Decision Support That Seems To Really Make A Difference. Australia Should Subscribe!

The following appeared just a few days ago.

November 16, 2011, 4:14 PM ET

A Little Electronic Help for Doctors Helps Hospitals, Study Shows

Hospitals that use a computerized medical-information tool to help doctors make decisions at the point of care have better patient outcomes than those who don’t, according to a new study in the Journal of Hospital Medicine.

Researchers at Harvard University examined data for Medicare beneficiaries at 1,017 hospitals between 2004 and 2006 as the hospitals adopted a clinical-information system called, UptoDate. They compared that with data from 2,305 hospitals that don’t use the system and found that use of the system was an independent predictor of reduced mortality, shorter hospital length of stay, and better performance on widely used hospital quality metrics.

The study was funded by UpToDate, but the researchers say it had no role in the study design or results.

Lead author Thomas Isaac, a physician at Beth Israel Deaconess Medical Center in Boston and instructor at Harvard Medical School, says that the researchers weren’t sure they’d find any association between the information system and the three quality measures. But hospitals saved approximately 372,500 hospital days per year and 11,500 lives over the three-year period, the study found. The hospitals using the system had better quality performance for care provided to heart-attack, heart-failure and pneumonia patients.

More here:

http://blogs.wsj.com/health/2011/11/16/a-little-electronic-help-for-doctors-helps-hospitals-study-shows/

Here is the abstract:

Use of UpToDate and outcomes in US hospitals

1. Thomas Isaac MD, MBA, MPH¹,
2. Jie Zheng PhD²,
3. Ashish Jha MD, MPH^2,3,4,*,§

Abstract

BACKGROUND:

Computerized clinical knowledge management systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known.

OBJECTIVE:

To examine the impact of UpToDate on outcomes of care.

DESIGN:

Retrospective study.

SETTING:

National sample of US inpatient hospitals.

PATIENTS:

Fee-for-service Medicare beneficiaries.

INTERVENTION:

Adoption of UpToDate in US hospitals.

MEASUREMENT:

Risk-adjusted lengths of stay, mortality rates, and quality performance.

RESULTS:

We found that patients admitted to hospitals using UpToDate had shorter lengths of stay than patients admitted to non-UpToDate hospitals overall (5.6 days vs 5.7 days; P < 0.001) and among 6 prespecified conditions (range, −0.1 to −0.3 days; P < 0.001 for each). Further, patients admitted to UpToDate hospitals had lower risk-adjusted mortality rate for 3 of the 6 conditions (range, −0.1% to −0.6% mortality reduction; P < 0.05). Finally, hospitals with UpToDate had better quality performance for every condition on the Hospital Quality Alliance metrics. In subgroup analyses, we found that it was the smaller hospitals and the non-teaching hospitals where the benefits of the UpToDate seemed most pronounced, compared to the larger, teaching institutions where the benefits of UpToDate seemed small or nonexistent.

CONCLUSIONS:

We found a very small but consistent association between use of UpToDate and reduced length of stay, lower risk-adjusted mortality rates, and better quality performance, at least in the smaller, non-teaching institutions. These findings may suggest that computerized tools such as UpToDate could be helpful in improving care. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

The abstract with access options for full text is here:

http://onlinelibrary.wiley.com/doi/10.1002/jhm.944/abstract

You can get an idea of what UpToDate does from the 2 minute demo.

http://www.uptodate.com/online/help/demo/web/conducting-a-search

Individual subscriptions are only about $500 per annum. It does not take more than one or two improved decisions a day to make this service worth its weight in gold!

The real world study that shows it really works in the real world makes it something the Government should be getting a national license for!

David.

Here Is A Good Exposition Of How PHRs Can Be Made Relevant. The PCEHR Misses Most Of What Is Needed.

This very useful review appeared a few days ago.

How Providers Can Make PHRs Relevant

Greg Freeman for HealthLeaders Media , November 30, 2011

This article appears in the November 2011 issue of HealthLeaders magazine.

Personal health records have been a forward-thinking idea for some time now, but the rewards and requirements of achieving meaningful use are putting more pressure on providers to adopt a system that allows easy access for the patient but a reliable conduit of information from the health provider. Of the many models available, how does a provider know which way to go?

The key may be creating a PHR that is actually used by the patient and provider, not just offering a system that sounds good on paper but might not be what either party wants. In the past, healthcare providers have found that some PHRs aren’t user-friendly for the patient; the data is often incomplete or inaccurate, and many doctors don’t trust the accuracy of records created and maintained by patients. The result is that the PHR isn’t utilized to any significant extent.

One of the first decisions when considering a PHR is whether to have it tethered to the electronic medical record so that data can be linked automatically, or to have the PHR be a standalone system in which information must be entered. The tethered (or shared) option is winning favor among many providers, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at the University of Pittsburgh Medical Center. UPMC uses a PHR system called HealthTrak, a Web-based portal that allows patients at its 20 hospitals and 400 outpatient sites to feed data into the electronic record. More than 70,000 patients currently use the system.

UPMC explored both options originally, developing its tethered HealthTrak system but also partnering with Google and its untethered PHR called Google Health. Even before the recent demise of Google Health, UPMC was seeing better results with the tethered option, which saw higher participation and more positive feedback.

“Our research shows that patients like having a direct connection to their physician. A shared connection is what consumers really want,” Martich says. “They want to communicate directly with them, get their lab results in a timely fashion, and see their appointments. They like seeing what their doctor sees.”

UPMC’s HealthTrak system was developed in-house six years ago through a grant from the Department of Defense, because the health system treats many military patients. UPMC uses Epic’s EMR system, and the UPMC HealthTrak PHR was built on the framework of Epic’s MyChart PHR. When Epic developed its MyChart patient portal, the health system linked its PHR to MyChart and the EMR. The PHR allows patients to see their lab results, vital signs, appointments, and most other data in real time, as soon as it is available to the physician, with the exception of MRI, CT, and radiology results. In addition, patients can correspond directly with the doctor, who is expected to reply within one business day.

Another question involves who is going to pay for this access. There are fee-based models for PHRs, in which the patient pays for the right to access the system, but Martich says UPMC patients were not interested in paying—even though they are enthusiastic about the PHR when it is free to them. UPMC does charge $40 for e-visits, in which an established patient with a new condition fills out an online form for 21 possible diagnoses and submits it to the physician for evaluation.

Epic charges UPMC for each patient using the PHR linked to its EMR, but the health system does not pass that expense on to the user. The charge is approximately $2 per year per patient, Martich says. 

Once your PHR is in place, how do you engage both patients and physicians in using it? More than 1,100 physicians at UPMC use the Epic EMR, and they are encouraged to have their patients sign up for the PHR. The health system fosters participation by both patients and physicians by holding tutorials during staff meetings and having contests with a prize—such as a catered lunch for the staff—for the physician office that signs up the most participants.

The corporate communications department also helps market to patients by providing leaflets and screen savers for computers in the exam rooms that encourage patients to ask their doctors about HealthTrak. Sign-ups average about 700 per week, up from 500 last year, Martich says.

Patients with the most diagnoses—the sickest—are the most likely to use a PHR, says Holly Miller, MD, MBA, FHIMSS, chief medical officer with MedAllies, a company in Fishkill, NY, that provides PHR and other technical support for healthcare providers. She also is on the board of directors of HIMSS and is former CMIO for Cleveland-based University Hospitals and Health Systems.

Lots more here:

http://www.healthleadersmedia.com/content/TEC-272637/How-Providers-Can-Make-PHRs-Relevant

The point that struck me as most interesting was that there was useful evidence suggesting that the use of a ‘tethered’ approach was more popular than a standalone solution when offered head to head.

I believe this is because this approach provides better access to an individual’s key clinician and allows much better interaction between provider and consumer.

It is also interesting that consumers even seem to be prepared to pay a small amount to have access to a tethered PHR.

As I have said before the PCEHR needs a basic re-design to deliver this functionality and it needs to happen soon - before more waste on an essentially in-appropriate system.

It seems odd NEHTA and DoHA are unable to consider new evidence when it becomes available.

Who was the famous economist who said “I am prepared to change my mind when the facts change - what do you do?”.

David.

The Discussions Around Patient Access To EHR Information Are Becoming More Common. We Really Need A Sensible Approach To This.

Discussions around this topic seem to have become much more frequent lately.

First we have this one:

Why Can't Patients See Their EHR Data?

Journal of the American Medical Informatics Association outlines arguments for and against expanding patient access to their health data.

By Ken Terry,  InformationWeek

November 29, 2011

Should healthcare providers give patients access to their electronic health records and if so, how do they make that happen? A new review in the Journal of the American Medical Informatics Association (JAMIA) examines the complexities of giving patient access to their records online.

Written by researchers at the University of Toronto but focused largely on the U.S. environment, the study notes that while EHR data is not typically being shared with patients, many consumers want access. And research suggests that data sharing with patients, coupled with communication and education, can help improve efficiency, quality of care, and patient satisfaction while also lowering costs.

On the other hand, the researchers point out, there are many barriers to making that goal a reality. Among them are:

-- The cost of integrating patient access features into existing EHRs that were not designed for it.

-- The fragmentation of data into many health information silos maintained by different organizations.

-- Lack of understanding of the privacy implications of online data sharing.

-- Liability concerns that may arise from the sharing of data among patients and multiple providers.

-- Disagreements over whether patients or providers control the data.

-- Disagreements over how timely patient access to data should be.

-- Lack of a consensus regarding which portions of an EHR should be available to patients.

-- Questions about whether physicians should be able to screen certain information, such as lab results, before patients can see it.

-- The inability of patients who lack medical training to understand much of the data in an EHR.

-- The lack of time (and incentives) for physicians to translate their EHR data into laymen-friendly terms.

Under the federal Health Insurance Portability and Accountability Act (HIPAA), every person "has a right of access to inspect and obtain a copy of protected health information." Although that data is supposed to remain electronic if it originated in an EHR, in practice it is usually printed out for patients when it is provided at all, according to Robert Steinbrook, writing in the New England Journal of Medicine.

The full article is here:

URL: http://www.informationweek.com/news/healthcare/patient/232200373

Here is the abstract of the JAMIA paper:

http://jamia.bmj.com/content/early/2011/11/25/amiajnl-2011-000261.short?g=w_jamia_ahead_tab

J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000261

The challenges in making electronic health records accessible to patients

1. Leslie Beard1,
2. Rebecca Schein2,
3. Dante Morra1,3,4,
4. Kumanan Wilson5,
5. Jennifer Keelan1,6

• Received 18 March 2011
• Accepted 19 October 2011
• Published Online First 25 November 2011

Abstract

It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians.

At the same time this appeared from the UK:

Government announces new Open Data plans

29 November 2011   Rebecca Todd

The government has pledged that everybody in England will have online access to their GP records by “the end of this parliament” in 2015.

The announcement was made as part of Chancellor George Osborne’s Autumn Statement, which painted a generally bleak picture of the UK economy, while including some measures to try and stimulate growth.

Among these are a Plan for Growth that includes a number of Open Data measures aimed at stimulating industry and jobs. These were developed in collaboration with a number of companies including GlaxoSmithKline.

A document outlining the measures says providing access to personal GP records online will empower patients and encourage the market for education in data management and learning platforms.

“GP practices that can already provide online access are encouraged to do so,” it says. Successive governments have promised patients electronic access to their records.

Giving patients ‘control’ of their records was a central plank of the ‘Information Revolution’ consultation that the government ran last year, that was supposed to lead to a new information strategy for the NHS.

More here:

http://www.ehi.co.uk/news/acute-care/7358/government-announces-new-open-data-plans

and in parallel we had discussions regarding image sharing:

Working toward patient control of information

Joseph Conn

I had a chance to speak with Dr. David Mendelson during the Radiological Society of North America show in Chicago this week. A project he mentioned provided another data point in what I've been seeing as a trend—restoring some measure of control to patients over the sharing of their healthcare information.

Mendelson is chief of clinical informatics at Mt. Sinai Medical Center in New York and co-chairman of Integrating the Healthcare Enterprise International. Mendelson was an RSNA presenter on health information technology to a standing-room-only crowd.

His talk included an update on a pilot project that his hospital and four other provider organizations are working on under a $4.7 million contract from the National Institutes of Health' National Institute of Biomedical Imaging and Bioengineering. The idea is for radiologists to use standards-based messages to send encrypted radiological images and reports to a data clearinghouse, where they will be routed to patients' personal health records.

Lots more here:

http://www.modernhealthcare.com/article/20111201/BLOGS02/312019993/working-toward-patient-control-of-information

And to remind us all what can happen when clinical information is not followed up, goes missing or whatever else goes wrong we have this:

Both Patients And Physicians Can Suffer When Test Results Aren’t Reported

By Michelle Andrews

Nov 29, 2011

Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient.

In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.

 More here:

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/Michelle-Andrews-on-delivering-test-results.aspx

It is clear that there are good reasons why individuals should have timely access to their own private information in a secure way. It is equally clear that as we move to having more patient involvement in their care patients are going to have to accept more responsibility for following up if for example they have had a test and do not know what the result was.

Additionally we are going to have to recognise that if access is available and used then there is a need to make the information user friendly or spend time explaining what various tests might mean. This may come at a cost - and we also need to make sure that results that might wrongly worry a consumer are just provided out of the blue. We need protocols and controls to ensure any bad news is given with the right sort of support and discussion available.

I am sure this will not be the last we have on this topic.

David.

It Seems Unlikely DoHA and NEHTA Will Do Better Than Others With Security and Privacy. Their Stubbornness and Haste May Destroy The PCEHR Program.

I was alerted to this pair of articles today:

Man gets £12,500 after girlfriend probes his medical data

Nurse ex-partner's data breach cost him a job

By Amberhawk Training • Get more from this author

Posted in Law, 5th December 2011 09:31 GMT

This is a rare event indeed: a data subject has taken successful action for compensation under section 13 of the Data Protection Act. Normally what happens if a data controller has caused damage is that there is an out-of-court settlement with a gagging (sorry "confidentiality") clause so no-one is the wiser.

The claimant brought an action following an unauthorised disclosure of his personal medical data from the Plymouth Hospital NHS Trust, in or about December 2007. The partner of the data subject had unlawfully accessed his medical records in the course of her employment as a nurse and thereby committed a breach of the Act. This and the handling of his resultant complaint caused a four-and-a-half year exacerbation of a pre-existing paranoid personality disorder and prevented him also from accepting an offer of employment.

More here:

http://www.theregister.co.uk/2011/12/05/unlawful_disclosure_of_personal_data_successful_action_for_compensation/

Second we have:

http://www.net-security.org/secworld.php?id=12048

IT pros can't resist peeking at privileged information

Posted on 05 December 2011.

IT security staff will be some of the most informed people at the office Christmas party this year. A full 26 per cent of them admit to using their privileged log in rights to look at confidential information they should not have had access to in the first place.

Lieberman Software’s recent password survey found that IT professionals just cannot resist peeking at information that is supposedly barred to them. It has proved just too tempting, and maybe just human nature, for them to rifle through redundancy lists, payroll information and other sensitive data including, for example, other people’s Christmas bonus details.

• 42 percent of those surveyed said that in their organisations' IT staff are sharing passwords or access to systems or applications
• 26 percent said that they were aware of an IT staff member abusing a privileged login to illicitly access sensitive information
• 48 percent of respondents work at companies that are still not changing their privileged passwords within 90 days – a violation of most major regulatory compliance mandates and one of the major reasons why hackers are still able to compromise the security of large organisations.

Philip Lieberman, President and Chief Executive Officer of Lieberman Software said: “Our survey shows that senior management at some of the largest organisations are still not taking the management of privileged access to their most sensitive information seriously.”

More here:

http://www.net-security.org/secworld.php?id=12048

Really the lessons from this are very clear. It is people, not systems, on which the proper respect for private, confidential information is based and, sadly, a good number of people simply don’t understand their responsibilities.

Absent a sudden change in human nature - which would have to be remarkably unlikely - we are going to have to rely on proper identification and authentication technologies to, at least after the event, find the serious serial offenders! It is only a real risk of being caught that will change behaviour - hence I don’t rob banks often!

As far as the PCEHR is concerned there is a central requirement to have the National Authentication System for Health (NASH) implemented and operational as much of NEHTA’s approach is fundamentally dependent on it being live and available. Without it the risk of being caught is dramatically reduced.

However, on page 1-5 of the NEHTA Blueprint - Version 2.0 (September 30, 2011) we read.

“NEHTA will deliver a Token Management System (for NASH) to manage the issuance, cancellation, modification, replacement, and operational support of the ~500,000 tokens/smartcards to be deployed between 2012 and 2017.”

So we won’t have token based identity authentication for providers  for up to 5 years after the PCEHR is meant to be implemented and never to authenticate consumers.

We see above how bad it can be without proper authentication systems - but the Government just steams ahead. I leave it as an exercise for the reader to assess their level of sanity and competence!

David.

Weekly Australian Health IT Links – 5th December, 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 week with the highlight being a review of the various submissions on the PCEHR Legislation. It was interesting to read the varying perspectives and to note there are certainly some groups who think there is more work to do on the part of Government to address a range of pretty basic concerns.

If what has happened to date is any guide I fear most of the comments and suggestions will be ignored. Going that way, of course, will lead to disaster for the overall project, as the issues raised really need careful attention.

I look forward to reader votes on the topic in the Weekly Poll.

-----

http://www.smh.com.au/it-pro/innovation/blogs/smoke--mirrors/information-systems-a-cure-for-sick-hospitals-20111125-1nyq7.html

Information systems a cure for sick hospitals?

November 28, 2011 - 9:13AM

George Wright

Recently my son broke his arm quite seriously and so I spent a few tense days in hospital with him while he had his upper arm wired back together. During my stay I was able to witness the workings of a large hospital and I couldn’t help but take an interest in their information systems and processes.

I don’t know how often an Area Health Service has its technical infrastructure reviewed nor when it was last completed but I would find it interesting to know what the findings and recommendations were.

Quite frankly what I saw was archaic, inefficient and created a stressful work environment.

Just one example that I had at a previous hospital visit was waiting for an ultrasound. There was a few ultrasound machines free and technicians available but we had to wait until a particular machine was free.

-----

http://www.theaustralian.com.au/australian-it/researchers-want-access-to-personal-e-health-records/story-e6frgakx-1226211430236

Researchers want access to personal e-health records

• by: Karen Dearne
• From: The Australian
• December 01, 2011 3:20PM

RESEARCHERS want access to information stored on personal e-health records so they can improve health outcomes.

Maximising use of the personally controlled e-health record system for research purposes “is fundamental to improving health outcomes”, Medicines Australia says.

The pharmaceutical industry body has been given some assurances over the conduct of clinical research involving voluntary patient participation in the PCEHR Bill introduced into Parliament by Health Minister Nicola Roxon last week.

The bill is intended to support the launch of the $500 million national health records system on July 1 next year, and was immediately referred to the Senate Community Affairs committee for a broad-ranging public inquiry.

-----

http://www.pcadvisor.co.uk/news/small-business/3322085/queensland-health-considers-data-warehouse-bi-pilot/

Queensland Health considers data warehouse, BI pilot

By Tim Lohman | Computerworld Australia | 30 November 11

Queensland Health is to begin piloting a new mental health data warehouse and business intelligence application as part of a wider push by the Queensland government to support mental health information management.

The project, formerly called the Integrated Mental Health Data Reporting Repository (IMHDRR), will address inefficiencies within the existing Queensland Health system that are associated with linking general health, mental health, human resources and costing data.

It will also help address the need for a business intelligence capability that's able to facilitate service planning, evaluation and the enhancement of an evidence base to support clinical practice.

-----

http://www.theaustralian.com.au/australian-it/government/e-health-records-liability-raised/story-fn4htb9o-1226211883106

E-health records liability raised

• by: Karen Dearne
• From: Australian IT
• December 02, 2011 5:36AM

MEDICAL defence groups warn that increased legal liability for doctors maintaining e-health records on behalf of patients "is a major disincentive" to participation.

Enabling legislation supporting the Gillard government’s $500 million personally controlled e-health record system is to be scrutinised during a public inquiry conducted by the Senate Community Affairs committee.

The Community Affairs committee has called for submissions from any interested parties by January 12; it is due to report by February 29.

Australia’s largest medical indemnity insurer, the Avant Mutual Group, says an “unknown number of health providers will be relying on shared health summaries” prepared by the nominated provider, usually a GP.

-----

http://www.theaustralian.com.au/australian-it/clear-e-health-compliance-laws-a-must-idc/story-e6frgakx-1226211890667

Clear e-health compliance laws a must: IDC

• by: Karen Dearne
• From: Australian IT
• December 02, 2011 6:18AM

MARKET analyst IDC warns of the need for clearer compliance laws for healthcare records, and says Australia will set the standard for the region.

Sash Mukherjee, senior analyst for IDC Health Insights Asia/Pacific, says the region has experienced dynamic growth in health IT spending in the past year, but laws relating to data security, privacy and access have not been updated to reflect the new realities.

“In fact, there are no laws specific to health records in most countries in the region,” he said.

“As Australia’s personally controlled e-health record project develops, citizens’ health records will be taken out of the traditional, controlled environments.

“As such, there is a need for clearer compliance laws.”

-----

http://www.nehta.gov.au/media-centre/nehta-news/941-add-specs

Additional specifications released

2 December 2011. Additional specifications for the eHealth records system set to launch nationally on 1 July 2012 have now been posted on the new Software Developers Resource Centre.

The new portal was launched in November by the Department of Health and Ageing and NEHTA and is an important means for communication and sharing of information with software vendors working on the personally controlled electronic health records system.

The additional specifications released include the Specialist Letter Solution, Discharge Summary Solution and Shared Health Summary Solution.

Software vendors and developers can access the resource centre via http://vendors.nehta.gov.au

The Specifications and Standards Plan, outlining the timeframes and process for the release of specifications and standards, can be accessed from www.nehta.gov.au

-----

http://www.theaustralian.com.au/australian-it/government/medibank-weighs-in-on-e-health-records-scheme/story-fn4htb9o-1226211883359

Medibank weighs in on e-health records scheme

• by: Karen Dearne
• From: Australian IT
• December 02, 2011 5:49AM

MEDIBANK has called on the Gillard government to consider the workload impact on medical providers as it rolls out the personally controlled e-health records system.

“Creating and maintaining records for patients for the PCEHR and the training required will necessitate a significant investment of time from healthcare providers and this needs to be factored in, particularly as it may have unforeseen implications in the short-term for the delivery of health services,” it says in a submission on the draft bill.

“Recognising that failure to consult sufficiently with health professionals was one of the signatory reasons for the failure of the e-health system in the UK, this mistake needs to be avoided in the Australian context.”

-----

http://www.theaustralian.com.au/australian-it/nations-states-win-bigger-e-health-role/story-e6frgakx-1226208565768

Nation's states win bigger e-health role

• by: Karen Dearne
• From: The Australian
• November 29, 2011 12:00AM

THE Gillard government agreed to give the states and territories a bigger role in managing personally controlled e-health records to gain their consent for enabling legislation for the $500 million program.

Health ministers signed off on the final legislation at a meeting of the Standing Council of Health on November 11.

Minutes show there had been "major changes and redrafting for better clarity" following consultations between governments. Each state and territory will have automatic membership of the advisory committee established to help manage the program.

-----

http://www.theaustralian.com.au/australian-it/government/pharmacy-guild-prescribes-fixes-for-pcehr-operating-arrangements/story-fn4htb9o-1226210305830

Pharmacy Guild prescribes fixes for PCEHR operating arrangements

• by: Karen Dearne
• From: Australian IT
• December 01, 2011 12:00AM

THE Pharmacy Guild will not support the rollout of personally controlled e-health records unless key concerns are finalised before the system is operational.

It warns that the guild “cannot fully support the continued development and implementation of the PCEHR until such time as it is satisfied that the operating rules are satisfactory and do not contravene patient safety, software vendor liability or pharmacy reputation”.

“The guild is greatly concerned that the appropriate governance framework is yet to be determined and that the Health Department Secretary will fulfil the role of system operator,” it says in a submission on the draft PCEHR bill.

“Governance of such an important system should not be vested in a single person who may or may not choose to follow advice from the (proposed) jurisdictional advisory committee and the independent advisory council.”

-----

http://www.medicalobserver.com.au/news/telemonitoring-trial-points-to-gp-future

Telemonitoring trial points to GP future

29th Nov 2011

Mark O’Brien

A TRIAL program delivering in-home telemonitoring technology connecting chronically ill veterans with their GPs and healthcare teams, set to begin next year, could signal the future of general practice.

The $8 million trial, announced today by Veterans’ Affairs Minister Warren Snowdon and Communications Minister Senator Stephen Conroy, will involve about 300 veterans living in areas of NSW, WA, Queensland and Tasmania connected to the National Broadband Network.

Senator Conroy said the trial would assess the benefits of telemonitoring services and aim to develop a model that could be more widely adopted.

-----

http://www.computerworld.com.au/article/408712/federal_govt_flags_e-health_trial_chronically_ill_veterans/

Federal Govt flags e-health trial for chronically ill veterans

The $8 million project will enable 300 chronically ill veterans from NBN connected areas to have their health monitored from home

• Chloe Herrick (Computerworld)
• 29 November, 2011 15:34

The Federal Government has flagged a trial of in-house telemonitoring technology for chronically ill veterans via the National Broadband Network (NBN), kicking off in July 2012.

Both the veterans’ affairs minister, Warren Snowdon, and communications minister, Senator Stephen Conroy, announced the $8 million project which will enable 300 chronically ill veterans, from NBN connected areas in Toowoomba, Coffs Harbour, Armidale, Mandurah and Geraldton to have their health monitored without leaving their home.

“Vital statistics will be monitored from home and veterans will also have access to high definition video consultations with their GP or nurse coordinator when required,” Snowden said in a statement.

-----

http://www.cio.com.au/article/408608/nehta_licenses_csiro_software_e-health_rollout/

NEHTA licenses CSIRO software for e-health rollout

The software will aid the transition to a standardised dictionary of clinical terms

• Chloe Herrick (Computerworld)
• 28 November, 2011 15:31

The National E-Health Transition Authority (NEHTA) has licensed software from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to aid the move to a standardised dictionary of clinical terms as part of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project.

The $467 million project involves the establishment of a PCEHR system that encompasses patient health summaries which both patients and their healthcare providers can access by 1 July 2012.

Australian e-Health Research Centre (AEHRC) chief executive, David Hansen, told Computerworld Australia that the Department of Health and Ageing (DoHA) and NEHTA would soon require healthcare software vendors to make the transition to SNOMED CT, a clinical terminology which encompasses a group of terms that would underpin the PCEHR going forward.

-----

http://www.theregister.co.uk/2011/11/29/csiro_snapper_nehta/

CSIRO software tapped for e-health transition

Translating records in a snap

By Richard Chirgwin

Posted in Law, 29th November 2011 00:30 GMT

CSIRO has announced that it is to supply software to Australia’s National E-Health Transition Authority (NEHTA) to support the transition to Personally Controlled Electronic Health Records.

Its Snapper software is designed to help translate old health records into the standard terminology used in e-health systems, known as SNOMET CT.

According to the CEO of the Australian E-Health Research Centre (AEHRC), Dr David Hansen, there’s still a lot of non-standard records out there. “Most existing electronic systems do not use the SNOMED CT dictionary, but a mix of existing standard and local data dictionaries,” he said. “The Snapper tool helps to translate terms in the existing system to terms from SNOMED CT.”

-----

http://www.itnews.com.au/News/281216,australias-ehealth-record-a-security-disaster.aspx

Australia's eHealth record a security 'disaster'

By Brett Winterford on Nov 28, 2011 7:00 AM

AusCERT chief warns of need for new approach.

One of Australia's most respected security professionals has warned that the Federal Government project to give citizens access to an electronic health record will lead to rampant fraud and privacy abuses.

Graham Ingram, general manager of infosec emergency response centre AusCERT told the Security on the Move conference in Sydney that the personally-controlled electronic health record project keeps him awake at night.

"E-Health worries me significantly," he told the conference, after explaining that his not-for-profit organisation is usually employed as the fire brigade to "put out the flames" after a breach incident.

-----

http://www.6minutes.com.au/news/uncertainty-hangs-over-the-agpn-conference

Gemma Collins: Uncertainty hangs over the AGPN conference

• By Gemma Collins on  21 November 2011

It was the first GP Network Forum since the divisions began their transformation into the long-awaited Medicare Locals.

So surely we could expect the four-day AGPN conference in Melbourne to give members of the divisions the chance to discuss their plans for their areas and hear from those people in high places what they can expect in the future?

But after years of discussions about the planned 62 Medicare Locals, the four day conference just proved that everyone is still awaiting the answers to their much anticipated questions.

How are these organisations going to be run? How much funding will they be receiving? Where will this funding come from? Will it be fee-for-service or fund holding? And most importantly – what is it all going to mean for after hours care?

-----

http://www.theaustralian.com.au/australian-it/government/m-to-restart-standards-australias-e-health-work-program/story-fn4htb9o-1226209198597

$1.4m to restart Standards Australia's e-health work program

• by: Karen Dearne
• From: Australian IT
• November 30, 2011 12:00AM

STANDARDS Australia has been paid $1.4 million to restart work on technology specifications needed for the $500 million personal e-health record system due to launch next year.

Voluntary members of Standards Australia's expert health IT committees were forced to halt work after the Health Department cut funds in June.

As in previous years, the department has allocated funds for the organisation's work in relation to establishing standards needed for the personally controlled e-health record (PCEHR) system.

Standards Australia received the new funding in September, and the current grant runs to the end of June next year.

-----

http://www.theaustralian.com.au/australian-it/government/victoria-slams-e-health-consultation/story-fn4htb9o-1226207637108

Victoria slams e-health consultation

• by: Karen Dearne
• From: The Australian

VICTORIA has taken a massive swipe at the Gillard government, saying the state had expected to approve legislation for the $500 million electronic patient record system before its introduction to federal parliament.

Victoria's Health Minister, David Davis, said federal Health Minister Nicola Roxon had jumped the gun, as funding for the states to adopt the system and key governance arrangements is yet to be hammered out.

Ms Roxon tabled the Personally Controlled E-Health Record Bill and a separate related regulations bill in the Lower House on Wednesday, after rushed consultations on an exposure draft issued on September 30.

-----

http://www.zdnet.com.au/cohen-brother-sues-isoft-for-over-14m-339326920.htm

Cohen brother sues iSoft for over $1.4m

By Luke Hopewell, ZDNet.com.au on November 28th, 2011

Brian Cohen, the brother of iSoft founder Gary Cohen, is suing the healthcare services company to the tune of over $1.4 million, following an alleged breach of his employment contract during his stint as the company's chief technology officer.

Court documents obtained by ZDNet Australia reveal that Brian Cohen is suing iSoft's Australian and Asian unit under provisions set out in the Fair Work Act 2009 (PDF). The suit sees Brian Cohen seeking $1,445,885.84 in unpaid remuneration, long-service leave, contract allowances and retention payments, as well as costs and interest.

-----

http://www.crn.com.au/News/281540,former-isoft-cto-claims-14m-contract-breach.aspx

Former iSoft CTO claims $1.4m contract breach

By James Hutchinson on Nov 29, 2011 9:36 AM

Unpaid annual leave, long service pay.

Former iSoft chief technology officer Brian Cohen has filed court proceedings against the e-health software vendor for an alleged breach of contract, claiming $1.45 million in unpaid annual leave, redundancy, long service and other payments.

Cohen alleged he was due $409,109 in damages for an allegedly unpaid redundancy package and a further $725,238 for failing to provide proper notice for his termination this year.

Further costs were also claimed for long service leave, underpayment and an unpaid retention payment.

In court documents filed last month, Cohen alleged iSoft breached agreed employment contracts between 2000 and 2010 while he was employed as chief technology officer at IBA Health and subsequently iSoft.

-----

http://www.newsmaker.com.au/news/13230

Electronic medication management heralds new era in patient safety and staff development at Calvary Health Care Bethlehem

Monday, November 28, 2011 - iSOFT a CSC Company  

The Little Company of Mary Health Care (LCMHC) group is in the final stages of rolling out iSOFT MedChart, an electronic medication management system, at the first of the group’s hospitals and hospices.

Sydney, NSW - Calvary Health Care Bethlehem is in the final stage of a progressive rollout of MedChart, an electronic prescribing, medication management and administration system from iSOFT, a CSC company. In addition to improving medication safety, the rollout marks a major milestone on the journey toward an electronic medical record (EMR) for the hospice.

A leader in palliative and neurological care services, Calvary Health Care Bethlehem, part of the Little Company of Mary Health Care (LCMHC) group known as Calvary, is a 70-bed hospice located in South Caulfield, Victoria.

Describing Calvary’s new electronic medication management implementation as leading the hospital into the 21st century, Mark Heenan, a senior nurse at Calvary Health Care Bethlehem, says “this is a new era in patient safety and staff development.”

-----

http://www.computerworld.com.au/article/408848/information_commissioner_calls_privacy_act_changes

Information Commissioner calls for Privacy Act changes

Telcos wary of changes to the Privacy Act despite Commissioner's call for additional ways of protecting individuals’ privacy in Australia

• Tim Lohman (Computerworld)
• 30 November, 2011 12:02

The Information Commissioner has called for the updating of the national Privacy Act, including the introduction of mandatory data breach laws, to cope with the impact of technology on the privacy of Australians.

In a submission on the government’s Issues Paper investigating changes to the Privacy Act (PDF) the Commissioner said recent developments in technology mean that additional ways of protecting individuals’ privacy should be considered in Australia.

“[The OAIC] considers recent developments in technology mean that consideration should be given to providing for additional ways of protecting individuals’ privacy in Australia,” the submission reads.

-----

Enjoy!

David.