will-meet-its-targets/story-e6frgakx-1226106223117

CSC warns of hard times ahead, but believes it will meet its targets

• Fran Foo and Karen Dearne
• From: The Australian
• August 02, 2011 12:00AM

IT services giant CSC Australia has maintained its $1 billion-plus annual revenue performance, but has warned of tough economic conditions on the horizon.

The company indicated that it would conduct more hiring than redundancies, following its $480 million acquisition of e-health software maker iSoft.

CSC had been heavily investing in skills, said local chief Gavin Larkings, as evidenced by the $30.8m jump in human resources for the financial year ending March 31.

According to statutory accounts filed with the Australian Securities & Investments Commission yesterday, CSC booked revenues of $1.063bn in 2011, up 3 per cent from $1.032bn in 2010.

CSC said new work was valued at $902m while contract renewals were worth $225m.

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http://www.6minutes.com.au/news/telehealth-guide-released-by-racgp

Telehealth guide released by RACGP

• By Gemma Collins on 5 August 2011

Doctors are being advised on how to do online video consultations with patients with the release of telehealth guidelines by the RACGP.

As more GPs take advantage of the new Medicare rebates for telehealth consultations, the college has come up with a list of guidelines (link) on how they can set up their surgery for video conferencing, from advice on internet connectivity to recommendations on audio device requirements.

The guidelines provide the pros and cons behind a range a ways that doctors can set up their video consultations, through a specific software such as Skype installed on a desktop computer or a tablet or through an ‘immersive telepresence suite’.

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http://www.zdnet.com.au/gp-college-posts-video-conferencing-guide-339319911.htm

GP college posts video-conferencing guide

By Suzanne Tindal, ZDNet.com.au on August 5th, 2011

The Royal Australian College of General Practitioners released guidelines today to help general practitioners to choose video-conferencing systems to be part of the government's telehealth initiative.

Since 1 July, doctors have been eligible to receive a one-off payment for installing videoconferencing equipment for use in consultations of $6000 and an additional amount per consultation for conducting video conferencing consultations.

The idea is that patients in remote or regional areas will have better access to technology via video-conferencing appointments set up through their GP.

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https://www.tenders.gov.au/?event=public.atm.show&ATMUUID=8969FEF5-94D9-589C-5AD98FB761248E8D

National Health Reform Enterprise Data Warehouse Program

ATM ID NHR EDW Program IB

Agency Department of Health and Ageing

Category 81111700 - Management information systems MIS

Close Date & Time 9-Aug-2011 5:00 pm (ACT Local time)
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http://www.techworld.com.au/article/395873/enterprise_data_warehouse_key_national_health_reform/

Enterprise data warehouse key to national health reform

Systems and software, not data centres on roadmap

• Rodney Gedda (CIO)
• 03 August, 2011 10:01

The federal government’s Department of Health and Ageing is seeking information from suppliers in preparation for the upcoming national health reform enterprise data warehouse (NHR EDW) program.

The EDW program is a component of the wider $16 billion national health reform agenda that is being developed by the government and was announced by Prime Minister Julia Gillard this week.

According to the department, the EDW program goals are to “build the ICT capability for national reform stakeholders”.

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http://www.arnnet.com.au/article/395702/insight_changing_ehealth_landscape/

INSIGHT: The changing eHealth landscape

CSC Australia national director for health services, Lisa Pettigrew, talks about the opportunities and challenges for eHealth

• Patrick Budmar (ARN)
• 02 August, 2011 08:55

With the rapid evolution of technology and the gradual expansion of Australia’s NBN, significant developments are taking place in areas such as the digital delivery of medical service. Hot on the heels of CSC’s acquisition of iSoft, Patrick Budmar talks to CSC Australia national director for health services, Lisa Pettigrew, on what lies ahead for eHealth in Australia.

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http://www.itwire.com/it-policy-news/government-tech-policy/48896-agreement-breaks-e-health-deadlock

Agreement breaks e-health deadlock

By Beverley Head
Wednesday, 03 August 2011 11:03

The agreement between the Federal, State and Territory Governments on a series of national health reforms which was signed off this week has broken the deadlock for major e-health reforms across Australia. Coupled with the qualified support for the Personally Controlled Electronic Health Record which was also delivered by the Royal Australian College of GPs, it should provide a welcome nudge to the roll out of e-health initiatives.

According to Lisa Pettigrew, national director of healthcare for CSC in Australia, both events could only be positive for the progress or e-health. “This breaks the deadlock that was stifling health and e-health reform,” she told iTWire, speaking from a major healthcare conference currently being held in Brisbane.

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http://www.6minutes.com.au/news/pcehr-risks-need-to-be-resolved--racgp

PCEHR risks need to be resolved: RACGP

• By Michael Woodhead on 1 August 2011

The RACGP has released its position statement (link) on the PCEHR, saying it supports an e-health record but only if it is based on the foundation of a GP e-health summary

The College says any PCEHR program will have to win the trust of patients, integrate with clinical software and be fully funded by governments and supported by appropriate incentives, education and training.

However, the RACGP says there are also potential problems with the PCEHR that have yet to be resolved, such as the increased workload for the GP as the nominated healthcare provider, and their medico-legal responsibilities.

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http://www.computerworld.com.au/article/395402/it_children_hospital_still_delayed/

IT for children's hospital still delayed

The $23.9 million allocated for IT in the 2011/12 budget had come through too late to meet the project deadline

• AAP (AAP)
• 29 July, 2011 14:37

The IT system for Victoria's new Royal Children's Hospital will not be operating in time for its opening in November.

State health minister, David Davis, said $23.9 million allocated for IT in the 2011/12 budget had come through too late to meet the project deadline.

The former Labor government failed to include funding for the system in its costings.

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http://www.ehealthspace.org/news/nehta-s-bainbridge-tackles-old-age-question

NEHTA’s Bainbridge tackles the old age question

Posted Tue, 26/07/2011 - 11:04 by Josh Gliddon

It’s today’s healthy lifestyle paradox. The aged population in Western societies is growing as medical advances prolong life. But it’s a vexing issue for governments which face rising healthcare costs to support these aging societies.

In Australia, Treasury figures reveal significant demographic shifts over the past four decades, with even more change expected in the coming decades. The number of people aged 65 and older in Australia has grown from 8 percent in 1970-71 to 13 percent in 2001-02. Treasury’s Intergenerational Report indicates this figure will almost double in the next 40 years to around 25 percent, while growth in Australia’s younger workforce will slow to almost zero.

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http://www.apo.org.au/research/impact-telehealth-and-telecare-clients-transition-care-program-tcp

The impact of telehealth and telecare on clients of the Transition Care Program (TCP)

• Rachael Wade, Kelly Shaw, Colleen Cartwright
• Baptist Community Services

Read the full text

PDF The impact of telehealth and telecare on clients of the Transition Care Program (TCP)

01 August 2011This report outlines the findings of a randomised controlled trial of Telehealth and Telecare in the management of frail older people who are receiving post-acute care in their own homes under the Transition Care Program (TCP). Results of this study demonstrate numerous benefits to clients receiving post-acute care augmented by Telehealth and Telecare solutions. In particular, clients experienced improvements in personal wellbeing, particularly in perceptions of health, safety and future security.

Older people who participated in this study were willing and able to use Telehealth and Telecare products reliably. Clients demonstrated a positive attitude towards the use of technology and that age per se was not a barrier to the reliable use of technology for home monitoring of vital signs.

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http://www.theaustralian.com.au/business/legal-affairs/tort-lawsuits-could-hit-productivity/story-e6frg97x-1226105573119

Tort lawsuits could hit productivity

• Chris Merritt and Annabel Hepworth
• From: The Australian
• August 01, 2011 12:00AM

CANBERRA'S plan to create a tort of privacy has raised fears that productivity could suffer from a wave of class actions against business, police and hospitals.

Peak business groups have urged the government to reconsider, warning the proposed federal civil action on privacy was not justified and could drive up the cost of insurance.

Business Council of Australia chief executive Steven Munchenberg said the suggestion that extra laws were needed here after events offshore was "very poor justification for more regulatory change and regulatory intervention" and he was not convinced there was a problem.

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http://www.smh.com.au/opinion/politics/breaches-of-privacy-by-large-corporations-the-real-problem-20110802-1i9of.html

Breaches of privacy by large corporations the real problem

August 3, 2011

Opinion

Australian law is in a poor state when it comes to protecting our privacy. It should recognise that people are entitled to keep their lives out of the public domain and the reach of big business. There should also be consequences for a serious breach of privacy, including a right to compensation.

Unfortunately, the federal government has gone about this reform in the wrong way. It should not be sold as a response to the News of the World scandal - a hard sell when no local evidence has emerged of anything like those grievous, systematic breaches of trust. This leaves privacy reform in Australia open to attack as a knee-jerk reaction to events overseas.

It also casts the Australian media as the villain. Not surprisingly, this has provoked a furious response, with one headline in The Australian reading ''Tort a hate-filled strike on liberal democracy''.

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http://www.theaustralian.com.au/australian-it/government/conroy-welcomes-dido-plan/story-fn4htb9o-1226107587629

Conroy welcomes DIDO plan

• Stuart Kennedy
• From: Australian IT
• August 03, 2011 5:11PM

COMMUNICATIONS Minister Stephen Conroy said he would be delighted if US tech entrepreneur Steve Perlman's DIDO proposal for creating a super fast, ultra high capacity wireless network comes off.

Senator Conroy has often argued fibre is the most future proof network medium against those saying the $36 billion and the mostly fibre NBN could be built cheaper, faster and less disruptively with a greater mix of wireless and other technologies.

Mr Perlman, who once worked for Apple and drove the development of that company's Quicktime media player technology, released a white paper last week in which he said his company, Rearden, was developing a radical new wireless technology called Distributed Input, Distributed Output or DIDO that overcame the signal interference, shared bandwidth and high latency problems of conventional wireless and could potentially supplant conventional wired communications and even fast fibre.

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http://www.techworld.com.au/slideshow/396025/15_incredibly_useful_free_microsoft_tools_it_pros/?image=1

15 incredibly useful (and free) Microsoft tools for IT pros By Sandro Villinger

We've dug through the jungle that is Microsoft Downloads and found 15 of the best free tools you've probably never heard of.

WSCC — Windows System Control Center

My first pick isn't actually a Microsoft (MSFT) tool per se: Windows System Control Center is a one-stop downloader for almost 300 maintenance tools from Microsoft's Sysinternals and the ever-popular NirSoft suites: Simply download WSCC from KLS-Soft, check all the tools you need and hit "Install". Minutes later you're equipped with some of the most useful tools out there, including Disk2Vhd, Autologon and Autoruns (also described below). WSCC saves these files under C:Program Files (x86)Sysinternals Suite, while NirSofts tools are found under C:Program Files (x86)NirSoft Utilities.

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Enjoy!

David.

AusHealthIT Poll Number 82 – Results – 8 August, 2011.

The question was:

Should There Be One Or Two Large Scale Pilots Of the Full PCEHR System Before National Implementation Is Attempted?

Totally Unnecessary

- 2 (5%)

Probably Not Needed

- 3 (7%)

Probably Needed

- 6 (15%)

Absolutely

- 27 (71%)

With 71% saying the is an absolute need for large scale piloting we have a pretty clear outcome!

Votes : 38

Again, many thanks to those that voted!

David.

The Victorian Government Is Not Thrilled About the Current PCEHR Proposal - To Say The Least!

The following submission - among now 117 appeared quite recently.

They can be all viewed from this link.

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

At the very top is this one:

Submission by the Victorian Government

This submission was provided via email and can be accessed via the following document link(s):

• the Victorian Government's submission in PDF format (PDF 965 KB)

Having browsed the document all I can say is that there is some sanity returning to the discussion!

Similarly there is a fair bit of sense found here:

Submission by South Australia Health (SA Health)

This submission was provided via email and can be accessed via the following document link(s):

• South Australia Health (SA Health)'s submission in PDF format (PDF 103 KB)

It is interesting that there was nothing from the other States and Territories. Nothing to say or wanting to chat privately. I wonder?

Focussing on the Victorian Submission they make the following points (among others) in a 16 page document - as signed by the Health Minister.

Point 1. p(age) 2

The PCEHR should have an agreed national business case endorsed by all Governments and agreed at COAG to ensure funding into the future and integration with State systems. They note (p3) that a business case was developed for the old IEHR but never endorsed by COAG.

Point 2. p2

The PCEHR does not follow the approach in the (agreed) National E-Health Strategy not being an incremental and staged approach.

Point 3. p3

The ConOps provides a request for ‘complimentary investments’, these have not been committed but it has essentially just steamed ahead regardless.

Point 4. p3

“Consideration of the proposed PCEHR by the Victorian Government, including allocation of funding, will be based on the provision of a business case for the current ConOps “ i.e. we will not play if there is not a real business case for all this.

Point 5. p3

This makes it clear there are core design elements of the proposal with are not really satisfactory.

Point 6. p3

It is not clear the PCEHR will support clinical workflow.

Point 7. p3

It is not clear the PCEHR and even the HI Service are sustainable given there is no funding approved after June next year.

Point 8 p4.

There does not appear to be an evidence base for the current approach to the PCEHR.

Point 9. p4

The IHI, HPI, NASH, Terminologies and Secure Messaging are not ready.

Point 10 p4.

None of the PCEHR has been shown to work as a whole or piloted. The Wave 1 and 2 sites are all using interim techologies

Point 11 p4.

The governance and consultation has not really been done as it should have been.

Point 12 p5.

Integration with provider systems (both hospital and primary care) needs to be better done and properly funded.

Point 13. p5.

The hospitals in Victoria are not anywhere near ready to meet the Commonwealth expectations for clinical documents. Will need major system upgrades.

Here is the Conclusion in full (p6).

8 Conclusion.

“The draft Concept of Operations provided a high level view of what the PCEHR might look like in the future but provides a limited view of how it might be realised. Further work is required on how the health system will transition from its current mode of operations to the proposed new operational model.

The Victorian Government remains supportive of working towards a robust national system of electronic health records. For this to occur, through whatever is the finally agreed model that best supports consumer and clinical priorities, there needs to be a strong business case that has the support of all governments and sufficient resourcing for a program of this scale and complexity. The business case and funding arrangements must include adequate support for the necessary change management and incentives for participation by all parties to ensure it is a sustainable and integrated part of the health system into the future. These are complex and critical issues that must be addressed in order to progress e-health in Australia and which we believe further consideration at COAG.”

I think this says it all. Rushed, unfunded, untested, overly ambitious, under consulted and lacking a business case.

Needs to go back to a proper review and planning process in my view and that, it would seem, of at least on major State Government.

Detailed comments on the document then fill up the next 10 pages for your reading consideration. Lots of important issues also raised here.

The SA submission also has a few issues worth reading about! The best one I spotted was the recognition that to actually have an audit trail that works to identify individuals in the hospital context would be a major costly upgrade in SA Public Hospitals.

Lots of important stuff here.

David.