Australia’s Discombobulated E-Health Policy Governance Strikes Again! It Is Getting Really Silly.

We had a couple of press releases last Sunday.

First from Tassie:

http://www.media.tas.gov.au/release.php?id=34218

Michelle O'Byrne, MP

Minister for Health

Sunday, 12 February 2012

Tasmanian Drug Abuse Prevention Scheme Goes National

A system developed in Tasmania to prevent the abuse of painkilling prescription drugs has been so successful it will be rolled out across Australia, Health Minister Michelle O’Byrne said today.

Ms O’Byrne said the Australian Government’s decision is a huge vote of confidence in Tasmania’s system, which provides doctors and pharmacists with real time information about a patient’s history of prescribed drugs.

“We are leading the nation with our efforts to ensure medicines are used safely and effectively and to protect patients from the growing global problem of prescription drug misuse and diversion,” she said.

“We know that medicines, including opioids, play an important role in maintaining health, preventing illness and treating disease when used properly.

“Given to the right patients, under the right conditions, in the right doses and for the right length of time, they can improve health.

“But they can be dangerous when misused or abused.

“Our scheme alerts doctors and pharmacists to the possible abuse of prescribed medication through real-time information on a patient’s history of prescribed drugs to help them prescribe appropriately.

“It shows when repeat prescriptions are being claimed in quick succession which helps to identify patients who may be taking too much medication or perhaps passing it to others.”

Ms O’Byrne said previously, prescription information was only reported retrospectively on a monthly basis, which was too slow to guide required dosing and to prevent problems and protect patients.

The misuse, overuse and abuse of opioids and other drugs of dependence, such as morphine, is a significant public health issue in Tasmania and the rest of Australia. 

“We are proud that our response to this challenge has been recognised as one that will benefit the entire nation,” Ms O’Byrne said.

“As well as promoting the proper use of opioids, our project aims to reduce some of the adverse events that arise as a result of inappropriate opioid prescribing.

“Reduction in the scale of this problem and the deaths it causes is a significant positive preventative health initiative which will save people’s lives.”

The system provides secure controlled access to appropriate information at any time for clinicians who need to prescribe drugs of dependence and are unsure of their patient’s previous clinical history relating to these drugs.

Ms O’Byrne said information provided is restricted to that needed for a clinician to make an informed decision for a patient.

“The push for a national system similar to Tasmania’s comes from key professional organisations and coroners in numerous jurisdictions.

“A national scheme will also allow for information sharing across jurisdictions so we can all work together to minimise abuse and illegal use of these substances.”

And also from The Commonwealth:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr12-tp-tp014.htm

New System to Crackdown on Prescription Painkiller Abuse

The Australian Government will set up a new $5 million national electronic records system to combat abuse of controlled drugs including prescription painkillers.

12 February 2012

The Gillard Government will set up a new $5 million national electronic records system to combat abuse of controlled drugs including prescription painkillers, said Minister for Health Tanya Plibersek.

The Electronic Recording and Reporting of Controlled Drugs system will be made available to doctors, pharmacists and state and territory health authorities across Australia to monitor the prescribing and dispensing of addictive drugs in real time.

“While controlled drugs such as oxycodone, morphine and codeine play an important clinical role in managing pain, abuse of these drugs can cause enormous harm and is a growing problem in the community,” said Ms Plibersek.

“Following calls from coroners, law enforcers and consumer groups for greater control over distribution of the drugs, the Gillard Government is pleased to be making this electronic system available.”

Ms Plibersek said health professionals and administrators will be able to immediately detect people suspected, for example, of trafficking in painkillers, forging prescriptions and “doctor-shopping.”

“The new records system will be able to flag patients in real time who have repeatedly sought controlled drugs, helping to prevent people from inappropriately using the drugs or selling them to others.”

Health professionals will be able to access a centralised database over a secure computer network, which will contain prescription history records.

“If a pharmacist determines it is not clinically appropriate to dispense a medicine to a patient, it is their duty of care to restrict access to that patient.”

This information will enable state and territory health department regulators, pharmacists and prescribers to minimise the abuse of these medicines while also ensuring necessary access for consumers who have a legitimate need for these important medicines.

The amount of prescription opioids used in Australia is growing. According to the Internal Medicine Journal, the total value of Pharmaceutical Benefits Scheme opioid prescriptions increased from $2 million in 1992 to $7 million in 2007.

Ms Plibersek said the Electronic Recording and Reporting of Controlled Drugs system was first developed by the Tasmanian Government.

The Gillard Government has signed a licensing agreement with the Tasmanian Department of Health and Human Services and will make a nationalised system available to states and territories, which are responsible for monitoring controlled drugs, from July this year.

“The system has proved popular among Tasmanian health professionals where it has been operational for more than a year.”

Currently, some states use paper-based prescription records, which are slow and require significant resourcing, while electronic recording in others states is inconsistent between jurisdictions. A national electronic system will allow pharmacists to check on prescription records from other states.

Drugs that will be monitored on the system are listed under Schedule 8 of the Standard for the Uniform Scheduling of Medicines and Poisons, which is administered by the Therapeutic Goods Administration.

Abuse of controlled drugs can have severe health and economic consequences such as addiction, disruption to families, loss of work productivity, risk of blood-borne diseases for injecting drug users, depression, anxiety, overdose and even death.

---- End Release

We also had some press coverage here:

Appeal to stop drug shopping

• by: Carl Dickens
• From: Herald Sun
• February 16, 2012 12:00AM

AN online monitoring system should be introduced within a year to stop "prescription shopping" for drugs, a coroner said yesterday.

Coroner John Olle said the State Government should introduce a real-time system to track all prescription medicines.

It would be available to all drug prescribers and dispensers statewide, to determine whether someone was trying to get more medication than needed.

Mr Olle made the recommendation at an inquest on a 24-year-old man who died in October 2009 from an overdose of prescribed morphine and diazepam.

The Coroner's Court heard James, whose surname has been suppressed, spent hours each day visiting doctors and pharmacists, filling multiple drug scripts.

Records show that he visited 19 doctors and 32 pharmacies in his last three years, as his prescription drug addiction claimed his job, his love life, and his finances.

Mr Olle said the monitoring system should primarily focus on public health, rather than law enforcement, and should support rather than overrule health providers' clinical decisions.

Mr Olle said all the submissions he received from governments, health advocates, and individuals, supported real-time monitoring.

More here:

http://www.heraldsun.com.au/news/more-news/appeal-to-stop-drug-shopping/story-fn7x8me2-1226272227232

As I understand it essentially this proposal is for a national database of dispensed S8 (Drugs of Addiction) medications to be established that a pharmacist can look up and see if there has been more than they desire dispensing of such medicines to catch ‘doctor shoppers’ etc.

Now all this is well and good, and well motivated, considered in isolation - the problem is that it is not in isolation. There are public (think PCEHR) and private initiatives (think Medisecure and eRx) all designed to improve medication use and patient medication information availability.

Surely an initiative of this sort should actually be integrated into the overall directions for e-Health and not be announced and implemented as some sort of minute and unconnected component of the overall flow of development. I wonder is the IHI Service being used for instance? Surely it would be highly relevant? The releases don’t mention it. I wonder is this project in any way connected to the much vaunted Project Stop? See here:

https://www.epothecary.com.au/projectstop.aspx

It is my view that this sort of knee jerk policy making reflects the lack of national leadership and governance we really need in the e-Health space.

This is really little more than a bit of ‘Brownian Motion’ compared with what is needed overall.

The Strategic Vacuum we seem to have in OZ is really a bit sad.

David.

It Seems The NEHTA War-Room Has Gone Into Overdrive. Maybe They Have Realised The Jig Might Be Up!

That there has been not much news out of the Senate Legislative Committee’s PCEHR Enquiry should not leave anyone with the impression that nothing is happening.

Indeed the absolute reverse is true and there is a lot of not very edifying activity going on behind the scenes.

In the Australian yesterday we had this article appear in the Predictions 2012 section:

Creating record system a huge task

• by: Karen Dearne
• From: The Australian
• February 14, 2012 12:00AM

• INFLUENCER: PAUL MADDEN, CHIEF INFORMATION AND KNOWLEDGE OFFICER, DEPARTMENT OF HEALTH AND AGEING

A HUGE overhaul of federal IT systems in support of national health reform has begun, putting Health chief information officer Paul Madden in the hot seat with several big-ticket programs.

Under the Gillard government's shift to activity-based funding for public hospitals, new agencies, including the Independent Hospital Pricing Authority, National Health Performance Authority and National Health Funding Body, will between them set prices, monitor performance and ensure accountability.

The agencies need a common IT platform that ultimately ties the commonwealth, state and territory health departments into a unified system.

"We've recently awarded Accenture a contract (worth $111 million) for an enterprise data warehouse to support the information management and performance reporting that is part and parcel of activity-based funding," Madden says. "The same EDW will also support information management for the department."

Because all of the information will eventually be held in the one system, Madden will establish an enterprise data governance framework and enterprise information management plan "to ensure everyone is reporting on the basis of the same approach".

Madden is also looking for an enterprise documents and records management system, and an enterprise capability for grants management. "Part of my approach is to look at more expedient ways of doing things," he says.

"We can't afford multiple investments in what is essentially the same capability but supported by a different system.

"You're paying for the same thing more than once but, even worse, we've got people in different divisions using different work practices because they're on a different system. Staff should be using the same systems to do the same basic functions."

Madden is still developing a long-term strategy for the department's information systems but expects to have some conversations with the jurisdictions on aspects of data management along the way.

Lots more here:

http://www.theaustralian.com.au/australian-it/in-depth/creating-record-system-a-huge-task/story-fnc20bhu-1226269945442

And guess what not a single comment on the PCEHR and NEHTA. I wonder why?

Also of note is that we are seeing increasingly excited attacks from the NEHTA paid blogger ‘journalist’ on just what an awful collection of souls make up the MSIA and how the executive must be ‘unrepresentative swill’!

As an extra we have the last of many so far side swipes at me as well - saying I am not equipped in any way to be commenting - and presumably wondering why anyone reads the blog. (About 300 people per day do bye-the-way).

Incidentally I am also told that there is a chance there might be a short delay in the report of the PCEHR Committee Report and that the Committee would probably be able to consider additional submissions for the next week or two.

I note a new submission appeared as late as yesterday so input is still arriving and being considered!

Here are the contact details:

“For further information, contact:

Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Australia

Phone:  +61 2 6277 3515

Fax:        +61 2 6277 5829

Email:     community.affairs.sen@aph.gov.au”

If you have any views from any perspective get writing and submitting! Comments to the Committee addressing issues of patient safety, program governance and other issues I bang on about would be especially welcome!

What does all that is going on mean? From what I describe here and from a range of other sources what is actually happening is an attempt on the part of NEHTA to ensure any independent review of their activity and any independent scrutiny of the outcomes they create is simply suppressed or at best ineffective in causing any change to their plans - and especially their budget. If this is not true why all the public abuse rather than private e-mail and calls. I, and indeed the MSIA, are very easy to find!

NEHTA knows it is hanging on by a thread in terms of reputation and funding and is lashing out trying to protect its position. - it is as simple as that I reckon!

I can also tell you it is all getting pretty nasty and I don’t expect things to get better until we see the PCEHR report from the Senate!

David.

Senate Estimates Hearing Alert! This Afternoon!

Senate Estimates covering the Health and Ageing Portfolio is on this afternoon.

Here is a link to the program:

http://www.aph.gov.au/Senate/committee/clac_ctte/estimates/add_1112/commaff_addest_090212.pdf

Here is the link to the web-streaming of the session.

http://webcast.aph.gov.au/livebroadcasting/eventdetails.aspx?eventid=2356737


The session of interest runs from 3:45pm until about 5.15pm

Enjoy!

David.

It Seems We Are Not The Only Ones Bumping Up Against EHR Data Quality Issues. PCEHR Implications Are Worth Considering.

This very interesting report appeared a little while ago.

Thursday, February 09, 2012

EHR Data Not Ready for Prime Time, Studies Show

by Ken Terry, iHealthBeat Contributing Reporter

Two new studies cast doubt on whether the data in electronic health records are reliable enough to be used as the basis for publicly reported quality measurements and performance-based payments. A third study shows that EHR data on cervical cancer screening may be dependable, but only under certain circumstances.

Taken together, the studies -- all published in the Journal of the American Medical Informatics Association -- provide a snapshot of how well U.S. physicians are documenting preventive services and other clinical data in EHRs. This is important because public and private payers are beginning to require EHR-derived data to support programs aimed at lowering costs and improving the quality of care.

For example, Stage 1 of the meaningful use incentive program requires physicians to provide specific quality data through attestation. As early as 2013, they will have to submit the data electronically to CMS. Physicians already have the option of sending EHR data to Medicare's Physician Quality Reporting System.

Starting in 2015, CMS will use PQRS data to calculate a portion of physicians' Medicare payments under its value-based purchasing program. The ability of health care providers who join accountable care organizations to share in Medicare savings also will depend partly on electronically submitted quality data. And it's likely that private insurers will follow suit in their own ACO programs.

A lot is riding on the reliability of EHR data. But, in regard to the CMS programs, "we're not ready" to use this data, said Eric Schneider, distinguished chair in health care quality at the RAND Corporation. Moreover, he noted, "Until we get the EHR fully operational, we're pretty limited in the types of quality measures we can produce."

Structured Data Are Incomplete

In a study of New York City primary care practices that used the same publicly subsidized EHR, researchers assessed the accuracy of the structured data used for quality measurement. Structured data are computable information entered in discrete fields of the EHR. Researchers manually reviewed electronic charts to identify diagnoses related to preventive care measures anywhere within the record, including free text. According to the researchers, "the average practice missed half of the eligible patients for three of the 11 quality measures."

Because many preventive services were not documented as discrete data, the study also found that practices underreported the services their doctors provided on six of the 11 measures.

Another study -- conducted in a primary care network affiliated with Brigham & Women's Hospital in Boston -- focused on a clinical decision support tool designed to improve the completeness of EHR diagnosis lists, also known as "problem" lists. The program combed through lab, medication and billing data to find hints of missing diagnoses. Physicians who received prompts about these diagnoses through the EHR system added nearly three times as many old and new diagnoses to problem lists as doctors in the control group did.

The authors pointed out that in their prior research, a large portion of diagnoses had been missing from problem lists. For instance, only 51% of hypertension and 62% of diabetes diagnoses had been included. "Other institutions have found similar results," they added.

The third JAMIA study looked at whether EHR data could be used to detect overutilization of cervical cancer screening tests, known as Pap tests. Comparing manual e-chart reviews to the results of EHR queries, the researchers ascertained that EHR data could be used to measure accurately the overuse of Pap tests among low-risk women.

Jason Matthias -- the lead author and a research fellow in the Feinberg School of Medicine at Northwestern University -- said he was confident that every Pap test ordered during the study period had been documented as structured data. The EHR system had a lab interface, and "any results that returned from the pathologists were captured automatically," he said, adding, "If you didn't have results and you didn't have an order, the test hadn't been done."

Consequently, he said that data would be adequate for a quality measure. However, he added that similar information probably would be less accurate in a practice that had recently adopted an EHR system than in the university-affiliated clinic he studied. In a practice that was new to the technology, he said, it's likely that physicians would be less aware of the importance of problem lists and other discrete data.

.....

MORE ON THE WEB

• "Validity of Electronic Health Record-Derived Quality Measurement for Performance Monitoring" (Parsons et al., JAMIA, 1/16).
• "Improving Completeness of Electronic Problem Lists Through Clinical Decision Support: A Randomized, Controlled Trial" (Wright et al., JAMIA, 1/3).
• "Use of Electronic Health Record Data To Evaluate Overuse of Cervical Cancer Screening" (Mathias et al., JAMIA, 1/19).

Lots more with some comments here:

http://www.ihealthbeat.org/features/2012/ehr-data-not-ready-for-prime-time-studies-show.aspx

If ever there was an example of “garbage in, garbage out” in operation this has to be it. There has to be a great deal of care taken as we move from the most simplest data sharing to more complex efforts.

This very interesting study which is reported from the UK makes a similar point showing that after many years simple is actually starting to work!

Summary Care Record improving GP out-of-hours prescribing and helping patients die where they choose, DH data shows

By Nigel Praities | 03 Feb 2012

Exclusive: Out-of-hours GPs are changing their prescribing decisions after accessing a patient's Summary Care Record in around a third of cases, Pulse has learned, as the Department of Health prepares to publish data outlining the achievements of the programme so far.

• Video: 'Summary Care Record is not dead and buried'

Some 1,600 records are now viewed each week by out-of-hours providers and in other urgent care and hospital settings, with the programme's clinical director Dr Gillian Braunold claiming the rollout has now reached a ‘critical mass' in some areas.

One in five patients across England has now had a care record created – some 11 million in total – while more than 35 million patients have been contacted and told they will have a record created for them if they do not opt out.

Dr Braunold told Pulse the Summary Care Record was now proving of real benefit to clinicians, with the Department of Health due to publish official data imminently.

She said: ‘Primary care out-of-hours clinicians are finding that access to the information is making their consultations safer.'

‘On average, we are finding one in five of patients that turn up in out-of-hours, that is when we are finding it is making a difference. About 30% of cases, they are finding it is changing their therapeutic decisions because they have access to the Summary Care Record.'

Dr Braunold said there was also evidence from areas where end-of-life care plans had been uploaded to care records that more patients were dying in their preferred place.

She added that the future was to increase the scope of the Summary Care Record to help the 111 pilots run by NHS Direct and implement the Government's much-trumpeted ‘Information Revolution'.

Lots more here:

http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13383154/summary-care-record-improving-gp-out-of-hours-prescribing-and-helping-patients-die-where-they-choose-dh-data-shows

In the UK, as in Scotland, what is shared is the current information from the GP system on just demographics, current medications, reactions and allergies. Because this information is coded and is from the GP’s current record it has a high chance of being very reliable as the GP has a major interest in the information being correct so they can  provide repeats and the like.

All this supports my long held intention that the PCEHR is just way too much too soon. What we need is to scope the PCEHR back to just these basics, get it working as desired and then slowly and carefully grow from there.

You can read the scope of the UK Shared Care Record here:

http://www.connectingforhealth.nhs.uk/systemsandservices/scr/documents/scrscope.pdf

Because the UK system is Opt-Out (and very few have) where available we are starting to see some real use and some clinical adoption. This, once confirmed with relevant studies, will be very good news indeed. I am very keen to see confirmation that a really simple basic approach can make a difference! I look forward to the official studies coming out.

There is a lesson for the PCEHR here. The UK has taken near to a decade to get a very simple system going and we are hoping to have a much more complex monster going nationally in 18 elapsed months. They are dreaming!

David.

A Quiet Insider Spills The Beans On What Goes On Within Government. Very Interesting And Very Sad Indeed!

I had a contact from an insider in Government today - no names and no packdrill!
Here is what I was told.

“Many in the public sector are quite aware of the mess DoHA/NEHTA are in but are powerless to do anything meaningful about it. Public Sector accountability rules do not let Finance/AGIMO do much else than insist on agencies following the government's procurement rules. AGIMO is not empowered to ask if what an agency is doing will work. The Gateway review process is not much help - it's too much self-assessment.

ANAO tend to follow along after the event and do post implementation reviews. They don't often get involved in "in-flight" projects. They also don't have the technical ability to make value judgements.

The Senate hearings are mostly about politics and the reports will be on party lines. It's always been like this and probably always will be.

I'm afraid neither AGIMO nor ANAO can do much to stop the train wreck from happening. Health and NEHTA will probably redefine success so that the train wreck will appear to the average voter as a minor derailment, causing a slight delay typical of all major IT projects.

BTW, I came across this advert today.

http://www.seek.com.au/Job/solution-architect/in/sydney-cbd-inner-west-eastern-suburbs/21642590

It looks suspiciously like a NEHTA advert. If it is, it makes you wonder what they are up to so late in the project.

----- Quote:

As part of the Architecture team, you will work closely with the assigned Technology Partner who will be building this national E-Commerce platform to ensure the build is validated to the design specifications.

With your SOA background, you will create the Standards and Specifications for the artefacts.

Working with other 3rd party portal technology to ensure transactional and document management is within the Health standards.

----- End Quote.

And to follow up, I (David) asked!

 > What if Tanya (Plibersek) asked Penny (Wong) to help save her bacon?

I doubt that anyone external to Health could save Tanya's bacon. Penny certainly doesn't have much power in this area. The government has approved the expenditure, so it's up to Health to manage it. That's Tanya's and Jane Halton's job.

If we compare this project with some other notable failures - the Australian Customs Service's Cargo Management Re-engineering (CMR) and the Access Card there are some interesting parallels. This is an informative article:

http://www.zdnet.com.au/chris-ellison-takes-over-access-card-reins-339273989.htm

Minister Ellison got burned at Customs because the system was hurried and the legislation that it was based upon was not passed by the parliament early enough. When Ellison took over the Access Card he refused to authorise serious development expenditure until the enabling legislation was passed. - The Access Card project did not actually cost a lot of money. Of the $1.1billion estimated cost only about $100million (only?) was wasted. Eventually a change of government killed the thing, but Ellison greatly reduced the risk.

What Tanya could do, politically, is change the project timetable - delay as much as possible until the legislation was passed. That's effectively what Ellison did - he didn't want to get burned again. Tanya is going to get burned unless she does. As I said, this is all about politics, common sense does not come into it. She really needs someone external to blame (the Libs, AMA, anyone...) - or a change of government, but that's not in her best interest.

End Messages.

This is a very sad communication suggesting the money will just get spent - and probably wasted - and none of us can do zilch about it!

What a humongous mess we find ourselves in! All I can say is read, learn and weep!

David.

Weekly Australian Health IT Links – 13th February, 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

The big news of the week was clearly the public hearing at the PCEHR Senate Enquiry. I covered this in detail last week and there are a few more articles here in this blog.

Last week’s post is here.

http://www.aushealthit.blogspot.com.au/2012/02/outcome-of-senate-pcehr-enquiry-will.html

There is really little else going on as we wait for the Senate to report and wait for clarity as to what NEHTA and DoHA are really going to deliver. The next few weeks are likely to be very interesting indeed!

------

http://www.medicalobserver.com.au/news/nehta-a-secret-toxic-workplace

NEHTA a secret, 'toxic workplace'

7th Feb 2012

Mark O’Brien

A PARLIAMENTARY inquiry has heard the government body responsible for the planned e-health record system has become a “toxic workplace” operating under a “cloak of secrecy”, which has shut privacy advocates and consumers out of consultations.

Giving evidence before the inquiry into the legislation enabling the personally controlled e-health record (PCEHR), Medical Software Industry Association treasurer Dr Vincent McCauley complained about a lack of transparency from the National E-Health Transition Authority (NEHTA) – which is not subject to the same Freedom of Information laws as other government organisations – and of difficulty obtaining reports of safety assessments conducted as part of the implementation of the PCEHR.

“Without removing the cloak of secrecy… that currently covers NEHTA’s activities I believe that is impossible [to improve accountability],” Dr McCauley said.

Dr McCauley’s evidence echoed that of Australian Privacy Foundation chair Dr Roger Clarke, who had earlier told senators his organisation had been “held off to one side” throughout the consultation process surrounding the PCEHR.

-----

http://www.computerworld.com.au/article/414578/next_round_e-health_funding_finalised_three_months_over_schedule/

Next round of e-health funding finalised, three months over schedule

The funding was scheduled for allocation in November

• Chloe Herrick (Computerworld)
• 07 February, 2012 11:23

At least three months after it was scheduled to allocate the next round of funding for the Personally Controlled Electronic Health Record (PCEHR) project, the Department of Health and Ageing (DoHA) has confirmed a figure has been finalised.

A spokesperson for DoHA told Computerworld Australia it had finalised the funding with the National E-Health Transition Authority (NEHTA), originally scheduled to be allocated last November, for the “final scope” of activities to 30 June 2012.

“The final details of the work package have been completed,” the spokesperson said. “The funding figure will be published shortly."

The spokesperson said the change in federal health ministers, from Nicola Roxon to Tanya Plibersek in December, had not caused any delay in the $466.7 million initiative, with the exact figure to be published “shortly”.

-----

http://www.itnews.com.au/News/289226,e-health-stricken-with-privacy-and-software-lurgies.aspx

E-health stricken with privacy and software lurgies

By John Hilvert on Feb 6, 2012 9:07 AM

Analysis: Senate hearings begin.

With less than five months before launch, differences between interest groups in the planning of the Federal Government’s $466.7 million personally controlled electronic health record (PCEHR) will be aired today before a Senate Committee.

Submissions from medical associations, privacy groups, rural and remote services, and the medical software industry collectively raise questions over privacy, standards and the ability to service remote regions.

A common view is that the July 1 launch date is too ambitious.

-----

http://www.theglobalmail.org/feature/misleading-healthcare-register-puts-patients-at-risk/25/

Misleading Healthcare Register Puts Patients at Risk

Disciplinary records for dozens of doctors, nurses, and other health practitioners don’t show up on the national register – a new tool meant to improve transparency and public safety.

By Sharona Coutts, Joel Tozer

PATIENT SAFETY INVESTIGATION   |   February 6, 2012

Clare Blumer, Paul Farrell and Adam Glyde contributed to this report.

Misleading Healthcare Register Puts Patients at Risk

Disciplinary records for dozens of doctors, nurses, and other health practitioners don’t show up on the national register – a new tool meant to improve transparency and public safety.

The sound of a thud from a nearby room alerted a nurse at Caloundra Nursing Home in Queensland, that something was wrong. When she went to investigate, she found her supervisor standing above an elderly resident, who was lying on the floor.

The supervisor, a registered nurse named Christopher James Jones, yelled at the resident, and kicked him, according to a decision of Queensland's Nursing Tribunal, which was at that time responsible for oversight of nurses in that state. The nurse said she also heard Jones call the resident an "old fool."

The violence so shocked the nurse that she couldn't eat or sleep for days. Yet

Jones was not stripped of his duties at the home. In fact, less than a week later, on March 12, 2004, he kicked another frail, elderly resident in his left hip, after pushing the man to the ground with a stool. This time, three staff members witnessed the incident, according to the judgment.

-----

http://www.smh.com.au/national/health/hospital-computer-system-found-lacking-20120210-1so7j.html

Hospital computer system found lacking

Julie Robotham

February 11, 2012

THE computer system that runs emergency departments across NSW is chronically underfunded and produces inadequate patient records, according to an independent report commissioned after some hospitals last year lost so much confidence in the software they returned to manual record-keeping.

But despite continuing problems and excessive time spent on data entry, the system - known as FirstNet - is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, according to the report by consultants Deloitte, obtained by the Herald under freedom-of-information laws.

Doctors and nurses were not adequately consulted on how the software should be used, the report found, and the system could not provide an acceptable record of the care received.

''With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,'' the authors concluded.

-----

http://www.healthintersections.com.au/?p=791#comments

Response to Critical Safety Issue for the PCEHR

Posted on February 7, 2012 by Grahame Grieve

While I was on leave at Tamboon Inlet (and completely off the grid), Eric Browne made a post strongly critical of CDA on his blog:

“I contend that it is nigh on impossible with the current HL7 CDA design, to build sufficient checks into the e-health system to ensure these sorts of errors won’t occur with real data, or to detect mismatch errors between the two parts of the documents once they have been sent to other providers or lodged in PCEHR repositories.”

Eric’s key issue is that

“One major problem with HL7 CDA, as currently specified for the PCEHR, is that data can be supplied simultaneously in two distinct, yet disconnected forms – one which is “human-readable”, narrative text displayable to a patient or clinician in a browser  panel;  the other comprising highly structured  and coded clinical “entries” destined for later computer processing.”

It’s odd to hear the central design tenant of CDA described as a “major problem with CDA”. I think this betrays a fundamental misunderstanding of what CDA is, and why it exists. These misunderstandings were echoed in a number of the comments. CDA is built around the notion of a the twin forms – a human presentation, and a computer processible version. Given this, it’s an obvious issue about how the two relate to each other, and I spend at least an hour discussing this every time I do a CDA tutorial.

Note: This link is for those who want to see the other side of a complex discussion where it is. Close reading of the whole thread will make it clear just how hard and contested some of the details are!  I leave it to others much smarter than myself to sort it out!

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http://www.computerworld.com.au/article/414876/web-based_counseling_--_telepsychiatry_--_taking_off

Web-based counseling -- Telepsychiatry -- is taking off

More bandwidth, better security and emerging video technology are making telemedicine more acceptable to doctors, patients

• Lucas Mearian (Computerworld (US))
• 09 February, 2012 22:33

Dr. Avrim Fishkind, a psychiatrist in Houston, rarely sees any of his patients in person, and that's the way they like it.

Fishkind is part of a fast growing movement in the mental healthcare field where therapists counsel patients via inexpensive, Web-based video conferencing technology.

"We've had just over 60,000 patient encounters. To my knowledge, only six have refused to be seen via teleconferencing," he said. "When it comes to mental health issues and the difficult things you need to talk about in a crisis, a lot of patients feel it's less threatening and easier to be open and communicate via telemedicine."

Fishkind said telepsychiatry is limited only by insurance reimbursements. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as they do for in-person visits, the emerging medical field will grow exponentially.

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http://www.theaustralian.com.au/news/health-science/electronic-organ-donor-records-finally-on-way/story-e6frg8y6-1226267067109

Electronic organ donor records finally on the way

• by: Leigh Dayton
• From: The Australian
• February 11, 2012 12:00AM

AS the Gillard government's plans for electronic health records were raked across the coals this week at a Senate inquiry, one arm of the Health Department is going it alone.

While organ donor information is to be included in the proposed $500 million Personally Controlled E-Health Records program, the Australian Organ and Tissue Donation and Transplantation Authority is poised to put out to tender specifications for its own national electronic donor record.

The goal: streamlining the sensitive and complex process of moving organs from donation to transplant. The present system is based on a paper form almost 20 pages long.

"We called for an expression of interest late last year and various companies responded," says AOTA general manager Elizabeth Flynn, adding that the firms built "dummy systems" that were trialled in confidence.

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http://ehealthspace.org/news/racgp-calls-clear-pcehr-governance

RACGP calls for clear PCEHR governance

Posted Fri, 03/02/2012 - 12:31 by Josh Gliddon

The Royal Australian College of General Practitioners (RACGP) has weighed into the debate surround the PCEHR, stating GPs must have confidence in the system if it is to succeed.

The statements were made in the RACGP’s recently-released comments on the legislation surrounding the PCEHR.

According to Dr John Bennett, chair of the RACGP National Standing Committee, the RACGP takes issue with several aspects of the PCEHR Bill.

These issues include the need for clear governance, clarity regarding the administrative burden on GPs, and issues associated with the professional and financial risks associated with breaching provisions of the legislation.
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http://www.australiandoctor.com.au/news/govt-claims-e-health-records-on-track

Govt claims e-health records on track

7 February, 2012 AAP

The National e-Health Technology Authority (NEHTA) has told a Senate inquiry hearing that while building the new e-health records system was very complex it was still on track.

The authority was responding to a savage attack by the software industry and privacy advocates, who claimed the Federal health department had failed to provide the support needed to maintain the e-health records in the longer-term.

The Medical Software Industry Association and the Australian Privacy Foundation called for a pared-back scheme to be introduced on  July 1 this year, with a second-stage release to follow in mid-2013 when more functions have been finalised.

But chief executive of NEHTA, Peter Flemming, told the Senate committee in Canberra: "NEHTA began this journey back in 2005 and on July 1 the personally-controlled electronic health record (PCEHR) will be available for consumers to register."

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http://www.itnews.com.au/News/289451,e-health-sites-ready-consumer-pile-on.aspx

E-health sites ready consumer pile-on

By James Hutchinson on Feb 7, 2012 11:16 AM

Six-week delay to live implementation.

The Federal Government's decision to halt work at preliminary sites testing components of the personally controlled electronic health record have cost the project a further six weeks delay, according to one of the sites involved.

Metro North Brisbane Medicare Local chief executive Abbe Anderson told a Senate inquiry inspecting legislation for the e-health project that her implementation site now planned to sign up the first consumers to test live shared health summaries in mid-March, rather than January 30 as previously planned.

The delay comes after ten of 12 implementation sites were told by the National E-Health Transition Authority (NEHTA) on January 19 to halt work on "primary care desktop software development" due to "technical incompatibilities across versions" of the specifications provided to the sites in November last year.

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http://idm.net.au/article/008865-pcehr-not-what-doctor-ordered

PCEHR not what the doctor ordered?

02.07.12

Doubts about Australia’s $A467 million Personally Controlled Electronic Health Record (PCEHR) project have emerged during submissions to a Senate inquiry underway this week in Canberra.

Under the proposed scheme, due to begin operation on July 1 2012, all Australians will have the option of registering for a PCEHR, designed to ensure medical professionals have access to comprehensive patient data.

The Australian Medical Association (AMA) does not believe that requiring patients to “opt-in” to the PHECR will deliver a sufficient uptake to make the system successful.

“Experiences of opt-in systems from Australia and from overseas indicate that adoption amongst consumers will progress slowly,” submitted Dr Steve Hambleton, AMA President.

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http://ehealthspace.org/news/ama-tells-senate-pcehr-deadline-problematic

AMA tells Senate PCEHR deadline is problematic

Posted Tue, 07/02/2012 - 09:58 by Josh Gliddon

The head of the Australian Medical Association (AMA), Dr Steve Hambleton, has told the senate hearing into the PCEHR legislation that the deadline for the electronic record’s introduction is problematic.

The PCEHR is set to become available to every Australian wanting one on July 1, 2012.

Dr Hambleton said the AMA supports the development of ehealth records, but he also stated a working system is years from completion.

He told the hearing there are problems with expectation levels associated with the introduction of the record, and with the ability of doctors to deliver meaningful connectivity using the record by the July 1 deadline.

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http://www.zdnet.com.au/qld-releases-nbn-strategic-plan-339331291.htm

Qld releases NBN strategic plan

By Luke Hopewell, ZDNet.com.au on February 8th, 2012

The Queensland Government has released a laundry list of National Broadband Network (NBN) opportunities it will seize if it is returned to power in the upcoming state election, which includes partnering with the CSIRO, Energex, local governments and NBN Co to make sure that those in the state get the most from the incoming fibre network.

The 12-page plan said that the state government will look to align infrastructure deployment with local disaster rebuilding efforts, among other initiatives.

The January 2010 floods that tore through Grantham in the Lockyer Valley saw countless properties destroyed, and left a repair bill of several billion dollars. As the rebuilding effort continues, the Queensland Government is looking to speed up the NBN roll-out in construction areas.

"The Queensland Government is working with NBN Co to identify opportunities to align NBN infrastructure plans as part of the disaster reconstruction effort.

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http://www.techworld.com.au/article/414727/qld_govt_demands_answers_after_pay_glitch

QLD govt demands answers after pay glitch

Queensland Premier Anna Bligh wants answers after yet another Commonwealth Bank payroll glitch, affecting 15,000 police and civilian staff.

• AAP (AAP)
• 08 February, 2012 12:58

The Queensland government is demanding answers from the Commonwealth Bank after another glitch left thousands of police and civilian staff unpaid.

About 15,000 officers and staff were left without their fortnightly pay after money which was supposed to be paid into their bank accounts on Tuesday night did not arrive.

Premier Anna Bligh said she had received a guarantee from the Commonwealth Bank that the money would be paid on Wednesday but said she was furious about the bungle.

"I am very unhappy with the way the Commonwealth Bank is managing the government payroll," she told reporters in Townsville.

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http://www.technologyreview.com/computing/39669/?nlid=nldly&nld=2012-02-08

Turing's Enduring Importance

The path computing has taken wasn't inevitable. Even today's machines rely on a seminal insight from the scientist who cracked Nazi Germany's codes.

By Simson L. Garfinkel

When Alan Turing was born 100 years ago, on June 23, 1912, a computer was not a thing—it was a person. Computers, most of whom were women, were hired to perform repetitive calculations for hours on end. The practice dated back to the 1750s, when Alexis-Claude ­Clairaut recruited two fellow astronomers to help him plot the orbit of Halley's comet. ­Clairaut's approach was to slice time into segments and, using Newton's laws, calculate the changes to the comet's position as it passed Jupiter and Saturn. The team worked for five months, repeating the process again and again as they slowly plotted the course of the celestial bodies.

Today we call this process dynamic simulation; Clairaut's contemporaries called it an abomination. They desired a science of fundamental laws and beautiful equations, not tables and tables of numbers. Still, his team made a close prediction of the perihelion of Halley's comet. Over the following century and a half, computational methods came to dominate astronomy and engineering.

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Enjoy!

David.

AusHealthIT Poll Number 108 – Results – 13th February, 2012.

The question was:

After Hearing and Reading About the Senate PCEHR Hearing Do You Expect Significant Changes To Come From The Enquiry?

Major Changes

-  7 (18%)

Minor Changes

-  17 (44%)

No Changes

-  10 (26%)

I Have No Idea

-  4 (10%)

Votes: 38

Interesting result. It seems many now think there will be some change with the majority seeing at least some small change and a significant minority seeing major change.

Again, many thanks to those that voted!

David.

I Have An Answer For What the Senate PCEHR Committee and Minister Plibersek Could Do To Sort Out the DoHA / NEHTA / E-Health Imbroglio!

While chatting with a colleague it hit me!

What the Government needs to do is mobilise its internal resources - already mostly paid for - to take a look at NEHTA and the PCHER. Program.

There are 2 key resources they might use.

First we have:

The Australian Government Information Management Office

The Australian Government Information Management Office (AGIMO), Department of Finance and Deregulation is working to make Australia a leader in the productive application of information and communication technologies (ICT) to government administration information and services.

Key AGIMO Roles and Responsibilities (AGIMO Blog)

e-Government Strategy

Responsive Government: A New Service Agenda

The strategy charts how the Government is building on progress in e-government to date, and how the Government is progressing towards the vision of connected and responsive government by 2010. Activities are in four main areas:

• meeting users' needs
• establishing connected service delivery
• achieving value for money
• enhancing public sector capability.

ICT Reform Program

• Implementation of the recommendations of the Review of the Australian Government's use of Information and Communication Technology

AGIMO programs

Further information on AGIMO programs is available on the following topics pages:

• ICT Strategy & Governance
• ICT Procurement
• ICT Service Improvement & Delivery
• ICT Security & Authentication
• ICT Better Practice & Collaboration
• ICT Infrastructure
• ICT Investment & Budget Advice

Recent Publications

• Australian Government ICT expenditure, 2008-09 – 2009-10
• Interacting with Government: Australians' use and satisfaction with e-government services - 2011
• Australian Government Architecture Reference Models version 3.0
• A Guide to the Australian Government: Structure, Organisations and Key People - October 2011
• The Australian Government’s study into the Accessibility of the Portable Document Format for people with a disability

More here:

http://www.finance.gov.au/agimo/index.html

Looking at those AGIMO programs - who better to advise Senator Collins and the Committee on the quality and so on of what has been done by DoHA and NEHTA in the PCEHR Program.

Better still this organisation reports to the Finance Department led by Penny Wong!

The other entity is, of course the Auditor General.

Read what these people are intended to do!

About Us

The Auditor-General is responsible, under the Auditor-General Act 1997 (the Act), for providing auditing services to the Parliament and public sector entities. The Australian National Audit Office (ANAO) supports the Auditor-General, who is an independent officer of the Parliament.

The ANAO's primary client is the Australian Parliament. Our purpose is to provide the Parliament with an independent assessment of selected areas of public administration, and assurance about public sector financial reporting, administration, and accountability. We do this primarily by conducting performance audits, financial statement audits, and assurance reviews. The ANAO does not exercise management functions or have an executive role. These are the responsibility of entity management.

We also view the Executive Government and public sector entities as important clients. We perform the financial statement audits of all Australian Government controlled entities and seek to provide an objective assessment of areas where improvements can be made in public administration and service delivery. We aim to do this in a constructive and consultative manner. This includes working co-operatively with those with key governance responsibilities in entities, including Audit Committees.

As part of its role, the ANAO seeks to identify and promulgate, for the benefit of the public sector generally, broad messages and lessons identified through our audit activities. The ANAO's Better Practice Guides disseminate lessons on specific aspects of administration. In addition, our newsletter, AUDITFocus, captures succinctly some of our experiences that are likely to be of general interest to public sector managers.

The ANAO has extensive powers of access to Commonwealth documents and information, and its work is governed by its auditing standards, which adopt the standards applied by the auditing profession in Australia. In accordance with these standards, our performance audit, financial statement audit and assurance review reports are designed to provide a reasonable level of assurance. The actual level of assurance provided is influenced by factors such as: the subject matter of the audit, the inherent limitations of internal controls, the use of testing and cost considerations.

The ANAO adopts a consultative approach to its forward audit program, which takes account of the priorities of the Parliament, as advised by the Joint Committee of Public Accounts and Audit, the views of entities and other stakeholders. The program aims to provide a broad coverage of areas of public administration and is underpinned by a risk-based methodology. The final audit program is determined by the Auditor-General.

The ANAO plays an important professional role by contributing, both nationally and internationally, to the development of auditing standards, professional practices and the exchange of experiences through participation in various peer and professional organisations.

Here is the link!

http://www.anao.gov.au/About-Us

Assessment and review by these two agencies of what has gone on, who has done what with whom and why, how well it has been done, is it reasonable and safe to proceed, where we now are and so on is what the Committee needs. With this expert advice the Senate Committee can then decide what comes next.

Even if the reporting of the Committee was delayed for a month or two, in the grand scheme of things it would not be any real problem and we could also all know that there were sensible hands on the tiller going forward!

How annoying I did not think of this when writing this late last week.

http://www.aushealthit.blogspot.com.au/2012/02/what-questions-does-senate-pcehr.html

Silly me!
I apologise in advance if such referrals have already happened for offering gratuitous advice!

David.