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."

Tuesday, September 27, 2011

The AMA and Others Are Stiffening Its Opposition to the PCEHR. Minister Roxon Should Be Really Worried.

A little while ago I pointed out in a blog that the PCEHR was going to go very badly unless the medical profession was on side.
See here:
Earlier this week we had this appear following Ms Roxon’s suggestion the AMA should just stop complaining and ‘get on board’!
Now we have a response from the AMA - a day later!

Dangers of de-medicalising the PCEHR

21-Sep-2011
Guest editorial by Dr Steve Hambleton
The Federal Government has released the final version of the Concept of Operations for the Personally Controlled Electronic Health Record (PCEHR) system — a document that is very similar to the draft version. The AMA is extremely disappointed in both versions.
For a health record that is being promoted as revolutionary for patients and health professionals, including doctors, it is sadly bereft of sufficient medical input to its design and intended purpose.
It appears that the personally controlled e-health record has effectively been ‘de-medicalised’. It appears that consultation has been merely conversation. Medical input has been ignored, while the government has caved in to noisy minority consumer groups.
Everybody in health wants e-health and the personally controlled e-health record to succeed. The AMA has been one of the strongest supporters of the government’s e-health initiatives. If it works properly, it will certainly save lives.
But we cannot support aspects of a system that do not improve on what we have now.
Nor can we support something that potentially creates risks to patient health.
Unfortunately, that is where we find ourselves with the release of the Concept of Operations. Under the proposed arrangements, people will be able to alter their health record without consultation with their doctor. Patients could entirely remove from their record clinical documents they had previously considered worth sharing with healthcare providers.
The personally controlled e-health record will no doubt give patients greater involvement in and responsibility for their healthcare.
We are all for giving patients greater control, but not total control that excludes medical moderation. This is reckless and dangerous. It could undermine all the potential benefits of an electronic health record.
If this goes ahead, we will have a system that doctors want to support but can’t because their patients may not give them access to their records or parts of their records.
The AMA had hoped that the personally controlled e-health record would have contained a shared electronic medical record that sat within it. The medical component would contain reliable and relevant medical information about individuals that had been posted by doctors.
Consumers with serious concerns about privacy, or an objection to their medical and health information being shared, could actively make the choice not to participate in an opt-out system.
.....
Dr Hambleton is president of the AMA.
More here
This article is blazingly clear. Ms Roxon you want help having this work there are some major changes we will insist on. No change, no deal is how I see it.
Of course all this could have been avoided if NEHTA bothered to listen to those who responded to their request for submissions.
We even now have the RACGP seemingly being a bit more concerned about workflow and time impacts:
“Dr John Bennett, chair of the RACGP’s national e-health standing committee, said: “I don’t think the government has any clear idea of what the workload implications are going to be. I think for a small proportion of patients — those with multiple diagnoses on multiple medications, those in aged care — there will need to be more time spent gathering information and updating records.
“No doctor loves spending time doing that work but I think if they see real benefits for patients, that this system works, that will be something they are willing to do.”
Dr Bennett said that despite the safety concerns raised by the AMA, the system would be a “vast improvement” on the fragmented information doctors currently relied on to care for patients.”
Full article here:
Interestingly a small poll from Medical Observer is suggesting that of a sample of 30+ GPs on 12% would not bill for PCEHR maintenance (12% didn’t know and 76% would bill).
This whole thing will run off the rails unless some rapid work is done to fix the basics!
I will leave it as an exercise for the reader to see how many of the Australasian College of Health Informatics suggestions were addressed (see page 4) of their submission which is found here:
“However, there are a number of areas where substantial improvements for the next release of the Concept of Operations can be achieved:
  • Provide clarification if the PCEHR is part of a total EHR and what the specific goals of the PCEHR are
  • Provide more detailed information on the business case for the PCEHR
  • Include recommended implementation approaches and criteria
  • Include "Build on and strengthen the patient‐doctor relationship" in the PCEHR Principles
  •   Include more rationale how practitioners' will use electronic systems vs paper‐based systems
  •  Add features to increase the trust of patients (particularly "opt out" patients) and practitioners
  • Make the access arrangements more implementable and simpler for the majority of users
  • Include more details on a simple and complete audit trail access by consumers
  • Provide more details on PCEHR data retention/archival and access for secondary use of data
  •  Give priority to a small number of useful "low hanging fruit" functions to ensure fast adoption
  •  Combine the approach to Referrals and Discharge Summaries and add hospital dispensing systems
  • Include more details on which interfaces and interface standards are to be used for which function
  • Ensure the 12 first and second wave projects are able to seamlessly interoperate and share data
  • Include specific design guidelines how the clinical quality of unstructured data can be assured
  • Review the value and data quality of consumer‐entered information
  • Include a long‐term implementation timeline with clearly defined major milestones
  • Include consideration of the e‐Health Workforce limitations
  • Include a section on how the PCEHR will compete with and leverage new technologies
It is a pretty long list and not much was addressed! As the AMA etc. say - really just not listening!
David.

I Am Not Sure I Can Stand Too Much More of This! The PCEHR Seems To Have A New Name!

What on earth is going on (that is the polite way of saying it I really meant WTF!).
I came across this today.

Clinical E-Newsletter

Welcome to the fourth clinician e-newsletter brought to you by the Clinical Unit of the National E-Health Transition Authority (NEHTA) providing information on key issues and current events related to e-health in Australia.
Edition:   04 Date:  Tuesday, 27 September 2011
The lead item is this:

Personally Controlled Electronic Health Records (PCEHR) aka (Personal Electronic Health Record Summary (PEHRS)

NEHTA has commenced preliminary work on developing the concept of operations for a PCEHR: bringing together many ideas about what could be on an Electronic Health Record Summary. The Clinical Leads and other stakeholders participated in a two-day workshop in Brisbane in mid-July to contribute to the development of a hymn sheet to which there was some agreement and therefore a fixed ‘target’ PEHRS which could then be socialised and e-health architecture built around it. This document will form the basis for drawing in consumers and clinicians in particular into the developments. A workshop will be held in August to complete this work. Additional workshops involving the NEHTA Clinical Lead group and consumers to discuss options for the proposed PCEHR/ PEHRS are planned.
-----
Go here for other news:
What on earth does this mean? Who has slipped their moorings? Do we need any more acronyms? Does aka mean ‘also known as’? Where has this come from?
And WTF does this mean?
“The Clinical Leads and other stakeholders participated in a two-day workshop in Brisbane in mid-July to contribute to the development of a hymn sheet to which there was some agreement and therefore a fixed ‘target’ PEHRS which could then be socialised and e-health architecture built around it.
How are hymns involved and so on?
Walks off shaking head! They have utterly lost the plot is the only viable conclusion!
David.

Monday, September 26, 2011

Weekly Australian Health IT Links – 26th 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

An interesting diverse week for news. From my perspective we have had a major warning with the failure of the UK National Program for Health IT to be delivered as planned. As I noted earlier in the week there are real lessons here but sadly the evidence that we are noticing is yet to emerge:
See here for link:
Another report and comment on all this appeared late Friday.

UK health IT debacle a lesson for Canberra

  • Karen Dearne
  • From: Australian IT
  • September 23, 2011 4:06PM
THE plug has been pulled on Britain's massively costly, long-delayed and significantly under-delivering National Health Service IT reform program.
The Conservative government has announced "the dismantling" of the 11.5 billion pound ($18.14bn) project that commenced under Labour in 2002 and was this year condemned by unflattering findings from the National Audit Office, the parliamentary public accounts committee (PAC) and a Cabinet Office review.
In August, PAC chair Margaret Hodge urged the government to cut its losses and use the remaining funds to "buy systems that work".
Earlier this year, the auditor found the original vision of a fully integrated electronic records system holding an individual care record for every NHS patient "had no hope" of ever being realised.
And now the Major Projects Authority (MPA) has concluded that the program "has not and cannot deliver to its original intent".
-----
I will provide a wrap up of all this later in the week.
-----

eHealth deadline may be a bad imperative

Techno Blog | 16 September 2011
BY KAREN DEARNE
HEALTH Minister Nicola Roxon is one brave lady.
Not many politicians would be willing to stake their credibility on the uncertain notion that a huge and complex IT project will be up and running on a certain date - a target set not by those who have to deliver but a political deadline set by the minister herself.
Ms Roxon has unsurpassed confidence in those who advise her, it seems. Maybe they have crystal balls, maybe they are smoking something stronger than no-label tobacco.
But what if they’re wrong, and the personally controlled e-health record (PCEHR) project is not ready for go-live on July 1?
Is it really worth risking a $500 million program - intended to transform the way sensitive medical information belonging to every Australian is shared among 850,000 healthcare providers nationwide - by rushing so the minister can say, “Well, the deadline was met”?
-----

Slashing hospital time with self-serve kiosks

By Suzanne Tindal, ZDNet.com.au on September 22nd, 2011
Patients in the out-patient departments of three Queensland hospitals now follow kiosks that direct them between different services within the departments, cutting down on the amount of time they need to spend in clinics.
Redcliffe Hospital's specialist out-patient department (SOPD) offers orthopaedics, surgical, gynaecology, fracture, medical and private practice to 45,000 patients per year.
It was having problems with patient flow, with patients getting stuck in the hospital for hours on end, being transferred from one section of the hospital, such as medical imaging, to another. Patients arriving would face a queue of 20 to 30 people, just to register their presence at the hospital. Then they would have to wait while nurses alerted the consultants that the patient had to see. A patient's visit might also involve multiple visits back to the administration desk to facilitate their moving between service areas. In order to tackle the issue, the hospital decided to hold a tender process to see what vendors had on offer to handle patients' visit from referral, through consultation to discharge.
-----

http://www.medicalobserver.com.au/news/gps-expected-to-set-up-ehealth-roxon

GPs expected to set up e-health: Roxon

23rd Sep 2011 Mark O’Brien
GPs are considering charging patients, billing Medicare or demanding yearly registration fees to work on electronic health records, while Health Minister Nicola Roxon has reiterated the government’s expectation that the profession would do the bulk of the work on the new system.
National E-Health Transition Authority (NEHTA) clinical lead Dr Emil Djakic said in the absence of funding for GPs’ time, it could be the patient who footed the bill.
“[If the person benefiting from a service is the patient], the patient is going to be bearing the cost of it,” he said.
RACGP national e-health standing committee chair Dr John Bennett said GPs might try to recoup costs by billing longer Medicare consultations or through rebates for care plans, but direct incentives would be a much better option.
-----

Plea to back e-health records

20-Sep-2011
Paul Smith
Clinicians leading the rollout of e-health records have offered assurances the records are safe, despite patients being free to delete potentially critical clinical information without their GP’s knowledge.
Last week, the Federal Government unveiled its blueprint for the $467 million system due to be launched by July next year.
Patients will be able to remove clinical documents, including event and discharge summaries — a concession the AMA dubbed “reckless and dangerous”.
“It appears that the [personally controlled e-health record] has effectively been ‘de-medicalised’,” AMA president Dr Steve Hambleton said. “Medical input has been ignored, while the government has caved in to noisy minority consumer groups.”
-----

Varying mortality rate in private hospitals data

PATIENTS using 12 leading private hospitals in Australia have a far higher than average chance of dying, a contentious analysis of private health insurance data shows.
The study by Flinders Medical Centre professor David Ben-Tovim also reveals nine top performing private hospitals with a much lower than average mortality rate.
Because the identity of both sets of hospitals remains secret, the 2008 study has fuelled debate about the right of patients and taxpayers who subsidise private care to information on hospital performance.
-----

Dangers of de-medicalising the PCEHR

21-Sep-2011
Guest editorial by Dr Steve Hambleton
The Federal Government has released the final version of the Concept of Operations for the Personally Controlled Electronic Health Record (PCEHR) system — a document that is very similar to the draft version. The AMA is extremely disappointed in both versions.
For a health record that is being promoted as revolutionary for patients and health professionals, including doctors, it is sadly bereft of sufficient medical input to its design and intended purpose.
It appears that the personally controlled e-health record has effectively been ‘de-medicalised’. It appears that consultation has been merely conversation. Medical input has been ignored, while the government has caved in to noisy minority consumer groups.
-----

GE and HP latest to clamber on e-health bandwagon

The Government’s e-health initiative, for which it has so far earmarked $467 million worth of investment is acting as a lure for the big names of IT with HP and GE the latest to bring new healthcare solutions to Australia.
GE this week announced that its Health Information Exchange, already being used in 17 sites in the US to allow clinical data to be stored and viewed, would be available for Australian clients early in 2012. The company has been tweaking the product for the local market including adding fields to allow management of Australia’s 16 digit health identifier numbers which were introduced last year.
-----

Working Towards an Integrated System

Interview with GE Healthcare’s Vice President of eHealth Solutions, Blair Butterfield.

GE Healthcare announced to launch its eHealth Information Exchange in Australia this week which is seen will make an impact on eHealth in Australia. As current aspirations and concerns about the development of eHealth in Australia continue to unveil, Blair Butterfield shares his experience working on eHealth projects internationally and how Australia could learn and benefit from this.
Interview conducted by Rebecca Merrett
Transforming the Nation’s Healthcare: Explain how the eHealth Information Exchange works and how you see it being adopted in Australia?
Blair Butterfield: How the eHealth Information Exchange works is it’s based on global standards for sharing documents which can be either structured or unstructured and we believe that the architecture is very compatible with what NEHTA has chosen for the Australian national infrastructure. Our hope is that it will be able to provide some of the regional solutions that are needed to connect up to that national back-bone.
-----

Motion Announces The Winner Of Its First Annual Excellence In Mobile Point Of Care Award – Asia Pacific

September 20, 2011
Austin Health Awarded for Enhancing Clinician Satisfaction and Delivering Quality Patient Care
Motion Computing, a leading global provider of tablet PCs and supporting mobility solutions, recently announced from the Healthcare Information and Management Systems Society (HIMSS) Asia Pacific 2011 Conference that Austin Health is the first recipient of its Excellence in Mobile Point of Care Award – Asia Pacific. The annual award program recognises commitment and dedication to deploying mobile point of care solutions that focus on enhancing clinician satisfaction and delivering the highest quality of patient care possible.
Austin Health is a major tertiary academic hospital that services the northeast suburbs of Melbourne, Australia. Comprised of three hospitals, Austin Hospital, Heidelberg Repatriation Hospital and Royal Talbot Rehabilitation Centre and a full-time staff over 5,200 employees, Austin Health has over 900 inpatient beds and treats around 95,000 inpatients, 172,000 outpatients and 59,500 emergency attendees per year. Its major services include a liver and gastrointestinal transplant unit as well as spinal cord injury, cancer and respiratory services.
-----

HIMSS Asia Pac’11 focuses on eHealth records

Published on September 21, 2011 at 12:02 AM
The HIMSS (Healthcare Information and Management Systems Society) Asia Pac ’11 Conference and Exhibition incorporating the HIMAA 2011 National Conference, opened on Tuesday, bringing together leading international experts in healthcare information systems and technology.
The three-day event, which is being held at the Melbourne Convention and Exhibition Centre, is particularly relevant to the city, given Australia’s National E-Health Transition Authority (NEHTA) is establishing a national eHealth infrastructure. The organisers have put together a special Australia and New Zealand track for country-specific sharing and learning opportunities.
“It is the first time that we’ve held the HIMSS Asia Pac conference in Australia and we’ve brought together some of the world’s best health IT practitioners. It’s great to be able to facilitate an information exchange for effective deployment of healthcare IT solutions to improve patient care and delivery across the region," said H. Stephen Lieber, CAE, HIMSS President/CEO.
Dr. Mukesh Haikerwal (AO), National Clinical Lead for NEHTA, who delivered the keynote address to open the conference, said that the release of the Personally Controlled Electronic Health Record (PCEHR) Concept of Operations in September was a major step forward for eHealth in Australia and all Australians will have the opportunity to register for an eHealth Record from 1 July 2012.
-----

Better Health Channel goes mobile       

20 September 2011: Deloitte, and the Victorian Department of Health, have jointly created an iPhone and iPad application for the award winning Better Health Channel. This free app will help Victorians conveniently locate health services anytime and anywhere across Victoria and learn more about medical conditions and treatments.
Frank Farrall, National Leader of Deloitte Australia’s Online practice said: The Better Health Channel is a multi-award winning website and making it mobile will encourage consumers to take even more control of their own health. They can now receive up to date health and medical information whenever they need it and wherever they are within Victoria.”
Deloitte’s Online practice utilised their extensive mobile development expertise to help the Department of Health deliver an app which places up to date, easy to understand and trusted information, which has been quality assured by medical experts in the palm of people’s hands.
-----

Primary care quality indicators launched

A series of 34 practice-level indicators of safety and quality for primary health care have been drawn up and released for consultation.
The indicators (link), which cover aspects of care such as waiting times, adherence to evidence based guidelines and monitoring of adverse events, are not intended to be performance indicators, says the Australian Commission on Safety and Quality in Health Care.
“These indicators will be designed for voluntary inclusion in quality improvement strategies at the local practice or service level and may be used by organisations and individuals providing primary health care services,” it says of the draft indicators released this week.
-----

Privacy override could ‘undermine confidence’ in e-health system

20th Sep 2011 Mark O’Brien
GPs and consumers are at odds over a ‘break glass’ emergency provision that will allow doctors to override patient privacy settings in the government’s personally controlled e-health record (PCEHR) system.
The debate comes as Health Minister Nicola Roxon last week ruled out paying GPs to help establish and curate patient records in the system.
Ms Roxon, unveiling the system’s concept of operations last week, told reporters the government was “not contemplating” a special rebate to compensate GPs for the time it takes to create and maintain the records.
-----

Shift to medical e-records worries majority of Australians with sensitive medical information

Source: The Australian
MORE than 80 per cent of Australians with sensitive medical information are concerned about the shift to electronic records.
A Harris Interactive survey of 5246 people living in Australia and in the US and Britain found a remarkable correlation of results, with 83 per of Australians, 80 per cent of Americans and 81 per cent of Britons indicating a range of worries.
The May survey, commissioned by US-based identity management specialist SailPoint, noted healthcare organisations were sharing information electronically, and asked respondents: "What are you most concerned about in relation to your own personal medical information?"
In Australia, 37 per cent said they were most concerned about the potential for identity theft, while almost 30 per cent feared their information would be exposed on the internet.
-----

HP wins ICT deal for Royal Adelaide Hospital

HP will supply and maintain a portion of the ICT systems for the new $2.1 billion hospital
HP Australia has won a contract to supply and maintain ICT services to a portion of South Australia’s new $2.1 billion digital Royal Adelaide Hospital (RAH).
Under the contract, HP will work with the SA Health Partnership (SAHP) consortium, which encompasses Leighton Contractors, Hansen Yuncken, Macquarie and Spotless, to design, build and maintain the hospital’s ICT infrastructure for the facility throughout its construction, which is scheduled to be completed in 2016. It will also operate and maintain the ICT systems for the following 30 years.
HP South Pacific vice president of enterprise services, Alan Bennett, said he could not disclose the exact figure the contract is worth, but told Computerworld Australia the new 800-bed hospital would be the first recipient of HP’s “version 2.0 digital hospital solution”, which includes software applications that link conventional building engineering systems to the communications systems and their mobile devices.
-----

Privacy of patients breached by Professional Services Review

  • Sean Parnell, FOI editor
  • From: The Australian
  • September 19, 2011 12:00AM
PATIENT privacy has been compromised in the federal government's bid to control health spending, with a key agency found to have illegally merged data from Medicare and the Pharmaceutical Benefits Scheme.
In a case likely to fuel privacy concerns over planned electronic health records, the embattled Professional Services Review has been ordered to add computer system and practice changes to a growing list of reforms.
The PSR investigates alleged doctor rorts, but a wave of legal challenges has this year forced 39 potential cases to be abandoned and left about 50 completed cases at risk of collapse. The government, which is preparing an appeal to the High Court, has ordered an independent review and a parliamentary committee is also examining the PSR.
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Trusted identities model for online security

WHEN Paul, a retired grazier from central Queensland, began an online relationship with "Selina" from Ghana, he had no idea that over the next several months this scammer and her accomplices would fleece him of more than $200,000.
Online scams are big business. A study by the Australian Bureau of Statistics found about six million people a year are exposed to scams or frauds, with more than 800,000 robbed. The Australian Federal Police puts the cost of such scams at more than $1 billion.
Security firm Symantec says 69 per cent of Australians have been the target of online fraud, despite the fact that they are more careful than most when considering online transactions.
According to a Symantec survey of 7000 people in 14 countries, few Australians feel safe online, with 98 per cent expecting to be caught out by cybercrime.
-----

Tragic script will be repeated

By Martin Whitely
September 18th, 2011, 12:54 pm
Methadone is meant to save lives by preventing drug abuse. Other prescription drugs are supposed to improve physical and mental health.
So when the WA Coroner Alastair Hope told me in writing that an otherwise healthy 40-year-old woman died from an overdose of methadone, prescribed to prevent her continuing to abuse prescription drugs, it was obvious something had gone terribly wrong.
And when he added that "in recent times this office has become aware of a number of cases of methadone overdose", it became obvious something is going terribly wrong far too often.
-----

Gamers beat boffins to enzyme code

  • From: AFP
  • September 19, 2011 8:58AM
ONLINE gamers have achieved a feat beyond the realm of Second Life or Dungeons and Dragons: they have deciphered the structure of an enzyme of an AIDS-like virus that had thwarted scientists for a decade.
The exploit is published on Sunday in the journal, Nature Structural & Molecular Biology, where - exceptionally in scientific publishing - both gamers and researchers are honoured as co-authors.
Their target was a monomeric protease enzyme, a cutting agent in the complex molecular tailoring of retroviruses, a family that includes HIV.
-----

Particles found to break speed of light, challenging laws of physics

September 23, 2011
  • Finding could overturn laws of physics
  • Scientists confident measurements correct
An international team of scientists says it has recorded sub-atomic particles travelling faster than light - a finding that could overturn one of Albert Einstein's long-accepted fundamental laws of the universe.
Antonio Ereditato, spokesman for the researchers, said that measurements taken over three years showed neutrinos pumped from CERN near Geneva to Gran Sasso in Italy had arrived 60 nanoseconds quicker than light would have done.
"We have high confidence in our results. We have checked and rechecked for anything that could have distorted our measurements but we found nothing," he said. "We now want colleagues to check them independently."
-----
Enjoy!
David.

AusHealthIT Poll Number 89 – Results – 26th September, 2011.

The question was:
What Do You Believe Is the Chance Of Successful Delivery of the PCEHR?
100%
- 9 (18%)
80%
- 3 (6%)
60%
-  3 (6%)
40%
-  6 (12%)
20%
-  8 (16%)
0%
-  20 (40%)
Votes 49
A pretty clear  vote. 68% give the chance of successful delivery at less than evens on a good number of votes.
Again, many thanks to those that voted!
David.

The Pharmacy Guild Has Gone Over The Top Here. Using Health IT Help Them Up-Sell Blackmore’s Products!

I am sorry but this plan of having a dispensing system suggest complimentary medicine to take with your prescription is really just astonishing.
See here:

Doctors hit out at pharmacists' deal with Blackmores

Barbara Miller
Updated September 26, 2011 12:25:36
The Australian Medical Association (AMA) has accused the Pharmacy Guild of Australia of putting commercial interests ahead of patients' health under a new deal which will see pharmacists prompted to recommend supplementary medicines to consumers.
The guild has struck an agreement with the company Blackmores to promote the company's products alongside certain prescription drugs.
Under the deal, pharmacists dispensing medicines for several common conditions will receive a prompt in their computer system reminding them to promote a complementary Blackmores product.
The AMA says it appears commercial interests are being put ahead of patients' needs.
But the association has previously been accused of doing the same, and the Pharmacy Guild says it is thrilled about the deal.
The guild says the four Blackmores products in the range have been designed specifically to offset possible side-effects of common prescription drugs.
But AMA president Steve Hambleton says the agreement is just an opportunity to up-sell and increase profits.
"We rely on our pharmacy colleagues to actually assist us in healthcare of the patient," he said.
"It is a very good relationship between doctors and pharmacists, and I'd hate to see anything undermine that.
"That sort of advice from a professional pharmacist will have a great impact on patients and they may well decide to choose those products.
"We know some patients won't even take all of their medicines because of the price - I'd hate to think that they'd substitute one of their prescribed medicines for one of these companion products."
Dr Hambleton says there is potential to sell companion products with around 58 million claims for PBS prescriptions.
"This is a big financial deal. We can't put finances ahead of the health of a patient," he said.
More here:
Talk about giving the concept of electronic Clinical Decision Support a bad name and worse using such systems to improve pharmacist and Blackmore’s revenue where there is such clear conflict of commercial interest. We need to know the pharmacist isa cting totally in the interest of the patient and not to have them conflicted by the possibility of extra and possibly un-necessary sales.
Note that the patient will not be aware that the pharmacist has been reminded to provide ‘fries with that’!
I am not saying pharmacists don’t act in the patient’s best interest but to avoid the obvious perception they are simply commercially motivated, this idea should just be dropped.
If it is important for the extra complimentary medicine to be provided it should be on the recommendation of the clinical prescriber not the pharmacist.
David.

Sunday, September 25, 2011

The Troubles In Qld Health (QH) IT Really Seem To Be Building - QH Seems To Be Ignoring The Lessons of History!

Last week I reported on some issues the Opposition was raising with the Government regarding the procurement of the planned Hospital Information System for Qld Health.
Here is the link.
At the very least from a political perspective this certainly seems to be a story that is keeping on giving!
At the earlier post I had not seen this press release from the Opposition health spokesman.
Tuesday, 20 September 2011 15:14

Labor's $182m health IT contract suspect

The State Opposition fears a repeat of Labor's health payroll debacle is looming with internal State Government emails raising serious questions over how a $182 million health records IT contract will be awarded.
Emails obtained through an Opposition right-to-information application have revealed senior Queensland Health bureaucrats made requests to the author of a Gartner market analysis report that may have excluded competition for the multi-million dollar integrated electronic medical record system (ieMR).
LNP Shadow Minister for Health Mark McArdle said Paul Lucas, who was Health Minister at the time, must make a full explanation of why he signed off on this procurement strategy.
"An email between senior bureaucrats reveal Queensland Health had contacted the "Gartner author" to make changes to the "market scan report"," Mr McArdle said.
"By narrowing the scope of the market analysis after the draft was circulated, potential competitors may have been unfairly excluded from bidding for the ieMR platform contract."
Queensland Health is currently in contract negotiations with Cerner Corporation over the procurement of an integrated electronic medical record system, worth a reported $182 million in 2011-12.
"We should be opening the ieMR tender up to domestic and international competition to ensure we get the right platform at the right price for the taxpayer, and to avoid repeating the mistakes of the health payroll system," Mr McArdle said.
"This approach is unspeakably stupid by a Labor government that has already given our health workers a $220 million failed payroll system."
There are already reported concerns in both New South Wales and Victoria over the performance of Cerner platforms in their hospitals.
Mr McArdle also said he received a letter from LNP Candidate for Stafford Dr Chris Davis today, refuting claims by Health Minister Geoff Wilson that Dr Davis supported Labor's approach to procuring the eMR platform. (Letter attached)
"Dr Davis is a man of principle and believes a well functioning e-Health program, just like a payroll system, is an essential part of our health system," Mr McArdle said.
"The Bligh Labor government has adopted a blinkered approach to pursuing a single product, corner cutting the tender process with a poorly defined business case, which may end in disaster for patient care."
The latest revelations support a string of leaked documents showing Queensland Health's IT system was plagued with problems, with 'extreme' risks of poor patient care and reduced Federal funding for health services.
A leaked Queensland Audit Office report also found Queensland Health at odds with the independent auditor over recommendations to increase accountability and transparency of the troubled IT program.
"The Bligh government is the greatest risk to getting our health system back on track as the IT crisis spreads from payroll to patients," Mr McArdle said.
"We have never seen such gross mismanagement and a total failure of leadership in a portfolio than we have seen in Queensland Health under Labor.
"A CanDo LNP Government will be open and transparent and get action on the basics."
Download attachments:
The release is here:
This was followed by these reports in the Courier Mail.

Queensland Health eyes software system despite red flags

QUEENSLAND Health is poised to sign a multimillion-dollar contract for computer software similar to that labelled "defective" by an IT expert who audited its use in southern hospitals.
University of Sydney's Professor Jon Patrick said electronic medical records systems built by Cerner Corporation for the NSW Government crashed frequently and risked patient safety.
A similar Cerner system installed by the Victorian health department also has been plagued by glitches and is five years behind schedule.
"I don't think there's any reason for optimism that they can be improved," Prof Patrick said.
Leaked internal documents have surfaced detailing problems already looming within Queensland, as bureaucrats negotiate with US-based Cerner to build a $243 million electronic medical records system in Queensland hospitals.
Technical information for the proposed Cerner system and existing IT platforms that it must work with was "often incomplete, not-comprehensive, inaccurate and out-of-date", a leaked position paper found.
Another email addressed to chief information officer Ray Brown, released to the State Opposition under Right to Information laws, warned of the increasing need to document potential risks "even if we can't find the resources to remove them" in case of disaster and patient death.
"The no-surprises rule may be applicable and would help in a Coroner's Court," the clinical adviser wrote.
More here:
And then this:

Queensland Health's new electronic medical records system already year behind schedule, leaked documents reveal

QUEENSLAND Health's controversial new electronic medical records system already lags almost a year behind schedule, leaked documents reveal.
Internal timelines show a "gold build order", indicating the software was configured and ready for rollout, and should have been issued last December.
But months later, the troubled department remains locked in contract negotiations with Cerner Corporation as technicians battle potential system risks.
In a further blow to QH, which had tried to keep the platform's cost under wraps, more leaked reports show the spend will hit $194 million by next June.
Chief information officer Ray Brown this week scrambled to show the hi-tech system was on time and budget, after a series of damning reports in The Courier-Mail.
He insisted the gold build was "prototyped" last December and said a subsequent risk assessment took several months "as we were extremely thorough".
But his office was yesterday unable to say when the Cerner contract would be signed, allowing the software to roll out across Queensland hospitals.
Health Minister Geoff Wilson said: "I make no apology for taking a few extra months now to ensure a strong result and save time in the long run."
More here:
Mark McArdle MP
Shadow Minister for Health
LNP Member for Caloundra
24 September 2011

Auditor-General called to investigate Labor’s $182m IT program

The Bligh Labor Government’s troubled integrated electronic medical record program has been referred to the Auditor-General.
Shadow Minister for Health Mark McArdle yesterday wrote to the Auditor-General asking him to step in and conduct a full audit of the health IT program to ensure future patient care is not placed at risk, and taxpayers’ funds are not wasted.
“Labor Health Minister Geoff Wilson has lost control of his department’s IT division – and the result is a massive waste of taxpayers’ money,” Mr McArdle said.
“These are the same people that gave us the controversial health payroll system that squandered $220 million of Queenslander’s money, and now Labor’s got patients’ records in their sights.
“It’s time we had an urgent independent audit into the program.”
This week there have been revelations that the proposed medical record program is over 12 months behind schedule – and more disturbingly, the $182 million contract may have unfairly excluded potential competitors from bidding.
“The medical record system Queensland Health want to purchase has already been subject to criticism for its pitiful performance in New South Wales and Victoria,” Mr McArdle said.
“People want the truth not more deceitful spin from Geoff Wilson and his army of taxpayer-funded media advisors.”
Mr McArdle wrote to the Auditor-General asking him to examine whether the ieMR program had been open to market competition, whether approval was given by the Minister’s office, how much the program had spent to date and the estimated future costs, and whether the program was open and accountable.
“Queensland can’t afford for another expensive Labor IT bungle like the health payroll system,” Mr McArdle said.
“We need to act now and undertake a full audit.
“Only a CanDo LNP Government will be cut waste and be open and accountable,” he said.
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While all the political attempts to score points and seek advantage is always a great spectator sport there is actually a serious issue which needs addressing - and soon.
It is clear that the substantial hospitals in Queensland (and they have some of the biggest in the country) need their core information systems replaced and there is no political issue on this point - the old ones being at their life’s end - indeed they genuinely reached beyond that point years ago!
The key issue is how this replacement - and hopefully significant upgrade - should be achieved.
I have to say the colour drains from my face when I read about ‘gold build’ contracts and state-wide rollouts!
It really seems to me that there is a risk with all this that Queensland is again trying to replicate a state-wide implementation approach that has been shown to cause a great deal of pain and frustration in the southern states.
Frankly to approach large complex teaching hospitals with other than a totally locally managed implementation process where the vendor and the hospital work together to implement a system that suits the client (the large hospital NOT the Department of Health) is just very stupid and very, very risky.
It really does not matter which of the major vendors is chosen (indeed in the very large hospitals, as long as the hospital is happy having more than one is hardly a disaster) as long as they are allowed to use their own implementation methodology directly within the target organisation and work unconstrained to obtain implementation success with that organisation. This way the politics, structures and workflows can all be properly addressed and the chances of success rise exponentially.
(Note: the above does assume selection of any vendor (single or not) has been with full input from clinicians and administration at all levels - and agreement the system will do what they need as well as appropriate technical due diligence etc. has been undertaken.) 
Any ‘gold build’ will not fit the Royal Brisbane and PA anywhere near as well as a local implementation done directly with the vendor and the hospital jointly. Sure it costs more initially - but the long term costs and pain are certain to be lower.
Bureaucrats know nothing about Health IT implementation in large complex organisations compared with HIT providers and the major hospitals (anything more than about 200 beds) should work directly with the vendors to get the success they both want as painlessly as possible! They simply do not need a Health Department in the middle messing things up!
I really don’t understand why we refuse to learn this basic lesson - to our ongoing cost!
David.