An Update On The Progress of E-Health in The Shaky Isles. There Seems To Be Some Action!

A day or so ago the following press release piqued my interest in what was going on in NZ.

Important changes to accessing to personal medical records

West Coast DHB Friday 04 November 2011, 9:48AM

Media release from West Coast DHB

A new way of managing personal medical records is being introduced on the West Coast, and residents are encouraged to actively 'opt-in' to the system.

The Share for Care system is being introduced this month by Healthy West Coast. It is a way to safely share a summary of a person's General Practice based electronic health information with other health care providers on the West Coast.

Share for Care allows health workers approved access to necessary information. This will improve the care people receive across the health care system, for example at the pharmacy or at the hospital's Emergency Department.

David Meates, West Coast DHB Chief Executive, says while it is important medical records are protected for privacy reasons, medical staff also need to be able to quickly access information to ensure effective provision of the best patient care.

"Share for Care does this. Although, to ensure the system works, people have to sign a form to opt-in to the process. There is a choice to opt-out but that also requires a form to be signed," Mr Meates says.

'Opt-in' forms can be completed and returned to a person's general practice.

People who want to be excluded from the system also need to complete the appropriate form and return it to their general practice before November 30 to ensure their records will not be available to anyone other than the health provider who holds them (such as their GP).

If neither an opt-in nor an opt-out form is completed, health records will be available only in an emergency outside the general practice.

Mr Meates says a secure system is in place to ensure records are protected from being casually or inappropriately accessed and more personal information, such as notes made by a doctor or practice nurse, are not included in the information shared.

"This is a logical move to getting patient records more effectively stored for quick efficient access by those people providing health care," Mr Meates says

"We are urging people to take a quick moment to fill in the opt-in form so there is smooth access to their records when needed."

Mr Meates says the Healthy West Coast hopes to eventually expand the system to allow patients to be able to access their own medical records online.

• Opt-in and opt-out forms are available at all pharmacies, general practices, medical centres, DHB facilities and the West Coast Messenger or can be downloaded online at www.shareforcare.health.nz , www.westcoastpho.org.nz or www.westcoastdhb.org.nz

• More information is also available from general practices and pharmacies

The release is found here:

http://www.nzdoctor.co.nz/un-doctored/2011/november-2011/04/important-changes-to-accessing-to-personal-medical-records.aspx

This prompted me to ask my mate Tom Bowden for a quick update on the state of play over there.

Here is what I received (published with permission):

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New Zealand’s health sector has decided it is time to take further steps to use IT to improve healthcare delivery. After several years with 100% of GPs using electronic medical records (since 2000) and being rated as one of the world’s most joined up health sectors (the average GP communicates electronically with 58 other parties, we are top of the Commonwealth Fund comparisons), the race is now on to make a patient’s records available to all providers involved in a patient’s care. 

Rather than develop a national strategy, build an architecture over several years and work through a Gordian knot of standards, funding arrangements and competing interests, the dwellers of the shaky isles have quietly pushed out their canoes and started paddling fiercely toward the far horizon (hoping they have their charts the right way up).  As of today, at least three politely competitive initiatives are trying to establish their bona fides in this space.  While some may take the view that contesting the exact approach to take is inappropriate, I believe that experimentation goes hand in hand with innovation and that by trying different health records paradigms we will learn from each others’ efforts and eventually settle upon a good approach, ideally it will be open, standards based and be replicable in a range of settings.

Following Hillary Clinton’s advice to “never waste a good crisis”, the good citizens of Christchurch decided to use the Canterbury earthquakes as an opportunity to try and create a universal patient health record in their region, ably assisted by local PCEHR expert Orion Health.  Armed with a toll free opt out number the eSCRV (electronic Summary Care Record View) burst into life a week ago, as a limited trial, ready to discover the myths and realities of an ‘opt out’ shared health record system.

See news item

http://www.stuff.co.nz/the-press/news/christchurch-earthquake-2011/5757573/Quakes-speed-up-start-of-Canterbury-database

Meanwhile, across the Southern Alps another breed of New Zealander, the rugged individualists of the West Coast region decided that a slightly more conservative approach was needed and with an opt in system (except in emergencies) this system is now in place also.  Both the Canterbury and West Coast systems involve aggregation of data into a shared record which is made available as needed.

See details here

http://www.shareforcare.health.nz

Further north, in the Nelson and Napier regions, healthcare providers are experimenting with a third approach, in this one, no records are aggregated, they are dynamically accessed from general practices and pharmacies, at the point of emergency care, with the patient’s consent, on an as needed basis.  This system has been in place since March and its use is growing steadily.

See details

http://www.healthlink.net/careInsight.html

Further north again, the Auckland region is going live with an online referral system that will see all hospital referrals electronic, using online forms and a web services interface by March 2012.  This is one of the most advanced online referrals initiatives anywhere.  A large scale collaboration taking over two years to come to fruition, it is a very comprehensive approach to the transfer of care between primary and secondary care providers.

See details

www.careconnect.co.nz

A key point is that none  of this locally driven innovation requires any central government involvement except to keep an eye on use of standards (which we all view as most important).  Each of these projects involves extensive collaboration between local health authorities and vendors.

We are pretty busy right now with all of this but will be happy to let you know which of these new HIT paradigms are working best over the next 12- 24 months.  It is an exciting time to be involved in New Zealand healthcare IT.

Kind regards,

Tom

Disclosure of Interest:  Tom Bowden is CEO of HealthLink, the company that provides the CareInsight service used in the Nelson and Hawkes Bay regions and the CareConnect eReferrals system.

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Many thanks Tom for the summary!

The number of lessons that flow from this are really legion. Among the most obvious are the totally ‘bottom-up’ driven approach, the use of a single common standardised communications infrastructure, an approach based on a small start and grow from there and so it goes on.

There is no doubt NEHTA and DoHA need to keep these basic initially provider centric approaches in mind as the over complex PCEHR totters off its pedestal. The Opposition could also look closely to this as a rather more vendor friendly approach to making some real progress in e-Health.

David.

The Medical Software Industry Association (MSIA) Has Lost Patience With NEHTA. This Is Getting Serious.

The following appeared today.

Medical software group raises e-health safety issues

• by: Karen Dearne
• From: Australian IT
• November 10, 2011 12:00AM

The peak medical software group is concerned about the Healthcare Identifiers service.

THE Medical Industry Software Association has warned unresolved patient safety and liability concerns relating to the year-old Healthcare Identifiers service leave members at risk of liability "for any and all adverse outcomes" arising from use of the service.

"Implementers should take legal advice with respect to potential liability, inform their software indemnity insurers and ensure end-users sign comprehensive waivers," the MSIA says in a white paper adopted by members at its annual CEO Forum last month.

The eight-page white paper -- obtained by The Australian -- was provided to all members of the Healthcare Identifiers (HI) stakeholders working group, including the National e-Health Transition Authority, federal Health department and Medicare, for their consideration.

Members should consider implementing existing Medicare Online patient checks for Medicare and Veterans’ Affairs numbers "as a proven alternative without the risks of fines and criminal liability", the paper said.

"Members have been concerned about the safety and clinical liability aspects of the current service since the specifications were first made publicly available.

"More than six months was spent negotiating with Medicare in an attempt to have it accept liability for system failures or data errors. Medicare refused to do so."

The current HI developer agreement is "restricted solely to accessing Medicare’s development environment, while the use of the live HI service is governed by the HI legislation and associated regulations".

"This leaves software implementers potentially liable for any and all adverse outcomes arising from incorrect functioning of the system or bad data supplied by the service," the paper said.

"Given the failure of the Medicare Online patient verification facility for Medicare numbers two years ago, this is not a theoretical risk."

In February 2010, a serious glitch in Medicare’s systems involved the potential incorrect updating of up to 30,000 patient records held in doctors’ own systems after a coding error during routine maintenance.

Medicare was alerted by software vendors who noticed the problem, but the agency was slow to act. Eventually, it was forced to write to 2700 medical practices, warning them to check for flawed data return messages generated over a three-day period.

"It is known that the Medicare data is not perfect, despite investing a large effort in cleaning its patient data over the past two years," the MSIA said.

"However, it is possible that duplicate and/or replicate IHIs will occur either in its database, or be introduced by operator or system errors in patient management and downstream systems.

"At present, even if Medicare is aware of a problem with an IHI, it has no mechanism for informing anyone."

The MSIA said it had repeatedly requested a copy of a patient safety risk assessment of the HI service apparently conducted a year ago from Medicare, the Health Department and the National e-Health Transition Authority. The information is needed by its members who are tasked with upgrading their products to interface with the system.

Much more here:

http://www.theaustralian.com.au/australian-it/government/msia-raises-e-health-safety-issues/story-fn4htb9o-1226190483587

I don’t need to comment - the white paper says it all.

Download that from here:

http://moreassoc.com.au/downloads/MSIA%20National%20Healthcare%20Identity%20Service%20Whitepaper.pdf

David.

Fascinating Approach To The Use Of Health IT in Difficult Cases. Worth A Read.

The following interesting article appeared in the NEJM a few days ago.

Evidence-Based Medicine in the EMR Era

Jennifer Frankovich, M.D., Christopher A. Longhurst, M.D., and Scott M. Sutherland, M.D.

November 2, 2011 (10.1056/NEJMp1108726)

Many physicians take great pride in the practice of evidence-based medicine. Modern medical education emphasizes the value of the randomized, controlled trial, and we learn early on not to rely on anecdotal evidence. But the application of such superior evidence, however admirable the ambition, can be constrained by trials' strict inclusion and exclusion criteria — or the complete absence of a relevant trial. For those of us practicing pediatric medicine, this reality is all too familiar. In such situations, we are used to relying on evidence at Levels III through V — expert opinion — or resorting to anecdotal evidence. What should we do, though, when there aren't even meager data available and we don't have a single anecdote on which to draw?

We recently found ourselves in such a situation as we admitted to our service a 13-year-old girl with systemic lupus erythematosus (SLE). Our patient's presentation was complicated by nephrotic-range proteinuria, antiphospholipid antibodies, and pancreatitis. Although anticoagulation is not standard practice for children with SLE even when they're critically ill, these additional factors put our patient at potential risk for thrombosis, and we considered anticoagulation. However, we were unable to find studies pertaining to anticoagulation in our patient's situation and were therefore reluctant to pursue that course, given the risk of bleeding. A survey of our pediatric rheumatology colleagues — a review of our collective Level V evidence, so to speak — was equally fruitless and failed to produce a consensus.

Without clear evidence to guide us and needing to make a decision swiftly, we turned to a new approach, using the data captured in our institution's electronic medical record (EMR) and an innovative research data warehouse. The platform, called the Stanford Translational Research Integrated Database Environment (STRIDE), acquires and stores all patient data contained in the EMR at our hospital and provides immediate advanced text searching capability.1 Through STRIDE, we could rapidly review data on an SLE cohort that included pediatric patients with SLE cared for by clinicians in our division between October 2004 and July 2009. This “electronic cohort” was originally created for use in studying complications associated with pediatric SLE and exists under a protocol approved by our institutional review board.

Much more here (free access):

http://www.nejm.org/doi/full/10.1056/NEJMp1108726?query=TOC

This just shows how valuable physician EMRs can be in the hands of specialists to address the thorniest of questions. The clinical problem here was very tricky and there was no rule book. What there was, was a system that could provide a chance of getting the best outcome for a young girl with a problem where the text-books - even the big ones - were of no use.

The authors are to be commended for what they did!

David.

The Issue Of The Safety of Deployment and Use Health IT Is Becoming Hotter. We Need To Pay More Attention!

The following appeared a few days ago.

Tuesday, November 01, 2011

Health IT: A Boon or Bane for Patient Safety?

by Kate Ackerman, iHealthBeat Managing Editor

WASHINGTON -- Last week, health care experts warned that although health IT adoption holds much promise, there is a risk for unintended patient safety consequences.  

The experts were part of a panel discussion, titled "International Perspectives on Patient Safety and Health Information Technology," at the American Medical Informatics Association's 35th Annual Symposium on Biomedical and Health Informatics.

Rainu Kaushal -- director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College, and director of pediatric quality and safety at the Komansky Center for Children's Health at New York Presbyterian Hospital -- said there are documented patient safety benefits for certain technologies in certain settings.

For example, one study found a 20% decrease in inpatient mortality after the implementation of a computerized provider order entry system, while another study found that a stand-alone electronic prescribing system led to an 85% decrease in medication errors, Kaushal noted.

However, Kaushal said that there has been limited research on the unintended risks of health IT use and how those risks can be addressed.

Dean Sittig -- a professor of biomedical informatics at the University of Texas Health Science Center at Houston -- said he believes health IT can improve patient safety, but "we're not doing it optimally."

Sittig said that EHR-related errors can occur when:

• EHR systems are unavailable because of a power outage or other incident;
• An EHR malfunctions;
• An individual incorrectly uses an EHR system; or
• An EHR system interacts with another health IT system component incorrectly.

He said he is "a little worried" that the meaningful use incentive program could complicate patient safety issues as the country experiences rapid advances in EHR development, implementation and regulation.

Former National Coordinator for Health IT David Blumenthal said, "Safety is absolutely important," but he noted that safety is always a concern whenever a new technology or new drug is introduced.

Blumenthal, a Samuel O. Thier professor of medicine at Harvard Medical School, noted that improving patient safety and care quality is one of the five main goals of the meaningful use incentive program.

Blumenthal said, "There has been and there will continue to be controversy" over whether the meaningful use program "was the right solution." However, he said it is "way, way too soon to reach judgment" and it will "be years before we'll know with clarity if it was successful."

How To Bolster Safety of Health IT Systems

Sittig said improvements are needed in EHR design, development, implementation and evaluation, including oversight.

He compared the strategy of improving the safety of health IT systems to previous efforts by the National Transportation Safety Board to boost the safety of cars through policies related to speed limits, seat belts, airbags and anti-lock brakes.

Sittig said that new safety features and practices likely will place an additional burden on clinical users and vendors, just as putting on a seat belt takes a few extra seconds for passengers in a car. However, Sittig said he is confident that such safety practices will be well worth it in the long run.

Sittig offered three recommendations for limiting EHR-related errors that could jeopardize patient safety:

• Identification of best practices for design and development of EHR systems;
• Better monitoring and analysis of problems from the field; and
• Development of a culture of high reliability.

.....

MORE ON THE WEB

• "Safe Electronic Health Record Use Requires a Comprehensive Monitoring and Evaluation Framework" (Sittig/Classen, Journal of the American Medical Association, 2010).
• "Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions" (Menachemi et al., American Journal of Medical Quality, 2007).
• "Decrease in Hospital-Wide Mortality Rate After Implementation of a Commercially Sold Computerized Physician Order Entry System" (Longhurst et al., Pediatrics, 2010).

Lots more here:

http://www.ihealthbeat.org/features/2011/health-it-a-boon-or-bane-for-patient-safety.aspx

This issue was emphasised by this announcement a day or so ago.

IOM to release new report on health IT and patient safety

November 04, 2011 | Bernie Monegain, Editor

WASHINGTON – Citing concerns raised over the potential harm that could stem from a digital healthcare system, the Institute of Medicine, best known for its 1999 report on medical errors “To Err is Human,” is poised to release another report – this time on the risks associated with electronic health records.

IOM will make its report, “Health IT and Patient Safety: Building Safer Systems for Better Care,” public on Nov. 10 at a briefing in the nation’s capital.

The federal government is investing billions of dollars to encourage hospitals and healthcare providers to adopt health information technology so that all Americans can benefit from the use of electronic health records by 2014,” said IOM officials in a statement. “However, concerns about potential harm are emerging as providers increasingly rely on electronic medical records, secure patient portals and other information technologies to deliver care.”

“Health IT and Patient Safety: Building Safer Systems for Better Care” examines a broad range of health information technologies and recommends actions the government, healthcare providers and technology vendors should take to improve patient safety.

More here:

http://www.healthcareitnews.com/news/iom-release-new-report-health-it-and-patient-safety

A quick search on the web does not show a great deal:

I did however come across this press release:

Clinical Safety Assessment Program (CSAP) developed for NEHTA

The Clinical Safety Assessment Program (CSAP) is an initiative of the National E-Health Transition Authority (NEHTA) to help ensure the discovery and effective control of safety related risks, hazards and issues surrounding the creation and use of clinical terminologies.  Initially CSAP is to be applied to those clinical terminologies and related software created by NEHTA itself.

The CSAP developed by Software Improvements, supported by Hyder Consulting, essentially comprises two key, generic processes drawn from standards used in the safety critical systems industry and standard practices employed as part of the independent verification and validation of safety critical software/systems.

Overall, the CSAP aligns with two newly released (draft) health informatics standards – ISO/TS 29321 and ISO/TR 29322, which are largely based on the key safety critical systems standard (AS/ISO/IEC 61508) and to a lesser extent DEFSTAN 0056.

The generic CSAP processes are configurable for enabling the assessment of differing clinical system products or practices according to ascertained safety levels.   The configured processes consist of a set of steps to assess whether a clinical terminology product and/or the associated processes used to construct the product are appropriate for the ascertained safety level.  That is, to determine whether a product possesses the requisite quality and behaviour deemed necessary to consider it safe, and whether management and implementation processes support practices that help ensure delivery of a safe product.

The two key CSAP processes are based on: a), a hazard identification and analysis technique referred to as Hazard and Operations Studies (HAZOPS), and b), independent verification and validation processes.  Other essential CSAP processes include assessment planning and management, estimation, recommendations and reporting.

Software Improvements has extensive experience in the application of, and training in, these processes and standards.

The release is here:

http://www.softimp.com.au/softeng/News%20Items/news14Apr09.html

It also seems there is a Clinical Safety Unit within NEHTA. Here is a link to a conference where this unit was discussed in late 2011.

http://www.epsmabec2011.org/highlights.asp?KathyDallest

What there is not - as usual - is any documentation on just what is being done, and how it is being done in the public domain.

It can hardly be that NEHTA clinical safety processes are a State Secret. Really all this lack of openness just goes way to far!

It will be interesting to see what the Institute of Medicine has to say!

David.

Note: After I had finished this blog - this appeared this morning. The issue is real and not properly addressed in what NEHTA is doing!

e-Health authority defends work record

• by: Karen Dearne
• From: The Australian
• November 09, 2011 5:57AM

THE National e-Health Transition Authority insists that after two years in operation, the work of its clinical safety unit is "fully embedded" into all areas of software product development, despite not having produced any formal reports on IT systems and patient safety.

Patient safety is emerging as a key risk as the adoption of clinical information systems accelerates.

While technology is generally seen as the best way to reduce adverse outcomes, it is increasingly clear that IT also introduces new risks.

NSW Health is currently reviewing the use of Cerner’s FirstNet software in hospital emergency departments after concerns were escalated by Sydney University e-health expert Jon Patrick this year.

Professor Patrick found the software “increased risks to patient safety” due to data being lost during transfers between administration and clinical systems, “antiquated” messaging standards that did not alert users to non-received mail and a "practically unusable" electronic discharge system.

Other problems involved mislabelling of patient samples on the pathology orders system, and the deletion of forward orders for services like x-rays after three weeks when appointments were booked up to three months in advance.

Clinical safety work is intended to identify and mitigate situations that put patients at risk of e-health harm, and is generally conducted in parallel with the technical design and testing of new systems.

Key concerns also include the risk of patient misidentification, incorrect medical records or clinical reference data, and unavailability of health IT services.

Sources in the health systems development community say they have been seeking information on the CSU's work for over a year, but have been unsuccessful so far.

In particular, they want access to a patient safety risk assessment apparently conducted by Nehta a year ago, as well as other findings and recommendations that may involve remediation by software vendors as they prepare to support the $500 million national personally controlled e-health record system.

A Nehta spokesman said its clinical safety unit (CSU) has undertaken work as part of the organisation’s overarching responsibility for the nation’s e-health rollout.

"It is a legitimate expectation of software vendors that products developed by Nehta are safe and have clinical utility," he told The Australian.

Vastly more here:

http://www.theaustralian.com.au/australian-it/government/e-health-authority-defends-work-record/story-fn4htb9o-1226189577819

D.

In extremely late breaking news. The IOM Report mentioned above is now online here:

http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx

and the MSIA has just released a white paper expressing a range of concerns with the safety of the Health Identifier Service. It is all happening!

D.

The Spin Just Oozes Out Of This Clap Trap. The Claims Are Really Not Mostly Supported By Fact!

The NEHTA Annual Report has been released for 2010-11.

On Page 5 (CEO’s Report) we read the following summary of all the goodness that has flowed from the work of over 250 staff.

“This year we have seen significant progress.

We can now correctly identify individuals and organisations in the health system and make sure the right information is attached to their health records:

Since July 2010, more than 23 million Australians have been allocated healthcare identifiers and by 30 June 2011 more than 1 million identifiers had been downloaded to support more accurate patient administration.

We can now conformance test new types of medical software systems that use Healthcare Identifiers:

In June, the National Association of Testing Authorities accredited the first two laboratories to test conformance of secure messaging services and software systems that will access the Healthcare Identifiers Service.

We now have a standard clinical language for Australian health professionals and it’s being put into action:

SNOMED-CT clinical terminology has been adapted for local conditions and is being progressively implemented. Australian Medicines Terminology is now in use in several clinical environments.

We can enable secure communications between health professionals:

NEHTA’s conformance test specification and automated open source test tools help software developers implement secure message delivery.

We are working towards national standards for electronic prescriptions:

Standards Australia have commenced consideration of Electronic Transfer of Prescriptions version 1.1 national specifications.

We can ensure the right communication gets to the right person:

The National Authentication Service for Health will support strong access control and audit trail mechanisms for the personally controlled electronic health record. This year we began working with IBM on design and build.

We are supporting greater continuity of care:

Our specifications for the eDischarge Summary developed in consultation with industry will enable GPs to receive timely information about their patients leaving hospital.

We are moving towards standardised eReferrals:

We released specifications that help standardise this very common healthcare communication by defining clinical content, business requirements and technical solution.

We are implementing eHealth on the ground:

Through our work with lead eHealth sites and jurisdictions around Australia, we are seeing eHealth foundations in action.”

It is really astonishing just how much distortion is here This is really just a huge wish list by an large.

NASH is nowhere near being used, NEHTA confuses working on or having a specification with delivering a working solution (there is a BIG difference), imagines SNOMED and the AMT are actually being used much and has no secure messaging as it lacks both NASH and any live end-point location service as far as I am aware.

Most of the ‘success’ listed here they have been saying has been a success for years but nothing has really changed on the ground.

A good example of exaggeration is found on page 16. The National Product Catalogue now apparently covers 359 companies. I leave it as a task for the reader to consider just how many companies actually supply the public health sector (Hint: 1000’s).

On page 20 we read:

Measuring the benefits of eHealth

“NEHTA’s Benefits Realisation framework was further enhanced this year to assess the impact of all NEHTA products, to ensure the benefits are fully understood and measurable and we can formally assess their capability.

During the year, NEHTA developed a Benefits Realisation Framework in partnership with IBM and the first wave of lead eHealth sites. The information on benefits achieved was fed into the second wave of lead eHealth sites and helped identify expected high level benefits.

In addition, NEHTA commissioned a best practice analysis comparing 12 shared electronic health record sites in Australia and contrasting these findings with other current large scale international programmes.

These findings informed the lead eHealth sites implementation plans and the Personally Controlled Electronic Health Records programme.”

One question - so where are the reports we can all read and see what has actually been achieved. State Secrets I guess!

The last thing that caught my eye was this (Page 20):

“Bringing NEHTA values to life

The NEHTA values were developed in consultation with staff across the organisation and during 2010-11 were further embedded in daily work through our performance and development review process. They are:

NEHTA people are ACCOUNTABLE

Clarify to confirm, confirm to commit, commit to deliver

NEHTA people are NURTURING

Learn to communicate, communicate to educate, educate to deliver

NEHTA people have INTEGRITY

In everything we do and deliver we demonstrate credibility and substance

NEHTA people COLLABORATE

Consult, listen, agree to take action and deliver”

I guess these values are so fully implemented that we have a staff turnover rate of 30% and reports of investigations into bullying.

Go here to read all about it in full.

http://www.nehta.gov.au/component/docman/doc_download/1393-nehta-annual-report-2010-2011

One tiny last point. It is interesting that for most of the reporting period the (former) NSW Health Director General only turned up for 2 out of 6 possible Board Meetings!

Bottom line for close to one Billion Dollars we are still actually to see a life saved because of all this as far as I know. Let me know when you spot the investment in NEHTA actually making a difference to patient outcomes in Australia - which is the purpose after all - isn’t it?

David.

p.s. I will leave it to clever financial heads to assess the financial statements but I would wonder why NEHTA’s cash holdings have doubled to $44+million (and operating surplus was almost $33 million) when mostly the public sector is expected, within prudent limits, to spend what it receives (and yes I know there are some contracts where all the bills are not in!). I also note (Page 54) that despite all the cash there is a claimed Operating Deficit. Presumably that will be made up by next year’s income when the bills actually need to be paid!

D.

Weekly Australian Health IT Links – 7st November, 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

A remarkably quiet week on the PCEHR front but a great deal of activity happening under the surface.

I will probably be proved wrong but I have the sense that we are about to see is another resetting of expectations as to what will be delivered via the PCEHR by June 30, 2012.

Everyone I hear from is telling me that the levels of anxiety within both DoHA and NEHTA about delivery are rising rapidly - exacerbated by the realisation that doing the PCEHR is a lot more complex than was been realised when it was conceived.

I think we can expect to see a dramatic resetting of expectations being initiated early in the new year, as June 30, 2012 gets closer and recognition of just what it will take for delivery of something credible dawns.

If there has been a theme for the week it has been an emerging sense that a range of older e-health initiatives (PIP Payments, Product Catalogues, Identity Management etc.) are also really not delivering to expectations. This rather seems to increase the execution risk for the PCEHR Program, as well as to other less advanced plans.

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http://www.theaustralian.com.au/australian-it/australian-privacy-foundation-slams-e-health-liability-law/story-e6frgakx-1226181887495

Australian Privacy Foundation slams e-health liability law

• by: Karen Dearne
• From: The Australian
• November 01, 2011 12:00AM

THE Australian Privacy Foundation has said it is unacceptable for governments to absolve themselves and their agents from liability for data breaches involving citizens' sensitive personal and medical information.

Draft laws to underpin the operation of the Gillard government's $500 million personally controlled e-health record system also provide another loophole allowing authorities to decide a data breach was "not deliberate".

"Under this legislation, no government and no employee can be sued or prosecuted for any harm or damage arising from a breach," APF Health chairwoman Juanita Fernando said.

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http://www.computerworld.com.au/article/406241/aarnet_kinect_elderly_over_nbn

AARNet to Kinect the elderly over the NBN

The network provider has joined a collaborative project driven by the IBES which aims to keep the elderly active in their homes

• Chloe Herrick (Computerworld)
• 03 November, 2011 11:25

The Australian Academic Research Network (AARNet) has jumped onboard a collaborative broadband project to develop enabling technology for the elderly to exercise at home over the National Broadband Network (NBN).

AARNet chief executive, Chris Hancock, told Computerworld Australia that the 18-month project, driven by the Institute for a Broadband Enabled Society (IBES), will aim to teach the elderly how to use ICT for health outcomes, whether they are in a wheelchair or are able to stand, and will allow them to exercise different muscles in the body.

“We also believe it’ll help reduce their social isolation and improve their frailty and social inclusion and get them exercising and just generally building up their support and confidence,” Hancock said

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http://www.theaustralian.com.au/australian-it/government/doctors-paid-845m-for-e-health-secure-messaging/story-fn4htb9o-1226185310643

Doctors paid $84.5m for e-health secure messaging

• by: Karen Dearne
• From: The Australian
• November 04, 2011 7:16AM

THE federal government paid doctors $84.5 million in the financial year ended June 30 for using three secure messaging specifications that are still stuck in the National e-Health Transition Authority’s standards traffic jam and is likely to pay out a similar amount this financial year.

The standards setting process has been thrown into chaos this year, after the Health department cut funding for work being done by Standards Australia’s IT-014 committees in June.

The e-health experts were involved in a large work program on technical specifications needed for the Gillard government’s $500m personally controlled e-health record (PCEHR) system.

Then last month NeHTA announced a plan to ram through specifications by forming “tiger teams” to fast-track completion of essential work by the end of November.

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http://www.theaustralian.com.au/australian-it/senate-call-for-delicate-medicare-merger/story-e6frgakx-1226181926260

Senate call for delicate Medicare merger

• by: Karen Dearne
• From: The Australian
• November 01, 2011 12:00AM

A SENATE committee is calling for changes to permit the merger of Medicare claims and pharmaceutical benefits information after the federal government's financial oversight agency was found to have illegally merged data.

The Professional Services Review has been ordered to make changes to its computer systems and work practices after the Privacy Commissioner, Tim Pilgrim, found the agency in breach of the Privacy Act in relation to its handling of patient information.

In September, Mr Pilgrim told The Australian: "PBS and MBS claims information were being stored in the same database, and this was in contravention of PSR's obligations under the privacy guidelines for Medicare benefits and pharmaceutical benefits programs."

Similar concerns may apply to the personally controlled e-health record program, where it is intended to include patients' MBS and PBS data along with shared health summaries and other medical information.

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http://www.dailytelegraph.com.au/new-health-hotline-a-band-aid-solution/story-fn6b3v4f-1226180471230

New health hotline a Band-Aid solution

• Rosie Squires
• The Sunday Telegraph
• October 30, 2011 12:00AM

A HEALTH hotline designed to keep non-urgent cases out of emergency wards has been slammed as a waste of money. Figures show 74 per cent of callers to the $126 million service are advised to go to hospital or see a doctor.

The after-hours GP hotline was opened in July by Federal Health Minister Nicola Roxon in a bid to take pressure off busy emergency rooms.

But of the 50,000 calls to the helpline, about 37,200 patients were told to urgently seek medical assistance.

The figures come as the Australian Medical Association questioned the service, arguing the best medical consultation is face-to-face.

"The hotline has been established to try and combat the rise in emergency admissions by patients who are not in need of urgent medical attention," AMA NSW director Brian Owler said. "But I don't think (it) is really going to be the solution.

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http://www.theage.com.au/national/patients-fail-to-follow-scripts-20111031-1msbi.html

Patients fail to follow scripts

Mark Metherell

November 1, 2011

ABOUT half of Australian patients fail to take their medicine as prescribed, exposing themselves to increased risk of serious illness and even death.

The refusal of many patients to follow the script has generated a rising number of patient support programs of the kind that triggered the controversy over drug company payments to pharmacies to enrol patients in such schemes.

Drug companies have moved into the vacuum, financing dozens of schemes to coax patients to keep to the script, helped in some cases by fees of up to $25 for pharmacists to enrol patients in the patient support programs.

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http://www.scoop.co.nz/stories/GE1111/S00026/orion-healths-ehealth-gives-global-leadership-opportunity.htm

Orion Health's eHealth gives global leadership opportunity

Thursday, 3 November 2011, 2:20 pm
Press Release: Orion Health

Orion Health's eHealth focus providing plenty of opportunity for continued global leadership

Auckland, 3 November 2011 - Orion Health's continuing success is putting it at the top of its game, with CEO Ian McCrae, describing Orion Health as a "global eHealth company" and the leading healthcare IT software vendor in health information exchange.

Orion Health delivers world-class software products for health information exchange, data integration, and clinical care that improve the efficiency and effectiveness of healthcare systems for both patients and healthcare professionals.

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http://www.nzdoctor.co.nz/un-doctored/2011/november-2011/04/important-changes-to-accessing-to-personal-medical-records.aspx

Important changes to accessing to personal medical records

West Coast DHBFriday 04 November 2011, 9:48AM

Media release from West Coast DHB

A new way of managing personal medical records is being introduced on the West Coast, and residents are encouraged to actively 'opt-in' to the system.

The Share for Care system is being introduced this month by Healthy West Coast. It is a way to safely share a summary of a person's General Practice based electronic health information with other health care providers on the West Coast.

Share for Care allows health workers approved access to necessary information. This will improve the care people receive across the health care system, for example at the pharmacy or at the hospital's Emergency Department.

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http://www.theaustralian.com.au/australian-it/it-storage-upgrade-downs-health-network/story-e6frgakx-1226181941105

IT storage upgrade downs Health network

• by: Fran Foo
• From: The Australian
• November 01, 2011 12:00AM

AN IT storage upgrade went so disastrously wrong at the Department of Health and Ageing that a one-minute computer task took up to 300 minutes to process.

Some department staff had to wait between three and five hours for simple actions, such as saving a document, to execute on a server.

This situation lasted for about 48 hours.

Health officials, including department secretary Jane Halton, were livid when the meltdown occurred after a storage software upgrade last weekend went awry.

The changes were made by Health's main IT outsourcing partner, IBM Australia.

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http://www.computerworld.com.au/article/406181/toyota_expects_offer_health_care_robots_2013

Toyota expects to offer health care robots in 2013

Robotic exoskeleton designed to help paralyzed patients walk again

• Sharon Gaudin (Computerworld (US))
• 03 November, 2011 06:23

Toyota Motor Corp. is bringing high tech to health care, as it works on a family of robots geared to lift patients and help the paralyzed walk.

The Independent Walk Assist is mounted onto the patient's paralyzed leg, and helps the knee to bend to facilitate natural walking. (Photo courtesy of Toyota)

The company announced this week that it expects to begin selling the health aid robots in 2013.

"[Toyota] endeavors to provide the freedom of mobility to all people, and understands from its tie-ups with the Toyota Memorial Hospital and other medical facilities that there is a strong need for robots in the field of nursing and healthcare," the company said. "We aim to support independent living for people incapacitated through sickness or injury, while also assisting in their return to health and reducing the physical burden on caregivers."

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http://www.theaustralian.com.au/australian-it/government/passenger-data-not-audited-for-privacy/story-fn4htb9o-1226185277229

Passenger data not audited for privacy

• by: Karen Dearne
• From: The Australian
• November 04, 2011 5:50AM

PRIVACY audits of Customs’ use of Passenger Name Record data supplied by airlines for advance screening purposes did not take place last year, despite being required under a renewed agreement with the European Union.

Just last week, Foreign Minister Kevin Rudd revealed that the Gillard government had quietly signed a revised Passenger Name Record (PNR) agreement with the EU in September.

Under strict EU rules on protection of personal data, PNRs can only be used for the prevention, detection, investigation and prosecution of terrorist offences or serious transnational crime.

Customs is required to demonstrate that adequate privacy protections are in place through audits that measure compliance with Australia’s Privacy Act.
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http://www.itnews.com.au/News/278901,aarnet-eyes-e-health-nbn-projects.aspx

AARNet eyes e-health NBN projects

By James Hutchinson on Nov 4, 2011 11:59 AM

Provides isolated broadband connections for research.

AARNet has unveiled plans to connect hundreds of homes for the first time over the National Broadband Network as part of several research trials it has lined up across the country.

The connections will mark the first time the research internet service provider has directly served broadband to residents that are not staff or students of a university.

Its private network has typically been used to connect universities, research institutions and more recently TAFE colleges and some high schools with high-speed broadband.

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http://www.theage.com.au/national/health-group-lures-private-patients-from-public-system-20111104-1n04h.html

Health group lures private patients from public system

Mark Metherell

November 5, 2011

AUSTRALIA'S second biggest private hospital group will reveal how it performs on sensitive measures including patient infection and repeat surgery rates, in an unprecedented tactic to lure private patients away from the public system.

Healthscope, which runs 44 hospitals including 17 in Victoria, says its rates of golden staph infections, patient falls and repeat surgery are well below the public rate.

On Monday, it will launch a website detailing individual hospital performance in other areas, including the diarrhoea-causing clostridium difficile infection, unplanned readmissions and orthopaedic fracture rehabilitation.

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http://www.computerworld.com.au/article/406392/cloud_adoption_takes_precedence_over_security_ernst_young

Cloud adoption takes precedence over security: Ernst & Young

Some 69 per cent of Australian companies have adopted Cloud but information security low on the priority list, finds survey

• Hamish Barwick (Computerworld)
• 04 November, 2011 11:24

Some Australian companies consider Cloud adoption more important than an updated information security strategy according to research conducted by consultancy firm, Ernst & Young.

In its latest Global Information Security Survey which surveyed 1,700 companies including 165 in Australia, 76 per cent of respondents said there was an increasing level of risk due to external threats.

However, only 42 per cent of the firms surveyed had updated their information security strategy in the past year.

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http://news.brisbanetimes.com.au/breaking-news-national/report-card-gives-public-hospitals-an-f-20111103-1mwp5.html

Report card gives public hospitals an F

Laura Harding

November 3, 2011 - 11:14AM

AAP

Australian public hospitals are failing to meet government targets for access to emergency department care and elective surgery despite extra funding, a new report says.

The Australian Medical Association's latest Public Hospital Report Card has found hospital performance in every state and territory is below Council of Australian Governments targets on both measures.

Public hospitals are struggling to meet demand and do not have the capacity to deal with the challenges of an ageing population.

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http://www.theage.com.au/national/androids-and-angels-20111105-1n13r.html

Androids and angels

Nick Miller

November 6, 2011

Futurist and inventor Ray Kurzweil believes humans will soon be able to live forever with the help of computers. Barmy or brilliant?

IT USED to be that you would go into a dark tent where an old woman would gaze into a ball and tell you about the dark handsome stranger in your future.

In the 21st century, it seems, the tent is a rather eccentrically decorated office in the suburbs of Boston; the old woman, a professorial chap in a suit; and the handsome stranger, a network of hyper-intelligent computers that will take over the world.

Seriously.

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Enjoy!

David.

AusHealthIT Poll Number 95 – Results – 7th November, 2011.

The question was:

How Confident Are You That NEHTA's National Authentication System For Health (NASH) Will Be FULLY Implemented in the Next 2 Years?

100%

- 2 (4%)

75%

- 1 (2%)

50%

- 6 (13%)

25%

- 11 (23%)

0%

-  26 (56%)

Votes: 46

Again, a very, very  clear  vote. 79% give it a 25% chance or less with 50%+ giving it zero chance!

Again, many thanks to those that voted!

David.

There May Very Well Be Something Important In This. Responding To Unreasonable Political Demands Is NOT the Way To Do Health IT Standards!

Grahame Grieve published an interesting blog a couple of days ago.

Essentially Grahame is pointing out that it may be that large scale national Health IT projects may cause some considerable stress on the National Standards setting frameworks for a range of reasons

National Projects and Standards

Posted on November 1, 2011 by Grahame Grieve

It’s something you can see all around the world: governments sponsoring large national healthcare projects of one form or another (EHRs, prescription systems, HIEs, etc), and the bodies running these projects getting very involved with international healthcare standards bodies (HL7, IHTSDO, IHE, etc) (yes, I know IHE isn’t a standards body. but everyone knows what I mean). I’m referring to ONC, Infoway, Connecting for Health, NEHTA, etc (btw, declaration: I’ve worked for nearly all of these – or still do – in their standards programs).

There’s a difference between the goals of the national project, and the value proposition of using standards, and this difference can create considerable tension.

Projects

These national programs are generally constituted by elected politicians who commit large sums of money to big goals that are difficult to achieve, and quite risky politically. In fact, these projects only happen because there’s such a huge pressure on the national programs in terms of getting more for less, and these projects appear to offer the prospect of delivering that – and they *will*, if they succeed. But these projects are difficult at every level – hard to make change, technically demanding, and at the limit of our knowledge of informatics, and how to deliver computing support in really well integrated ways to a wetware (very wet) dominated process.

So there’s real risks, and because of election cycles, short time lines run by risk averse sponsors. These projects have to succeed, and have to stick to their timelines. (Which does make me wonder, where do they make these timelines up from?)

Standards

The Standards process, on the other hand, doesn’t work like that. It’s a slow, consensus based process which emphasizes getting agreement to a common position, and voluntary participation from the community with gradual buy in. That’s its greatest strength. It’s not going to run out and transform a community prospectively. But gradually, incrementally, and surely, the presence of the standards transforms the community and empowers it. However you can’t rush the process – putting a timeline on it, or throwing money at the volunteers – that is a high risk option.

The full blog can be read here:

www.healthintersections.com.au/?p=679

Clearly what Grahame is pointing out is that the slow, considered, consensus driven processes that have been the norm in Australian Health IT IT-14 Standards Committee are now seen as being politically and practically utterly inconvenient and in desperate need of being essentially bypassed (in the nicest possible way) by NEHTA and DoHA ramming through what they want into untested implementation and hoping later to get a ‘rubber stamp’ tick from IT-14 for what they have done.

Politics is driving a helter skelter rush to specifications which may, or may not, be workable or safe. As far as I am concerned this is not a good plan at all!

While on the area it does need to be said that as far as I can determine, despite the 31 October, 2011 deadline there do not seem to have been many NEHTA / DoHA Specifications (intended to be used by the Wave Sites and later to become standards) published. Have things already started to slip, or have I missed the documents and their hoped for insights.

Additionally there are all sorts of subterranean ructions going on within the NEHTA Certification and Conformance Program (CCA) which is meant to be part of the mechanism to have the Wave sites interoperate.

You can read about CCA here:

http://www.nehta.gov.au/connecting-australia/cca

Right now it does seem to be in a little disarray!

While one can never be sure as to how things will play out overall, I would suggest that until real clarity on just what the plans for the PCEHR actually are, and how in detail it will actually work - and we have yet to see much in the way of actual public implementation plans from the Wave Sites - private software providers would be well advised to preserve whatever financial resources they have left. This is probably not a time to be investing in things that may turn out to be a mirage - like specifications that may never actually become Standards!

I plan to talk a little about clinical safety and Health IT a little later and this is another area where any progress is for some reason not being discussed all that openly. I wonder why that might be?

Frankly it really should not be this hard!

David.