I Wonder Who Has The Correct Story Here? Can They Both Be True?

In the NEHTA release on the Clinical Software ‘glitch’ which was made public last week we read the following.

NEHTA pauses implementation in pilot sites

24 January 2012. National E-Health Transition Authority CEO, Mr Peter Fleming has announced that following a detailed internal review and analysis, NEHTA is temporarily pausing implementation of Primary Care desktop software development around its specifications for the eHealth pilot sites.

"Our specifications are subject to rigorous assessment processes and this has highlighted some technical incompatibilities across versions. We have identified problems with the specifications and have made the decision in order to avoid any risks," Mr Fleming said.

The pilot sites were established to test and deploy software and eHealth capability in real world healthcare settings prior to the introduction of the personally controlled electronic health record system. While the pilot site and national infrastructure projects have operated in parallel, neither is a critical dependency for the other project.

More here:

http://www.nehta.gov.au/media-centre/nehta-news/947-nehta-pauses-implementation-in-pilot-sites

Separately NEHTA released the following to the eHealth Central blog.

“None of the software has ever gone live this is about quality control to ensure absolute confidence in the software being used in the eHealth pilot sites. One of the reasons for having these sites was to test software and ‘iron out the bugs’ prior to the national infrastructure go live.”

The full release is here:

http://www.ehealthcentral.com.au/wp-content/uploads/2012/01/NEHTA-statement-on-PCEHR-problem.pdf

For comparison we read in the (rather brief and oddly presented) NSW Health Submission to the Senate Enquiry.

St Vincent’s / Mater Health Sydney (Wave I)

·         Sending of Discharge Summaries from SV&MHS to participating GP practices;

·         Sending of Shared Health Summaries from participating GP practices; and

·         Sending GP electronic referrals from participating GP practices.

Progress to Date

·         SV&MHS was the first eHealth site to sign-up / register consumers to the PCEHR

·         230+ GPs have already signed up to participate (>80% of the target)

·         SV&MHS is now receiving electronic referrals to all areas of the campus from participating GP practices

·         St Vincent’s Hospital is sending electronic discharge notifications to participating GP practices

·         St Vincent’s Hospital will implement electronic discharge summaries commencing in December 2011 with completion by January 2012 – with the discharge summaries being sent electronically to participating GPs

·         St Vincent’s Private Hospital electronic discharge referrals (nurse initiated) will be implemented in December 2011 and sent electronically to participating GPs

·         Specialist letters from St Vincent’s Hospital clinics will be sent electronically to participating GPs commencing in January 2012

·         Consumer recruitment within St Vincent’s Hospital outpatient clinics will commence late January 2012

Note in items 3 and 4 of progress to date there are suggestions that sending and receiving are live.

I wonder what is actually going on? Is someone jumping the gun, over-claiming, or just a little detached from the real action. I am sure we will get an explanation soon enough!

I have to say it does look like some real progress is happening at SV&MHS- which is good to see. Pity NEHTA didn’t quite deliver their bit!

This might all seem like a trivial issue but it is actually important - for all concerned - that some clarity about what is live and what is not is provided - and of course the affected software may be not the same as is being used and SV&MHS - but with the confusing messages being sent about who is actually assessing Clinical Safety for the PCEHR program and just how good they are at addressing these issues we are entitled to explicitness which seems to be absent about just what is happening!

(Note in the Webinar of the 02/02/2012 we were told by NEHTA that the documentation on how safety was assessed is secret - you have to trust us. Sorry I don’t!)

That the clinical software community is less than happy about the shifting sands (of specification and expectation) with which they find themselves having to work will surprise nobody!

It also looks as though NSW Health Quality Control could use some work. On Page 3 we read

7. The products that NEHTA designed, made, tested, certified for use in the PCEHR;

“NSW Health will continue to work closely with all jurisdictions to ensure all national eHealth solutions are fit for purpose and will continue to integrate these solutions and standards into local initiatives.

A critical milestone was achieved in December 2012, with NSW Health achieving integration with the Healthcare Identifier (HI) Service. Medicare-generated Individual Healthcare Identifiers can now be used in our statewide Image Archive and for communication with General Practice as part of the Greater Western Sydney PCEHR lead site initiative.”

An example of forward retrospectivity it seems!

David.

There Was A Webinar On The Specification Problems With the PCEHR Today. Some Interesting Things Emerged.

The webinar ran between 8:30 and about 9:30. If things follow the usual pattern there will be audio and slides available from this link in due course.

http://www.nehta.gov.au/ehealth-implementation/pcehr-standards

I will let people listen for themselves if they want to understand all the details.

At a high level I came away with the following impressions from the reports I have heard.

1. The key issue is around 5 CDA Implementation Guides for such clinical documents as clinical letters, referrals and so on which are faulty and need to be revised and made ‘error free’.

2. There are some major issues between NEHTA and DoHA which are causing all sorts of problems and it is felt that unless things are got back on track fast there is an existential threat to the whole program.

3. Those who were building to the (old) specifications are pretty grumpy.

4. Astonishingly the CDA specifications were not tested via a ‘CDA Validation Program’ to ensure it was correct. Pretty basic stuff. The suggestion was made was that this was all due to the haste to meet various political deadlines

5. The documentation that shows what has been done to attest to the clinical safety of the specification releases is just not available. It has been developed but no one can know what is says. Struth!
6. There is a lot of unhappiness about the way the press knew what was going on with the problems before those actually involved in the program. NEHTA's media management really messed this up it would seem!

I leave it to readers to assess the chances of anything good coming from this program anytime soon!

David.

The Medical Software Industry Association (MSIA) Recommends Major Changes To NEHTA and the PCEHR Program.

The MSIA Submission to the Senate Enquiry on the PCEHR Bills was released yesterday.

It would be fair to say they are pretty “unhappy campers”

Press coverage appeared today.

MSIA doubts e-health record delivery deadline

The industry body argued the project lacks accountability, transparency and timely delivery.

• Chloe Herrick (Computerworld)
• 01 February, 2012 11:24

The Medical Software Industry Association (MSIA), whose members include Cerner, Cisco, iSoft and Microsoft, has delivered a scathing criticism of the National e-Health Transition Authority’s (NeHTA) handling of the government’s national e-health record project.

In its submission (PDF) to the Senate committee examining the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body said issues of accountability, transparency and timely delivery still needed to be addressed.

MSIA referred to NeHTA’s recent “pausing” of the implementation of primary care desktop software at a number of the PCEHR’s lead implementation sites and said the actions had taken industry by surprise.

“No one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure,” the submission reads. “A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years.

All the details are found here:

http://www.techworld.com.au/article/414031/msia_doubts_e-health_record_delivery_deadline/

The link to the full submission is found here:

https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=d55e2da1-2e4e-4908-affc-a4de67887102

The Executive Summary goes as follows:

Executive summary

The MSIA welcomes the opportunities that eHealth and the PCEHR provides for the medical software industry and Australia.

However, as with any large projects there have been a large number of challenges for all involved, but primarily a range of issues pertaining to accountability, transparency, and timely delivery.

Today, 24th January, an article in The Australian “E-health key trial halted by specifications glitch” caught many in the industry by surprise1. While a pause may be necessary, and a review of issues probably essential, no one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure. A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years. It does not make for trusting relationships, or inspire confidence in a way that allows industry to make decisions to invest in, and engage with processes in which NeHTA is involved.

This submission is to both provide information that accurately represents eHealth and PCEHR readiness and provides a range of recommendations for the Inquiry’s consideration.

The Recommendations are as follows:

Recommendations

The PCEHR BILL:

1. Add a more detailed description of the roles of all participants to aid understanding and uptake.

2. Commit to a date to publish “Rules” to allow adequate time for those who may be of risk of breach to be fully aware and compliant.

3. Increase Advisory group to include representation from research, secondary data and aged care experts. Ensure Advisory group reflects the 60% of health care delivery that is not provided by government or government agencies.

4. Make a provision that includes the taking of technical advice from the informatics community, Standards Australia and the software industry associations to ensure future changes and developments are appropriate, safe and timely.

5. Review the conflicts for the proposed System Operator in the various roles held :- as partial funder, system operator and as NEHTA Board Member

6. Review the ‘government furnished data’ liability issues, for example incorrect IHIs, incorrect PBS and MBS information, and incorrect AMT and SNOMED updates. Consider how the potential of such issues to act as disincentives, at worst, or to skew market and patient take up at best.

Healthcare Identifier and Patient Safety Issues

1. Action as an immediate priority, change requests to the HI Service that are deemed to have a potential clinical safety impact.

2. Action as an immediate priority, a government funded field study of AMT Mapping with at least 2 of the market-leading medication terminology vendors exchanging medication data.

3. All patient and clinical safety assessments and reports that have been funded either through NEHTA or other government agencies should be made publicly available immediately to provide confidence in the system. It seems unusual that the Australian Department of Health and Ageing has not required such reports of its manager of the PCEHR (NeHTA) to ensure the safety of the Australian public.

4. Review urgently all the issues in the MSIA White paper on the Healthcare Identifier Service and ensure changes are made to ensure the service can be used safely.

5. Review urgently the issues in the McCauley& Williams paper (Appendix 5). Consider a “consenting adults” model where software that acts in a parasitic way is tested with its “host” for all Conformance Compliance and Accreditation processes. Where such inherently unsafe software has been used there should be a post deployment review to ensure that patient safety and identification has not been compromised.

The PCEHR Program:

1. Reduce the scope of the 1 July 2012 release of the program (Release 1) by deferring elements that are not sufficiently mature or not sufficiently reviewed to ensure patient safety (for example, Australian Medicines Terminology, Health Terminology (SNOMED), Consolidated View, etc.).

2. Clearly define the scope of the national infrastructure partner relative to other software systems, including local PCEHRs and conformant repositories, to facilitate planning and investment by the software industry and healthcare providers.

3. Support the PCEHR program with sustainable, recurrent funding that supports the long-term viability of eHealth across the health sector (consumers, healthcare providers, healthcare provider organisations and technology providers). The National Change and Adoption and Benefits Evaluation Partners have provisionally identified national savings of several billion dollars a year from full operation of the PCEHR program; a modest percentage of these savings must be re-invested in the sector if the PCEHR program is to be successful.

Other Issues:

1. Make NEHTA accountable for its services and activities - NEHTA should be subject to federal FOI legislation (it is 100% funded by taxpayers and is for all intents and purposes a public entity).

2. The Auditor General (through ANAO) should conduct financial, information technology and efficiency audit of NEHTA as soon as possible.

----- End MSIA Text.

These recommendations deserve the most serious consideration by the Senate Committee. While I might personally have liked to see more emphasis on the leadership and governance issues which I believe are the ‘root cause’ of the present problems in Australian e-health the MSIA have clearly highlighted the absurd governance conflicts that surround the Department of Health Secretary as NEHTA Chair, PCEHR System Operator and Head of the Department of Health!

This full submission is worth a very close read!

David.

There Is A Very Important Point Contained In This Article. There Is A Need To Sort Fact From Fiction and Hope!

The following commentary appeared a little while ago.

Research data everywhere and not a drop to drink

By gshaw

Created Jan 25 2012 - 1:48pm

Physicians like numbers. Data, double-blind studies, peer-reviewed journal articles, evidence. And they clamor for scientific proof whether the issue is prescribing statins [1] to patients at risk for heart disease or whether the debate at hand is the value of e [2]lectronic health records systems [2], the pros and cons of email communication [3] between docs and patients, the benefits of e-prescribing [4], or the impact of m-health technologies on patient outcomes.

Show me any IT initiative that will affect a physician's workflow, schedule, paycheck, or liability risk and I'll show you a doctor who's calling for evidence that the rewards outweigh the risks.

And since m-health, e-health, connected health, telehealth and data-driven health (et al) are pretty much dead in the water without physician support, researchers are scrambling to deliver it.

The Journal of the American Medical Informatics Association recently published a flurry of such studies, including one that found using an automatic alert system in providers' EHR systems significantly increases the documentation of previously unknown patient problems [5]. Another found that poor EHR implementation can skew quality measures. A third found that some EHRs are lacking in adverse drug event detection [6]. And yet another said they're a good tool for identifying preventative services in order to avoid unnecessary procedures.  

But wait, there's more: On any given day you can find a new study that proves this or that about EHRs and other health IT tools. Web-based tools aren't effective for diabetes management [7]. EHRs improve hospital nursing care [8]. EHRs reduce racial disparities [9]. It goes on and on.

You see the problem, here, right? There are thousands--if not hundreds of thousands--of questions about electronic health data and the various tools physicians can use to harness it. By the time researchers finish slicing and dicing data in incremental studies such as these, the EHRs of today will be sitting on a shelf in the Smithsonian ... and we still probably won't be any closer to reaching a consensus about their overall benefits or efficacy.

Lots more here:

http://www.fiercehealthit.com/story/research-data-everywhere-and-not-drop-drink/2012-01-25

There are two threads here that I think we need to tease out. The first regards the need for evidence based practice and the second is the need for real clarity as to just what a particular piece of evidence means and just how far the findings of even a very conclusive and well conducted study can be extrapolated into drawing more general conclusions.

On the first issue we need first to accept that common sense and evidence are not the same thing! We also need to acknowledge that with the costs and risks of health care services rising we need not to be adopting and doing things that just seem right and make apparent sense. We need to devote increasingly scarce resources to those activities that can be shown to really make a difference to health outcomes.

If ever there was an example of the sort of woolly thinking that leads to bad decisions in action it is the thought bubble that has led us to the PCEHR. Never been tried, never been tested but off we go! What nonsense!

On the same point we also cannot go on pretending that e-Health is harm and risk free. There is now a lot of evidence that says that is simply not the case!

On the second issue I would be the first to admit that right now the evidence base for sweeping generalisations in Health IT looks very shaky indeed. There are all sorts of questions around whether an apparently conclusive study conducted at a major referral centre means much for the larger world of more normal facilities and whether what is found in premium implementations is actually seen to be generalizable. It is all too easy to say well it worked there, it makes sense that it does so the outcome will always be true in all situations. This is just not so - as the drug makers will testify. In careful clinical trials a particular therapy is excellent - but put into the hands of the ordinary clinician and a less motivated patient and the outcome can be very different!

I believe this is fundamentally important material that deserves more thought and reflection. It is just not good enough to hope something will work - as I keep being told elsewhere ‘hope is not a strategy’. We need evidence and proof!

David.

p.s.

As a coincidence - just as I finished this blog article this appeared:

http://blogs.crikey.com.au/croakey/2012/01/31/mental-health-funding-well-targeted-or-just-well-meant/

Guess what? The same problem of Government health policy being implemented in an evidence free way!

There Are Some Interesting Rumours Regarding NEHTA Doing The Rounds Tonight!

I don't have any details at this point - other than to say that apparently 'urgent reports' are being sought and assessments of the impact of the NEHTA 'product recall' on the PCEHR program are being requested.

Hardly a surprise - in fact I am surprised action did not come sooner!

It will be fun to keep an eye on www.health.gov.au and www.nehta.gov.au for any announcements / releases.

Please note this is all unconfirmed but I need readers to keep an eye out and let me know what happens and when!

David.

Weekly Australian Health IT Links – 30th January, 2012.

Here are a few I have come across the last week or so.

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

There was really only one bit of news this week that had been the source of rumours late last week and which then broke with the first article in the round up at the Australian on Tuesday morning.

It is amusing to see that the spin machine was still pumping out material even as briefings for the Wave sites were being organised (See items 2 and 3).

We now know at least some of what was reported is not quite ‘on the money’!

Other than that we see more submissions appearing for the Senate Community Affairs enquiry into the PCEHR and related matters.

You can be sure the lobbying pro and con is going on furiously behind the scenes at this point.

Sadly Queensland Health is also in the news again for all the wrong reasons!

All this bad news sadly made some reasonably good news on Telehealth from a large assemblage of publicity seeking ministers (nothing new in that!).

Have a good week - we should soon hear when the Senate Committee hearings will be. They will be interesting to watch!

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http://www.theaustralian.com.au/australian-it/e-health-key-trial-halted-by-specifications-glitch/story-e6frgakx-1226251676081

E-health key trial halted by specifications glitch

• by: Sean Parnell
• From: The Australian
• January 24, 2012 12:00AM

MOST of the trial sites for the federal government's electronic health record project have been taken offline after it was discovered they were working to different specifications than the planned national model.

The National E-Health Transition Authority (NEHTA) halted the rollout of primary care desktop software at 10 trial sites on Friday blaming incompatibility with the national specifications.

It is the latest blow for the Personally Controlled Electronic Health Record (PCEHR) project, which has attracted $466 million in federal funding over two years and is considered vital to efforts to combat preventable and chronic disease.

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http://www.theherald.com.au/news/local/news/general/hunter-ehealth-to-go-live/2428245.aspx

Hunter e-health to go live

BY JACQUI JONES

23 Jan, 2012 04:00 AM

The Hunter will launch personally controlled electronic health records in the coming weeks, ahead of a national rollout on July 1.

Hunter Urban Medicare Local has spent the past year doing preparatory work.

The Medicare Local’s primary care, IT and e-health director John Baillie said the Hunter system would go live in the next few weeks.

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http://www.canberratimes.com.au/news/local/news/general/electronic-records-create-healthier-system/2430144.aspx

Electronic records create healthier system

BY PETER JEAN, HEALTH REPORTER

24 Jan, 2012 04:00 AM

Lost and forgotten referral letters have led to countless Australians being turned away from specialist doctor appointments or forced to wait while administrative staff request faxed copies from GPs.

But when Sydney GP Raymond Seidler sends a patient to a specialist or the emergency department at the nearby St Vincent's Hospital, he knows his referral letter won't be forgotten.

That's because as an eHealth early adopter, Dr Seidler's Kings Cross practice is electronically connected to hospitals. ''The hospital receives up-to-the-minute information including pathology tests performed by the GP and has all the demographic information required clearly legible,'' he said. ''The GP no longer has to print page after page of referral letters and ensure that the patient actually takes the letter with them to the hospital often some weeks later to their appointment.''

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http://www.zdnet.com.au/specification-issue-halts-health-software-339330280.htm

Specification issue halts health software

By Suzanne Tindal, ZDNet.com.au on January 24th, 2012

The National E-Health Transition Authority (NEHTA) has confirmed that it has had to halt the planned implementation of primary-care desktop software at e-health pilot sites, due to an issue with specifications.

"This pause will impact work currently being undertaken by the primary-care e-health network sites: Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local and Accoras (Brisbane South). Greater Western Sydney, St Vincent's, Calvary, Cradle Coast, NT and Mater will be impacted on the primary care elements of their projects," the authority said in a statement, confirming a report by The Australian.

Only three projects will not be affected: two pilot sites run by Medibank and FredIT; and the Department of Defence's e-health program JEHDI.

NEHTA said that "internal checks" detected problems with a recent release of specifications, which was pushed out in November 2011.

"Our specifications are subject to rigorous assessment processes. These processes highlighted some technical incompatibilities across versions," the authority said.

It stressed that the software hadn't gone live, and that the decision to halt work is a quality-control call in order to reduce risk. It will work with the sites and the software vendors on what to do, given the delay.

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http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=825:march-the-target-for-nehta-specification-fix

March the target for NEHTA specification fix

Written by Kate McDonald on 25 January 2012.

The National E-Health Transition Authority (NEHTA) is hoping to finalise changes to its specifications for GP desktop software by mid to late March.

Problems have been discovered in the specifications for GP software development released in November last year.

NEHTA has put a hold on further implementation of the software, affecting most of the Wave 1 and 2 sites for implementation of the PCEHR.

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http://www.australiandoctor.com.au/news/e-health-records-moving-ahead--nehta

E-health records moving ahead: NEHTA

25 January, 2012 Sarah Colyer

The clinician leading the government's drive for e-health records is meeting medical colleges on Wednesday and will reasssure them that the program is moving ahead, despite newly discovered technical glitches that could render some software systems uselsss.

The National E-Health Transition Authority (NEHTA) confirmed on Tuesday that it had told GP software vendors to pause work on projects aimed at allowing GPs to send patients’ health information electronically, due to “technical incompatibilities”.

A spokeswoman for NEHTA would not elaborate on the problems. But sources within the organisation are worried that the rush to meet an unrealistic political deadline of July 1 for the start of the national scheme will lead to a system riddled with errors.

Speaking ahead of a meeting with the RACGP and other groups in Melbourne, NEHTA clinical advisor and former AMA president, Dr Mukesh Haikerwal, told Australian Doctor: “We have to be upfront about the fact that ‘things have been discovered’.”

Two separates sets of specifications for writing software have been circulated by NEHTA which are not compatible, Dr Haikerwal said.

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http://www.theregister.co.uk/2012/01/24/e_health_rollout_delayed/

Oz stalls e-health trials

Pilot catches bugs in specs

By Richard Chirgwin • Get more from this author

Posted in Business, 24th January 2012 22:00 GMT

Australia’s e-health implementation has stalled because of cross-version software incompatibilities, it emerged yesterday.

The agency responsible for the rollout, the National E-Health Transition Authority, made the announcement on January 24, stating that an assessment of the Primary Care desktop software “highlighted some technical incompatibilities across versions”.

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http://ehealthspace.org/news/nehta-halts-pcehr-pilot-sites

NEHTA halts PCEHR pilot sites

Posted Tue, 24/01/2012 - 19:01 by Mark Jones

The National E-Health Transition Authority has provoked fresh doubts about the $467 million PCEHR project after it formally halted most of its pilot ehealth sites today.

NEHTA chief executive Peter Fleming announced it had temporarily paused implementation of Primary Care desktop development due to a range of software incompatibilities.

Affected pilots include the Primary Care eHealth Network sites of Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local and Accoras (Brisbane South). Also affected are the primary care aspects of projects at Greater Western Sydney, St Vincent's, Calvary, Cradle Coast, NT and Mater. According to NEHTA, Medibank, FredIT and JEHDI will progress as planned.

The move comes after the government-funded organisation in November confirmed the deployment of “tiger teams” to drive the development and implementation of standards for the PCEHR. It also issued a new round of specifications in November.

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http://www.computerworld.com.au/article/413250/nehta_presses_pause_e-health_records/

NEHTA presses pause on e-health records

The implementation was stopped after internal checks detected issues in the specifications

• Chloe Herrick (Computerworld)
• 24 January, 2012 16:27

The National e-Heath Transition Authority (NeHTA) has halted the implementation of primary care desktop software development at a number of lead implementation sites for the $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.

A spokesperson for the authority told Computerworld Australia the decision to “pause” the implementation came after internal checks detected issues in the latest release of its specifications in November 2011.

“Our specifications are subject to rigorous assessment processes,” the spokesperson said.

 “These processes highlighted some technical incompatibilities across versions. We have identified problems with the specifications and have made the decision in order to avoid any risks.”

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http://www.medicalobserver.com.au/news/computer-glitch-stymies-nehta-trial

Computer glitch stymies NEHTA trial

24th Jan 2012

Byron Kaye

THE federal government's e-health trial has suffered an embarrassing setback after the National E-Health Transition Authority (NEHTA) discovered incompatibilities between the software used on its pilot websites and the main planned network.

NEHTA said it was "pausing" development of its primary care desktop software being tested at the Metro North Brisbane, Inner East Melbourne and Hunter Urban Medicare Locals.

The glitch would also affect other e-health sites, including those of Greater Western Sydney, St Vincent’s and Mater Health Sydney, Calvary Health Care ACT, Cradle Coast Electronic Health Information Exchange in Tasmania, the NT Health Department and Brisbane's Mater Misericordiae Health Services, NEHTA said in a statement.

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http://www.itnews.com.au/News/287992,government-struggling-to-meet-e-health-deadline.aspx

Government struggling to meet e-health deadline

By James Hutchinson on Jan 24, 2012 12:31 PM

NEHTA halts preliminary site work.

The Federal Government is unlikely to meet its promised July 1 deadline for completion of the $466.7 million e-health records project after the body overseeing implementation of the system halted preliminary work in lead implementation sites this week.

A spokesperson for the National E-Health Transition Authority (NEHTA) said "work on primary care desktop software development" at ten of 12 lead implementation sites around the nation had stalled due to "technical incompatibilities across versions" of the specifications provided to the sites.

None of the software affected by the issue had been pushed live to patients, but one report suggested NEHTA told heads of the implementation sites affected last week that there was a "potential clinical risk" if work went ahead using the specifications supplied.

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http://www.theaustralian.com.au/australian-it/long-road-ahead-for-e-health-records/story-e6frgakx-1226254000644

Long road ahead for e-health records

• by: Karen Dearne
• From: Australian IT
• January 26, 2012 7:37AM

The Health department spent $142 million on e-health activities in the last financial year – around one-third of a total $424m spent on health IT projects over the past 10 years.

Spending more than doubled during 2010-11, up from $60m a year earlier, reflecting a ramping up of work on the Gillard government’s $500m personally controlled e-health record program to meet its July 1 launch.

But documents released today show that while individuals may be able to register for a PCEHR from that date, national usage of the system is not planned in the foreseeable future.

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http://www.6minutes.com.au/news/latest-news/-limited--pcehr--set-to-flop-consumer-group-warns

"Limited" PCEHR set to flop says consumer group

19 January, 2012 Michael Woodhead

Patients are unlikely to participate in the PCEHR program because it will offers few benefits initially and will deny patients control over who has access to their records, the Consumers Health Forum says.

In a submission (link) to a Senate inquiry into the PCEHR bill, the CHF also calls for the personal  electronic health records system to be “opt-out “ by default rather than “opt-in”, which it says will lead to a lack of critical mass for the system.

The consumers’ group says a major  drawback with the “opt in” model is that patients may rely on their GP for registration, and thus may not feel personally  involved or engaged with the new system.

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http://www.techworld.com.au/article/413606/_opt-in_will_undermine_e-health_records_ama/

'Opt-in' will undermine e-health records: AMA

Government must issue data to support the "opt-in" model

• Chloe Herrick (Computerworld)
• 27 January, 2012 14:05

The Australian Medical Association (AMA) has continued to lobby the government to change its $466.7 million e-health record system to an “opt-out” model, arguing that the current “opt-in” model will undermine the system’s health improvement objectives.

In its submission (PDF) to the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body’s president, Steve Hambleton, maintained the current “opt-in” design will undermine the goals of the system, “to reduce the occurrence of adverse medical events and duplication of treatment”.

“In the early days we are concerned that if medical practitioners search for a PCEHR they will often not find one for their patient,” the submission reads. “This may deter future attempts by medical practitioners and consequently lead to a very low uptake of the proposed PCEHR by medical professionals.

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http://www.zdnet.com.au/e-health-funding-boost-required-for-x-rays-339330200.htm

E-health funding boost required for x-rays

By Josh Taylor, ZDNet.com.au on January 23rd, 2012

Extra funding for the personally controlled e-health records (PCEHR) will be required in order to support sharing and storage of diagnostic images, according to the Australian Diagnostic Imaging Association (ADIA).

The government has laid out $466.7 million in funding for the implementation of its e-health agenda, with PCEHRs scheduled to be made available to the public by 1 July.

While these records will allow sharing of basic medical information, more funding will be required to ensure that x-ray images and other medical diagnostic images are able to be shared between healthcare providers, the association noted in a submission to a parliament inquiry.

"This will involve some level of investment in e-health applications over and above that which has already been made," the association said. "We anticipate that a number of funding issues will need to be worked through with government to provide an incentive for practices to participate in PCEHR."

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http://www.6minutes.com.au/news/latest-news/insurer-wants-access-to-pcehr-data

Insurer wants access to PCEHR data

24 January, 2012

The nation’s largest private health insurer, Medibank is lobbying for access to patients’ PCEHR data so that it can identify fund members who may benefit from preventive health programs.

In a submission (link) to a Senate inquiry into the e-health record system, Medibank says that it is barred from using PCEHR data under current legislation, even if the patient consents.

Targeting of preventive health programs is also hampered because patients are unable to authorise insurers to access their records, Medibank says.

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http://www.couriermail.com.au/news/queensland/battered-health-hit-with-bias-accusation/story-e6freoof-1226250834924

Queensland Health accused of bias towards IT supplier Cerner Corporation

• by: Koren Helbig
• From: The Courier-Mail
• January 23, 2012 12:00AM

QUEENSLAND Health is again facing accusations it favoured an IT supplier that became the frontrunner for a multimillion-dollar government contract.

Confidential papers show a Health boss already was in talks with software company Cerner Corporation at least a year before consultants were hired to conduct an external investigation into potential suppliers.

The electronic medical records project was even given the codename "Project Mango" to avoid constantly naming Cerner in official correspondence, the papers said.

Queensland Health chief information officer Ray Brown rejected suggestions of favouritism by Queensland Health as "ridiculous", saying an independent probity adviser had reviewed the process and found no reason to believe Cerner was treated with undue bias.

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http://www.news.com.au/breaking-news/payroll-debacle-qld-health-staff-not-paid-today/story-e6frfku0-1226253079515

Payroll debacle Mk 2 - Qld Health staff not paid today

• By Harry Brumpton
• The Courier-Mail
• January 25, 2012 9:26AM

ANOTHER Queensland Health pay bungle is unfolding this morning as employees take to social saying they have not been paid.

Dozens of Health workers have contacted The Courier Mail to say they their pay has not appeared in the bank accounts.

 It is understood doctors, nurses, and administrative staff are affected.

Workers who have contacted the Courier Mail claim Queensland Health has made no effort to contact employees to alert them, and have instead told workers to "keep checking in,'' themselves with the payroll department.

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http://www.news.com.au/breaking-news/seeing-the-doctor-online-is-new-reality/story-e6frfku0-1226250562659

Seeing the doctor online is new reality

·         AAP

·         January 22, 2012 1:01PM

A NEW telehealth program will enable cancer patients to regularly consult their doctor even if they are hundreds of kilometres away.

The $20.6 million pilot program starting in July will use the national broadband network to deliver health services to older Australians with cancer and those in palliative care.

Health Minister Tanya Plibersek and Broadband Minister Stephen Conroy said patients in the first NBN rollout areas would find the high-speed broadband network more reliable in delivering e-health services.

They said the network would ultimately transform the way health care was delivered in Australia, particularly for rural and remote areas.

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http://www.computerworld.com.au/article/413069/online_doctors_new_reality/

Online doctors a new reality

A $20.6 million pilot program starting in July will use the National Broadband Network to deliver telehealth services to older Australians

• AAP (AAP)
• 23 January, 2012 08:20

Cancer patients and the elderly will be able to see their specialist or GP with the click of a mouse, even if they are hundreds of kilometres away.

A $20.6 million pilot program starting in July will use the National Broadband Network to deliver telehealth services to older Australians, cancer patients and those in palliative care.

Groups can apply for grants, typically of between $1 million and $3 million, to conduct two-year trials in telehealth services for patients, particularly in regional and rural areas.

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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr12-tp-tp008.htm

NBN to further boost Telehealth Takeup

A new $20.6 million telehealth program utilising the National Broadband Network (NBN) will provide new and innovative in-home telehealth services to older Australians, people living with cancer and those requiring palliative care.

22 January 2012

Health Minister, Tanya Plibersek, and Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, said the NBN Telehealth Pilot Program would deliver services to patients in NBN rollout areas and provide feedback on how this program and other health care measures can be delivered nationwide.

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http://www.smh.com.au/digital-life/smartphone-apps/iphone-app-scans-for-skin-cancer-20120123-1qctb.html

iPhone app scans for skin cancer

MICHELLE ROBINSON

January 23, 2012

A mobile phone app that allows people to analyse their moles for cancer risk is a good tool, but should not be relied on in isolation, the Cancer Society of New Zealand warns.

Skin Scan, an application for iPhones, allows users to take photos of their moles and find out whether they are likely to be cancerous.

Released by Romanian company Cronian Labs, the technology can be downloaded for $5.49.

The Cancer Society of New Zealand has applauded the technology as a way of reminding people to look after their skin and seek medical help for any changes to the appearance of moles.

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http://www.smh.com.au/national/phone-images-capture-a-moral-minefield-20120127-1qlgk.html

Phone images capture a moral minefield

Geesche Jacobsen

January 28, 2012

How far should citizen journalists go? Geesche Jacobsen investigates.

When amateur footage of a police officer allegedly punching a spectator at the SCG was released a week ago, police promptly announced an internal review.

Shortly before Christmas, a worried passenger filmed a bus driver texting while he was driving the bus on the M2; he was suspended from duty soon after the footage became public.

In the Middle East, authorities have come under greater scrutiny after the world-wide spread of mobile phone videos of the crackdown on demonstrators during the Arab Spring.

But while more and more images from citizen journalists around the globe have been disseminated to millions of viewers, thanks to the internet and the wide availability of mobile phone cameras, this technology also opens up legal and moral minefields

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Enjoy!

David.

AusHealthIT Poll Number 106 – Results – 30th January, 2012.

The question was:

Do You Believe The Various Wave Sites Will Eventually Coalesce To Form A Coherent National PCEHR System?

For Sure

-  8 (16%)

Probably

-  6 (12%)

Probably Not

-  8 (16%)

No Way

-  27 (55%)

I Have No Idea

-  0 (0%)

Votes 49

That seems pretty clear - around 70% of readers are not confident we will actually see a real working national system.

Again, many thanks to those that voted!

David.

What Does The Next Year or So Hold For E-Health in Australia? It Might Be Quite A Ride!

(The follow is a draft article for a magazine I do a column for - comments welcome)

I first have to point out that this short article is being written in late January and while, as we slipped off into the ‘silly season’ last year, we might have been forgiven for thinking the e-Health path for 2012 has been clearly marked, it seems, somehow that six short weeks have changed everything.

To go back to 2011 we had all watched the announcement of the Personally Controlled Electronic Health Record (PCEHR) by the then Health Minister, Nicola Roxon, the announcement of contractors and the selection of some pilot implementation (Wave) sites around the country. Funds has been allocated, a Concept of Operations document, explaining at a high level, what was planned had been released and, after some perfunctory consultation some enabling legislation had been introduced into Parliament.

We were assured that behind the scenes there was frenetic activity and that when we arrived at July, 1 2012 we would all be able to register at a web portal for our very own PCEHR, if we wanted one, and having your own PCEHR would be transformative for your patient care, the delivery of that care and the way the whole Health System worked.

Sceptics were pretty quiet by and large and there was also a sense that while it all looked very rushed the alternative of total inactivity was  obviously less desirable. This sense was doubtless heightened by the money that was on offer to those involved to get involved and make it happen.

I think was can pretty accurately date the moment when all the external gloss and smoothness started to erode and real concerns began to emerge about just how practical and realistic what was being proposed actually was.

I suggest the date was when this report was released by the Federal Parliamentary Library. The report was RESEARCH PAPER NO. 3, 2011–12 17 November 2011. The e health revolution—easier said than done. Author: Dr Rhonda Jolly.  In the broadest terms the report pointed out that there were more than a few issues that needed work and that the present plans might be a little over optimistic.

The report can be downloaded from this link:

http://www.aph.gov.au/library/pubs/rp/2011-12/12rp03.pdf

With the introduction of the Bills to enable the PCEHR the next shoe fell and the Senate Community Affairs Committee decided on an enquiry into the legislation and a range of related matters. Submissions closed in mid-January, 2012 and to date over 40 submissions have been published on the Senate web site. Without in any way pre-empting the Committee’s findings it would have to be fair to day a good number of concerns and issues get a pretty substantial airing in these written submissions and it is hard to see how the whole program can continue unchanged at this point.

The enquiry will oral take evidence in early February, 2012 and a report is due by the 29^th February - a date that it is hard to see will actually be met given the complexity of the matters raised in the submissions.

All of a sudden we now have all sorts of uncertainty about the timing of delivery of the PCEHR, the continuation for funding for National E-Health Transition Authority (NEHTA) and the PCEHR program and a host of other questions which have now been thrown up in the air.

The haste to meet the July 1, 2012 political deadline has had the effect of causing some ‘innovative’ approaches being adopted to specification development by NEHTA (the so-called Tiger Team process) and in the last week of January, 2012 it was announced that work on most of the pilot sites was being suspended for six to eight weeks while some erroneously issued specifications were corrected and re-issued to the affected technical teams. The impact on the time lines and budget are unknown at the time of writing.

With all this going on it would be fair to say the crystal ball was becoming pretty cloudy, but it has now become really opaque with the replacement of Nicola Roxon by Tanya Plibersek as Federal Health Minister as a result of a Cabinet reshuffle late last year.

From any sensible perspective it has to be concluded that the future for E-Health in Australia has become very uncertain for at least the next 2-3 months.

It is more than possible the new Health Minister will want to call a ‘pause’ and come to grips with just what is happening, what is doable and what the next steps should be. It is also possible the Senate Enquiry will make a series of important recommendations that change the landscape.

I do not recall a time when the forward direction of e-Health in Australia has been so unclear and indeed - on the basis of the submissions to the Senate Enquiry - so contested.

There is no doubt we need to make serious progress in the e-Health domain but it also seems that - on the basis of issues seen a many international programs - that progress is by no means as easy as it might seem at first glance!

I would suggest you drop back to the column in three months’ time to find out how all these possible options have actually played out and what the impact will be on your health service and those who are working there.

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David.