Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, September 21, 2011

There Are Real Risks Associated With the PCEHR. Here Are A Few!

Ms Roxon’s intervention in the discussions on the PCEHR made me wonder if there was actually a risk analysis of the PCEHR Program.
See here to read her comments I reported a day or so ago:
Reading the comments really made me wonder if the Minister - or her advisors - grasp the scale of risk associated with  the proposed PCEHR project.
Any large public projects carry substantial risk and large IT projects - and especially health IT projects - seem to be prone to nasty surprises and career ending outcomes.
Among the larger ones that have come seriously unglued we can think of the first attempt by Kaiser Permanente to undertake a major update of its IT infrastructure - that led to a write of in the many hundreds of millions of dollars - and the UK National Program for Health IT’s experience which is till playing out.
A very useful reference regarding all this is found here:
J Am Med Inform Assoc. 2009 May-Jun; 16(3): 291–299.

Health IT Success and Failure: Recommendations from Literature and an AMIA Workshop

Bonnie Kaplan, PhD and Kimberly D. Harris-Salamone, PhD 
The full text is here:
Here is the Abstract:

Abstract

With the United States joining other countries in national efforts to reap the many benefits that use of health information technology can bring for health care quality and savings, sobering reports recall the complexity and difficulties of implementing even smaller-scale systems. Despite best practice research that identified success factors for health information technology projects, a majority, in some sense, still fail. Similar problems plague a variety of different kinds of applications, and have done so for many years. Ten AMIA working groups sponsored a workshop at the AMIA Fall 2006 Symposium. It was entitled “Avoiding The F-Word: IT Project Morbidity, Mortality, and Immortality” and focused on this under-addressed problem. Participants discussed communication, workflow, and quality; the complexity of information technology undertakings; the need to integrate all aspects of projects, work environments, and regulatory and policy requirements; and the difficulty of getting all the parts and participants in harmony. While recognizing that there still are technical issues related to functionality and interoperability, discussion affirmed the emerging consensus that problems are due to sociological, cultural, and financial issues, and hence are more managerial than technical. Participants drew on lessons from experience and research in identifying important issues, action items, and recommendations to address the following: what “success” and “failure” mean, what contributes to making successful or unsuccessful systems, how to use failure as an enhanced learning opportunity for continued improvement, how system successes or failures should be studied, and what AMIA should do to enhance opportunities for successes. The workshop laid out a research agenda and recommended action items, reflecting the conviction that AMIA members and AMIA as an organization can take a leadership role to make projects more practical and likely to succeed in health care settings.
----- End Quote:
A key section is found here:

What We Know—Lessons from Experience

Participants drew lessons from their research and experiences on how management might improve project success. These included:
  • provide incentives, remove disincentives
Users may perceive that they have no time, or that what they are being asked to do moves work to them and away from others. Physicians, for example, would be more engaged if they experienced applications that helped them directly rather than providing disincentives to adopt the system. As an incentive, for example, physicians could get rounds done more easily if patient lists were ready when shifts begin.
  • identify and mitigate risks
Determine the social risks, the IT risks, the leadership risks, the user risks, etc, and consider them early and often during the project. These risks and possible ways to mitigate them should become part of new or existing policies and procedures pertaining to the new system and incorporated into training.
  • allow resources and time for training, exposure, and learning to input data
Participants described systems where clinicians had never used a keyboard or had exposure to computers, yet training was very limited. Sufficient training and time to learn need to be part of the implementation, and need to be on-going afterward.
  • learn from the past and from others
Participants spoke of the need for studies of successes, failures, and how failing situations were turned around. They suggested longitudinal studies, qualitative studies, more focus on health care teams as a whole, and incorporating insights from change management, diffusion of innovation and technology, social science and sociotechnical theory, and multilevel frameworks. Although participants suggested drawing on existing theories and knowledge and also incorporating project management and methodology issues, they advised caution when doing so because of differences between health care and the business settings where models were developed. There also were calls for measurable evidence, including evidence of publication bias concerning project failure, and for various databases to be created
----- End Quote
As I see it we have a system in the PCEHR which pretty much goes against all of this:
First - as noted in the last few days the incentives to use the proposed PCEHR are distinctly lacking (see the News in yesterday’s blog and various Ministerial comments)
Second we note the is no ‘risk assessment’ or ‘risk analysis’ in the PCEHR Concept of Operations.
Third we find the Program / Project being driven by a politically driven rather that pragmatic time frame for delivery.
Last we not the PCEHR spends all of about 2-3 pages of 160 pages in the Concept of Operation on analysis of previous national and international projects - hardly an in-depth analysis.
As well as careful analysis of relevant past experience any IT Project Risk Analysis needs to assess:
1. Strategic Risks - what is out there that can or may impact on the shape and delivery of the project?
2. Budgetary, Cost and Resourcing  Risks - is the budget allocation secure and adequate - with a contingency - to deliver the program.
3. Management Risks - are those charged with delivery of the program experienced and capable to deliver the program. In this case it might also be termed execution risk.
4. Timing Risks - is the project plan and proposed timing structured in such a way as to make delivery reasonably achievable. Have the sequence of activities and their duration been properly planned to make delivery possible?
5. Technical Risks - are all the technologies, Standards etc. all proven and known to work and will the desired outcome be possible from a technical perspective.
6. Cultural Risks - is what is planned suitable for use in the work environment for which it is intended?
7. Security and Privacy Risks - As any IT project needs to address but most especially Health IT projects.
8. Sustainability Risks - What are the plans to continuing support of the outcomes of the project?
It seems to me the ConOps should offer an analysis of all these as well as a few pages on risk mitigation to be used starting with addressing this list at least. Of course all this should have been done before we stated off on this journey.
David.

Standards for The PCEHR is a Looking Like A Mess. This Is Just Really Just Hopeless.

This appeared a few days ago

Ceasefire over e-health standards

James Hutchinson

NEHTA standards head made redundant.

The Department of Health and Ageing has agreed to resume the funding required to develop the technical standards that underpin its $466.7 million personally controlled electronic health record initiative.
The department had reportedly cut funding to an e-health standards development program by Standards Australia over the current financial year.
Negotiations around funding for Standards Australia's work continued well into August. A spokesman for the national body said an agreement had since been reached.
"The priorities of standards-related work relating to the PCEHR will be determined in the near future," the spokesman said.
The Department of Health and Ageing was contacted for comment but did not reply at time of publication.
The department this week released its revised concept of operations for the e-health record as the latest in a number of steps towards its ambitious goal for launch of the records on July 1 next year.
"We don't apologise for being impatient for success because we know how beneficial the e-health revolution will be for patient care," health minister Nicola Roxon said upon releasing the revised document on Monday.
According to a program plan published in March, Standards Australia planned to develop at least 26 standards with funding from the National E-Health Transition Authority (NEHTA), a body close to the department.
NEHTA focuses on 'engagement' for standards
Government-driven standards development work also faced another potential setback after NEHTA made its standards manager, Tina Connell-Clark, redundant in an internal restructure last Friday.
In an internal email sighted by iTnews, head of architecture Dave Bunker announced the departure of Connell-Clark, who had led standards work at the organisation from 2008.
Lots more here:
With all this I thought I would check just where NEHTA’s Standards Catalogue was up to. As of a day or so ago we have:

Standards Catalogue

The National E-Health Standards Catalogue (Standards Catalogue) consists of a collection of standards and specifications that are essential guidance for those who develop, sell, support, buy and implement e-health software in Australia. The catalogue provides a list of the standards recommended by, and specifications sourced or developed by, NEHTA, and is updated regularly.
......
The PCEHR Standards Catalogue currently being updated and will be available soon.
For any inquiries regarding Standards, please contact us at standards@nehta.gov.au
It is now known that Direkt Consulting gave NEHTA a PCEHR Program Standards Review on the 12th of May (Version 1.1) and that NEHTA produced a Draft PCEHR Standards Plan for Review (V0.2) on 16 May.
This is meant to produce a set of Product Work Plans that will have material available as needed.
It is of note that the Direkt Report says there are 37 New Standards / Specification needed with 7 needing update and only 17 needing no work.
The loss of the NEHTA Standards Manager and the funding hiatus caused by DoHA (which was only sorted a few days ago) must have left things in something of a mess - to say the least.
Really it seems clear actual execution of any real activity is just not a strong suit for this mob!
David.

Tuesday, September 20, 2011

If You Think The PCEHR Is Such A Great Idea Think About This. You Need To Fix The Information First!

A key objective of the PCEHR is to make clinical information that is captured electronically shareable with the patient and other relevant clinicians.
Underlying this information sharing is the unstated assumption that the information held in source systems will be ‘fit for sharing’.
All one can say is that if this recently published study is any guide we are a zillion miles from that situation.
Here is a report on the study.

Electronic records 'not fit for purpose'

The assumption that electronic medical records will improve care is unrealistic because data is often missing or inaccurate, an audit of emergency department records suggests.
A review of records for almost 2600 patients seen in NSW emergency departments with conditions such as diabetes, COPD and cardiovascular disease has found that discharge summaries were missing for 12-15% of patients.
In addition, where summaries were available, only three-quarters of the diagnoses were confirmed by the discharge summary audit, the study in Emergency Medicine Australasia (online Sept 19) found.
The study examined the accuracy of the diagnoses of chronic diseases in a ‘typical’ community hospital based on the ED information system (EDIS), and the NSW Health electronic medical record (EMR).
The accuracy of electronic records was best for diabetes and worst for asthma and COPD.
The full article is here:
Here is the abstract as published yesterday.

Health reform: Is routinely collected electronic information fit for purpose?

  1. Siaw-Teng Liaw,
  2. Huei-Yang Chen,
  3. Della Maneze,
  4. Jane Taggart,
  5. Sarah Dennis,
  6. Sanjyot Vagholkar,
  7. Jeremy Bunker
Article first published online: 19 SEP 2011
DOI: 10.1111/j.1742-6723.2011.01486.x

Abstract

Objective: Little has been reported about the completeness and accuracy of data in existing Australian clinical information systems. We examined the accuracy of the diagnoses of some chronic diseases in an ED information system (EDIS), a module of the NSW Health electronic medical record (EMR), and the consistency of the reports generated by the EMR.
Methods: A list of ED attendees and those admitted was generated from the EDIS, using specific (e.g. angina) and possible clinical terms (e.g. chest pain) for the selected chronic diseases. This EDIS list was validated with an audit of discharge summaries, and compared with a list generated, using similar specific and possible Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), from the underlying EMR database.
Results: Of the 33 115 ED attendees, 2559 had diabetes mellitus (DM), cardiovascular disease or asthma/chronic obstructive pulmonary disease; of these 2559, 876 were admitted. Discharge summaries were missing for 12–15% of patients. Only three-quarters or fewer of the diagnoses were confirmed by the discharge summary audit, best for DM and worst for cardiovascular disease. Proportion of agreement between the lists generated from the EDIS and EMR was best for DM and worst for asthma/chronic obstructive pulmonary disease. Possible reasons for this discrepancy are technical, such as use of different extraction terms or system inconsistency; or clinical, such as data entry, decision-making, professional behaviour and organizational performance.
Conclusions: Variations in information quality and consistency of the EDIS/EMR raise concerns about the ‘fitness for purpose’ of the information for care and planning, information sharing, research and quality assurance.
The two paragraph conclusion in the full article says it all:

Conclusions

The present study highlights what we already know – we are only as good as the information we have! The various purposes designated for the EMR as part of health reform are unrealistic if we cannot rely on data quality and consistency of our information systems. The current information quality and consistency of the EDIS/EMR system in a typical community hospital with an unaccredited ED needs improvement to easily support research. If it is not good enough for research, it is probably not good enough to promote and support safe and effective clinical practice.
Further systematic examination of the large repositories of routinely collected data is required to determine the fitness for purpose, which might be to share good-quality information among clinicians or to support electronic decision support systems. A logical next step is to repeat the present study with a representative sample of EDs and include a qualitative study of clinicians and information managers to understand the underlying reasons for any variations in data quality.
-----
NEHTA has recognised that ‘data quality’ is a critical issue (see page 46 of the PCEHR Concept of Operations) however it really has no idea how to actually fix the problem if the ‘management speak’ of the following 2 pages is to be read carefully. Their plan is (in summary):

4.2.1 Data quality

Ensuring a high standard of data quality is an essential requirement for the PCEHR System. High levels of data quality are required to assist healthcare providers and individuals in making safe healthcare decisions. Data quality within the PCEHR System will be ensured through a combination of validation of data loaded into the system, working with operators or source systems to improve the quality of data they are able to provide and by ongoing monitoring of data quality.
----- End Quote
The UK worked on this problem in the context of their shared EHR summary record and found a great deal of time, money and effort was required to get even close to clinical levels of reliability.
Doing a shared health record in haste and on the cheap as this plan suggests is going on, with but a brief outline plan for action, is a recipe for disaster in my view. I certainly don’t know any clinicians who would be interested in acting on the basis of the quality of information we see implied her as being planned for the PCEHR (Discharge Summaries etc.).
Much more careful planning, careful piloting and steps to ensure quality maintenance are vital - and none of this is quick or cheap!
David.

And Now For A Little Government Procurement Fun. You Be The Judge!

The following report appeared today in the Courier Mail.

Opposition claim of IT contract bias

QUEENSLAND Health bureaucrats ordered changes to an independent report to guarantee an IT supplier a multi-million-dollar government contract, the State Opposition says.
The troubled department last night vehemently rejected allegations it deliberately changed the report's scope to favour software company Cerner Corporation.
Queensland Health is now in negotiations with the US-based Cerner to build a $243 million electronic medical records system in Queensland hospitals.
Documents obtained by the Opposition under Right to Information laws show a public servant asked that extra information be added to the findings of a 2009 external investigation into potential suppliers.
Opposition health spokesman Mark McArdle said the emails, marked "confidential", asked that Cerner be highlighted as the only company with systems already in Australia. He said the change may have unfairly excluded other potential competitors.
It is the latest in a series of IT headaches for the Bligh Government, which is still battling to fix its disastrous health payroll system and was this month embarrassed by leaked reports detailing risks within other health technology projects.
In a statement last night, chief information officer Ray Brown rejected the latest claims as "categorically untrue".
He said an independent probity adviser had reviewed the process and found no reason to believe Cerner was treated with undue bias.
More here:
For your reading pleasure we are lucky to have the actual e-mails - so readers can be the judge if there was any issue with what was apparently going on behind the scenes.
The e-mails were made available under FOI so they are free for all to browse:
It will be interesting to see how this now plays out. Regular readers will know that implementations in NSW and Victoria of Cerner software have not been problem free but it also needs to be recognised that Cerner globally has been very successful in delivering working hospital systems elsewhere. Where any blame lies for issues in particular implementations is really not something that can be known without individual case analysis!
My suspicion, on the basis of the obvious evidence of a large number of successful implementations globally is that there is a need to closely examine how large scale, state-wide implementations are undertaken in Australia to see if there are major problems with that approach.
Others have also suggested that there are some software flaws and certainly few systems of the complexity of the Cerner product are likely to be ‘bug free’!
I keep an open mind but suspect there are a mix of causes!
We can all watch what happens now with interest!
David.

Monday, September 19, 2011

AusHealthIT Poll Number 88 – Results – 19th September, 2011.

The question was:
Have NEHTA / DoHA Responded Adequately And Fully To The PCEHR Submissions With the New PCEHR ConOps?
No Way
- 14 (56%)
Some Minor Progress
- 9 (36%)
Major Progress
-  2 (8%)
Full And Adequate Response
- 0 (0%)
Votes 25
A stunningly clear cut vote. DoHA and NEHTA are just not listening!
Again, many thanks to those that voted!
David.

Weekly Australian Health IT Links – 19th September, 2011.


Here are a few I have come across this week.
Note: Each link is followed by a title and a few paragraphs. 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

No doubt the big news of the week has been the release of the ‘Final’ Concept of Operations for the PCEHR.
Two other bits of news - the announcement of the Draft Telehealth Standards and the DoHA data warehouse have rather slipped between the cracks!
Setting up these warehouses to be data-mined for quality, performance and cost information may indeed turn out the be a much larger step than most are recognising right now!
The Draft Telehealth Standards are found here:
There is a lot of information - but it is not clear to me exactly what is being standardised at a technical level. Comments welcome on this one!
Certainly the control and governance of this information needs to be very closely watched.
Lots of other interesting stuff - including the rather sad note that one of our medical technology companies has hit a rather nasty bump on the road. This country produces only so many major successes of a technical kind and it is to be hoped this ship can be quickly righted.
-----

DoHA gets data warehouse in order

Enterprise data warehouse project will help facilitate the National Health Reform initiative
  • Tim Lohman (Computerworld)
  • 16 September, 2011 09:36
Australia’s National Health Reform (NHR) initiative has taken a step forward with the announcement that it will shortly begin the enterprise data warehouse (EDW) overhaul component of the initiative.
The NHR initiative seeks to unify the Commonwealth, states and territories in a nationwide health and hospital system overhaul.
The EDW program, one of many elements, will ensure the data collection and storage facilities for a range of key health-related data sets are in place to support the NHR.
The EDW will also provide access to key common and agency specific data collections; provide the tools for a range of data analysis, modelling and forecasting activities; and ensure activity based funding-related data transfer between the relevant national, state and territory agencies. The data sets involved in the data warehousing program are sizable.
-----

Ceasefire over e-health standards

NEHTA standards head made redundant.

The Department of Health and Ageing has agreed to resume the funding required to develop the technical standards that underpin its $466.7 million personally controlled electronic health record initiative.
The department had reportedly cut funding to an e-health standards development program by Standards Australia over the current financial year.
Negotiations around funding for Standards Australia's work continued well into August. A spokesman for the national body said an agreement had since been reached.
-----

Gillard government's health records rollout 'lacking in standards'

THE Medical Software Industry Association has warned that the Gillard government's $500 million e-health records rollout is a "standards-free zone" that will lead to massive costs and risks sinking local e-health providers.
The revised concept of operations for the personally controlled e-health record system, currently under implementation at 12 lead sites, was released by Health Minister Nicola Roxon in Canberra yesterday.
But the document reveals that a swag of technical standards needed for the build are yet to be decided. Instead, private contractors will have to rely on "specifications" developed by the National E-Health Transition Authority, which will ultimately progress these for acceptance by Standards Australia.
An MSIA spokeswoman said there was little point in having a dozen projects and a national repository for patient records if the work was being done without reference to appropriate standards.
-----

6minutes Online Video - the PCEHR

  • 15 September 2011
The final plans for the personally-controlled e-health record (PCEHR) have been released by health minister Nicola Roxon. However, medical groups such as the AMA say the government has not listened to the practical suggestions put forward by doctors for the scheme, which is due to start in July 2012. Michael Woodhead reports on what the scheme will look like.
-----

E-health push to give stars false IDs

  • Natasha Bita, Consumer editor
  • From: The Australian
  • September 16, 2011 12:00AM
CELEBRITIES, politicians and victims of domestic violence will be given fake identities to prevent hacking into their medical records stored in the federal government's new electronic health database.
The government has decided to let patients who "fear exposure due to the public nature of their work" use pseudonyms when they sign up for the $467 million e-health system, which will begin storing medical records in a central database from July next year.
-----

AMA pours cold water on PCEHR, again

The Australian Medical Association (AMA) has renewed its concerns about the structure of the PCEHR following the federal government’s launch of the final version of the Concept of Operations today.
In particular, the AMA has raised concerns about the ability for patients to excise aspects of their medical records from the record as something that could have serious consequences in an emergency situation. The AMA has repeatedly questioned aspects of the PCEHR’s operation in public and private forums.
-----

PCEHR needs fine-tuning: RACGP

The Royal Australian College of General Practitioners (RACGP) has welcomed the final Concept of Operations document for the personally controlled electronic healthcare record (PCEHR), with a caveat.
The peak organisation for GPs stated not all of its concerns had not been addressed, the plan did provide the clarity needed to get the record underway.
“The RACGP is pleased that the final plan for the PCEHR has been released and whilst not all our previously raised issues have been addressed, it is important that Australia gets underway with the implementation of the PCEHR,” said Dr John W. Bennett, chair of the RACGP National Standing Committee – ehealth, in a statement.
-----

Slow uptake better for e-health: Roxon

By Josh Taylor, ZDNet.com.au on September 13th, 2011
Slow uptake of the government's planned personally controlled e-health records (PCEHR) will be better for the system, according to Health Minister Nicola Roxon, who said that it may not be able to cope with 100 per cent adoption on day one.
At the unveiling of the government's final concept of operations report for the PCEHR system in Canberra yesterday, Roxon refused to be drawn on what level of take-up for the opt-in system she was expecting from the launch on 1 July 2012, instead saying that it will be better if fewer people sign up for the system on day one.
-----

Roxon defends opt-in system for e-health records

13th Sep 2011 AAP
FEDERAL Health Minister Nicola Roxon has hit back at critics of the opt-in system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number, but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
Doctors say that's a mistake, saying an opt-out system would be better.
-----

E-health rebates ruled out

  • Karen Dearne
  • From: Australian IT
  • September 13, 2011 9:08AM
HEALTH Minister Nicola Roxon has flatly ruled out paying for doctors to create and maintain electronic health records on behalf of their patients.
In a doorstop interview at the launch of a model e-health display in Parliament House yesterday (MON), Ms Roxon replied "no" when asked if there would be a special Medicare rebate for doctors using a new $500 million nationwide patient electronic record system due to start next July 1.
-----

No rebate for PCEHR adoption

The government has ignored advice from medical groups on the PCEHR,  with health minister Nicola Roxon ruling out any special rebate to cover the costs of adopting the new system.
In an interview yesterday she said GPs were already using computerised systems and would see the value in switching to a new and better record system.
“The government's commitments are to fund the infrastructure that's required so that the system can talk to each other. It's not to fund each and every bit of a general practice or a health practice of any type which is going to constantly update itself and want to keep up with modern technology,” she said.
-----

No rebates for setting up e-health records

13-Sep-2011
Paul Smith
There will be no new MBS items to fund the time GPs spend setting up the Federal Government’s $467 million e-health record system.
Yesterday saw the release of the government’s final blueprint, detailing how the records will work, the clinical information they will hold, the extent of a patient’s control over their content and the role of the GP.
GPs will be expected to become the so-called “curators” of patients’ shared health summaries, the part of the e-health record that will list diagnoses, medications, allergies and basic biographical details.
But Federal Health Minister Nicola Roxon, when asked by reporters if there would be special Medicare rebates for setting up the records, said: “No. Look, we are not contemplating that there will be a special rebate. I’m sure that over time there’ll be all sorts of different options and requests and they will be considered as they come.
-----

Issues still to be resolved on e-health records program

THE revised concept of operations for the Gillard government's $500 million e-health records program fleshes out some details but many of the ticklish issues around funding, governance and medico liability remain "out of scope".
Consultations threw up concerns that as yet, there are no arrangements for long-term management of the personally controlled e-health record (PCEHR) program and related services, that there is no ongoing funding beyond its July 1 startup date, and that there is no money on the table to compensate doctors for the creation and maintenance of uploaded patient information.
-----

Govt releases e-health plan for July 2012

Australians are a step closer to accessing their medical records from July 2012 after the government issued the blueprint for national electronic health records.
The government released the concept of operations for the personally controlled electronic health record (PCEHR) system on Monday.
Health and Ageing Minister Nicola Roxon said the plan would help build the core parts of the system in the move from paper-based records to secure e-health data.
"Ehealth will help us provide better care, save lives and save money," Ms Roxon said in a statement on Monday.
-----

Health System To Benefit From After Hours Video Conferencing

By Computer Daily News | Monday | 2011-09-12
The Federal Government has released a new blueprint for the deployment of its e-health project. The blueprint includes a timeline for the rollout of its e-health program, as well as development of personally controlled e-health records (PCEHR in Canberra-speak) and telehealth initiatives.
The Government has set out how it will meet 45 percent of efficient growth funding from July 2014, and 50 percent of efficient growth from July 2017 at an initial cost of $467 million.
It plans to have the national infrastructure for the PCEHR in place in the first quarter of 2012, with further enabling legislation ideally set to pass in March or April.
-----

Roxon strips final veil from ConOps

Five months to the day after releasing its draft concept of operations (ConOps) document regarding the use of personally controlled electronic health records (PCEHR), the Federal Government has unveiled the final version. The ConOps explains how the nation’s e-health system will be structured, how it will work, and what security and privacy principles will be embraced.
According to the minister for health and ageing Nicola Roxon; “The Concept of Operations will be used by our infrastructure partners to build the system to allow all Australians to sign up from July next year.” Despite multiple concerns raised during the consultation phase the regime remains opt-in, meaning that only those Australians that want a PCEHR will get one.
-----

Health allows for access to patient records in emergencies

Healthcare providers get unlimited "break-glass" access to patient records.

Healthcare providers will have access to all clinical documents and records in an emergency situation under a revised concept of operations released by the Department of Health and Ageing today.
The "no access" provision was proposed in the draft document in May as one of three document security levels that allowed users to fine-tune access to their personally controlled electronic health record, due to be available from July 1 next year.
It came in addition to the "general access" and "limited access" levels, the latter of which restricted access to some documents for nominated healthcare providers.
-----

E-health gets last-minute access change

By Michael Lee, ZDNet.com.au on September 12th, 2011
The Australian Government has finalised its plans for its personally-controlled electronic health record (PCEHR) system with the release of a final Concept of Operations report, which contains significant alterations to how the proposed system will work, including a change in how health providers will be able to access medical information.
The final plans (PDF) for the health record system, which is expected to be made available to the general public in July next year, were released by the Minister for Health and Ageing, Nicola Roxon, today.
-----

E-health uptake will be gradual: Roxon

Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for individual electronic health records
  • AAP (AAP)
  • 13 September, 2011 08:27
Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
-----

Southern Health rolls out iPads, BYOT, wireless network

Plans to expand wireless in the works
The rollout of iPads, a 'bring your own' technology (BYOT) policy and the trial of an internal wireless network have given Southern Health staff members greater access to patient information while on the move.
Southern Health CIO, Dr Philip Nesci, said that the largest public service provider in Victoria began to trial wireless internet at Casey Hospital earlier this year.
“We decided to go fully wireless in Casey Hospital, basically as a pilot to really understand not just wireless but technologies and the impact they can have on personal care,” he said.
-----

Online mental health services a step closer

A committee of mental health professionals, social media experts and carers has been appointed to oversee rollout of new services.
Access to online mental health services is a step closer after the federal government appointed a committee to oversee their rollout.
The committee comprises a mix of mental health professionals, social media experts and consumer and carer representatives.
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Electronic register could cut drug abuse

SOFTWARE under trial that warns pharmacists not to dispense addictive medication to drug addicts if they have been given such medication just days before could bring addictions under control if introduced.
West Australian Coroner Alastair Hope earlier this week called for a central register to monitor the sale and use of the addictive medicines after a 40-year-old mother of seven died from an overdose of methadone while being treated for an addiction to prescription drugs.
The Pharmacy Guild of Australia says it is working with the government on a real-time recording system that captures data on the dispensing of controlled Schedule 8 drugs such as codeine, methadone, oxycodone and pethidine.
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Doctors back push for drugs register

COLLEEN EGAN and ANDREW TILLETT, The West Australian September 14, 2011, 5:14 am
Doctors need a live computer database system if they are to keep up with trends in the black market prescription drug trade, according to the Australian Medical Association.
AMA WA president Dave Mountain said yesterday there was "a significant number" of people who made a living from visiting GPs and pharmacists for pills which they then sold for $30 to $50 each.
Dr Mountain said painkiller oxycodone and sedative Stilnox were "flavour of the month" in Perth because they had a reputation as party drugs, often when mixed with alcohol and other substances.
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Cochlear facing six-year low in earnings

COCHLEAR'S voluntary global recall of its unimplanted Nucleus 5 hearing device could see the company post its weakest full-year earnings in six years as sales decline.
The world's largest hearing implant maker began the recall on Monday after an increase in the number of failures, and has ceased manufacturing the unit while it investigates the cause of the "shut down", which it says does not injure users.
While Cochlear plans to increase production of the device's predecessor, the Nucleus Freedom, the company could not forecast the financial impact of its first major product recall or how long it would take for the device to re-enter the market.
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Kevin Rudd guru Joshua Gans slams NBN monopoly as deal 'will harm consumers'

KEY planks of the National Broadband Network business case are anti-competitive and will send Australia backwards, one of Kevin Rudd's "best and brightest" economic brains has warned.
In a blistering critique, economist Joshua Gans, who in 2008 was hand-picked to attend the then prime minister's 2020 summit to discuss productivity, has criticised plans to subsidise the rural NBN rollout through the prices that urban consumers pay.
The promise to put a cross-subsidy in place so that regional areas pay the same access prices for the NBN as people in the city was a key promise to the regional independents Tony Windsor and Rob Oakeshott that helped Labor form a second-term government.
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Aging population could benefit most from NBN

Digital business partner says technology can improve quality of life for aged care residents
The opportunity to help Australia's aging population with relevant technology must be taken account for in the rollout of the National Broadband Network (NBN), a KPMG digital business national managing partner has argued.
Speaking at an Enterprise Ireland trade mission in Sydney, Malcolm Alder, said that aged healthcare was a "burning issue" and the infrastructure provided by the NBN would deliver technological advances that could help aged care.
Alder shared the findings of an e-health pilot that he was involved with at a rest home in Foster, NSW, this year.
"The staff had been there 15 to 20 years and were not overly computer illiterate," he said "The thought that a whole bunch of [e-health] technology was going to descend on them was scary."
However, when the staff discovered that the technology was going to make their life easier and the quality of the residents that they were caring for better, their attitude changed, he said.
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Uncertain future for AGPN and SBOs

AGPN board members are to become the founder members of a new Medicare Local National Body, but a question mark remains over the future role  - if any - of the AGPN and GP division state-based organisations (SBOs).
A communiqué (link) from the AGPN Board says health minister Nicola Roxon has made it clear that SBOs will not continue in their current form when the Medicare Local National Body is formed
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Diagnosis? Elementary, with help from ‘Watson’

15th Sep 2011 Mark O’Brien
THE IBM supercomputer most famous for beating two former champions of American game show Jeopardy! earlier this year will soon be helping US physicians identify treatment options, under an agreement announced last week.
US healthcare company WellPoint has signed a deal for the first commercial applications for the IBM ‘Watson’ technology, which was designed to rival a human’s ability to answer questions posed in natural language.
The system can sift through an equivalent of about one million books or roughly 200 million pages of data, analyse the information and provide precise responses in less than three seconds.
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Objective-C, C#, D language: Winners in programming popularity

Java remains the longtime top-ranked language in the Tiobe Programming Community index
Objective-C, used for developing Apple iOS applications, climbs to No. 6 in the monthly Tiobe Programming Community index for most popular programming languages, after being ranked at number 8 a year ago. Also posting gains, C# rose to No. 4, a jump of two spots a year ago, while PHP dropped from No. 4 at this time last year to No. 5.
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Why be a pirate? Use open source software instead

Business decision-makers who get their proprietary software illegally need to wake up and check out the free alternatives.
Close to half of all computer users around the world tend to get their software illegally, and business decision-makers are no exception.
That's one finding from a recent survey commissioned by the Business Software Alliance (BSA) lobby group, which reported the results in a blog post last week.
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Enjoy!
David.

Minister Roxon Talks About the PCEHR on The Health Report This Morning.


You will be able to hear the conversation which is mostly about the PCEHR from this link later today.
The Minister for Health and Ageing, Nicola Roxon, talks about Australia's position at the United Nation's meeting on non-communicable diseases, which starts today.
The conversation is 1 minute about the advertised topic and 3-4 minutes about the PCEHR.
David.