Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, February 25, 2012

Weekly Overseas Health IT Links - 25th February, 2012.

Note: Each link is followed by a title and 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.
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Study: Docs Have EHR Rights, but Also Responsibilities

An article published Feb. 13 in the Canadian Medical Association Journal outlines 10 “rights” that clinicians should expect in the performance of an electronic health records system, as well as corresponding responsibilities of the clinicians to use the EHR to improve the quality of care.
The article’s authors are Dean Sittig, PhD., a biomedical informatics professor at the University of Texas Health Science Center at Houston; and Hardeep Singh, M.D., assistant professor of medicine at the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, who have collaborated in the past on studies of improving EHR use and safety, including a call in late 2011 for establishment of a National EHR Safety Board.
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GE Healthcare, Microsoft name their new company

By Mike Miliard, Managing Editor
Created 02/13/2012
REDMOND, WA – GE Healthcare and Microsoft have announced senior executives and the name of their joint health IT venture, which was announced in December. The new company, called Caradigm, is expected to launch in the first half of this year.
The name is meant to embody paradigm shift in care delivery, said the firm's CEO-designate, Michael J. Simpson –  said he was pleased to find such an evocative moniker
"You see a name that reflects your company and your mission, and it just works out," he said. "We were very surprised it hadn't been taken before."
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New York to test ONCs Query Health standards

By Mary Mosquera
Created 2012-02-13 07:15
The Office of the National Coordinator for Health IT will test in New York its standards and services for electronic and distributed population health queries.
The Primary Care Information Project (PCIP) in the New York City Department of Health and Mental Hygiene will test the standards and a reference model for the Query Health project with the New York State Department of Public Health in a pilot to expand population health monitoring, according to Rich Elmore, ONC coordinator for the Query Health initiative. 
PCIP, which supports the adoption of health IT among primary care providers who tend to the city's underserved populations, will use the Query Health standards and reference implementation to expand its population health monitoring network to encompass citywide health information exchange organizational coverage of inpatient and outpatient encounters.
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UnitedHealth Launches Patient Info Service For Doctors

By TOM MURPHY   02/14/12 10:19 AM ET  
-- UnitedHealth Group's Optum business is launching a service that allows doctors to share information about patients over the Internet, as health care companies continue their push to improve care with better coordination.
The system, known as cloud computing, involves storing information and software applications on remote servers that are accessed through a secure Internet connection.
In health care, this means a doctor does not have to go to a particular computer for patient information or care updates. He or she can use portable devices like smart phones or tablet computers.
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Making a game out of doc sepsis training

By gshaw
Created Feb 15 2012 - 1:36pm
Sepsis is no laughing matter--but a new tool aims to at least make learning about the dangers of the deadly infection a little more pleasant for docs.
The web-based game--Septris--is modeled after the popular computer game Tetris. Developed by Stanford University Medical Center physicians, researchers and education technology experts, the game can be played on a mobile phone, a tablet or a computer.
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HIT Tool Kit Targets Rural Providers

John Commins, for HealthLeaders Media , February 15, 2012

It's no secret that, in general, rural healthcare providers lag behind their counterparts in urban and non-rural areas when it comes to the implementation of electronic medical records and other healthcare information technology.
The Office of the National Coordinator recently announced that only 9% of critical access hospitals had attested to meaningful use of EHR in 2011, compared with 16% of hospitals in non-rural settings. Frankly, neither statistic is worth bragging about. But the lagging achievement in critical-access hospitals points to some unique challenges that rural healthcare providers face.
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CSC takes record hit on NHS IT project

9 February 2012   Jon Hoeksma
Computer Sciences Corporation has made a $1.49 billion write-off against the National Programme for IT in the NHS, in what is thought to be the biggest ever write-off against a single IT project in the UK.
The US computer services company announced the write-off in its quarterly financial results yesterday.
The write-off equals CSC’s entire investment in the contract for the North, Midlands and East of England, where it has been struggling to install the Lorenzo electronic patient record system at trusts.
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Possible ICD-10 Delay Nets Widespread Physician Support

John Commins, for HealthLeaders Media , February 15, 2012

Signals that federal officials might "re-examine the pace" of next year's implementation dates for ICD-10 are bringing mostly favorable reactions from healthcare providers.
Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, told an American Medical Association conference in Washington, DC on Tuesday that the federal government was sympathetic to physicians' concerns about the Oct. 1, 2013 implementation date for the new standard of diagnostic classification.
"I'm committing today to work with you to reexamine the pace at which we implement ICD-10," Tavenner said as a room full of doctors applauded, according to a post from the Massachusetts Medical Society. "I want to work together to ensure that we implement ICD-10 in a way that (meets its) goals while recognizing your concerns."
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'Too Much Information': Are EHRs Drowning Primary Care?

Kate Johnson
February 14, 2012 — Although electronic health records (EHRs) are intended to streamline patient care and communication between healthcare professionals, they can lead to information overload, according to results a study published in a letter in the February 13 issue of Archives of Internal Medicine.
"Strategies to improve efficiency of electronic clinician-to-clinician messaging should be pursued to avoid burdening busy frontline health care providers," recommend Daniel Murphy, MD, from the Veteran's Affairs Health Services Research & Development Center for Excellence in Houston, Texas, and colleagues.
Their study was conducted in the outpatient clinics of a large, tertiary-care Department of Veterans Affairs facility in which the EHR includes an inbox system for "additional signature request" (ASR) alerts, defined as any note requiring an electronic signature.
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NIST seeks vendors' EHRs to study usability

By Mary Mosquera
Created 2012-02-15 11:26
The National Institute of Standards and Technology needs the help of vendors to supply their existing electronic health records so the agency can conduct research on the systems to develop procedures for measuring and evaluating their usability.
NIST wants to come up with performance-oriented user interface design guidelines for EHRs as a framework for assessing the usability of EHRs, according to the agency.
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Massive London PAS and EPR tender issued

15 February 2012   Rebecca Todd
A tender notice has been issued for a patient administration system and electronic patient record system for nine London trusts.
The estimated value of the tender, issued in the Official Journal of the European Union, is between £250m and £400m.
EHealth Insider believes this makes it the largest collaborative procurement for healthcare IT outside the National Programme for IT in the NHS.
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Patients like EHRs but worry about data security: survey

Posted: February 16, 2012 - 1:00 pm ET
Patients generally see electronic health-record systems as a good thing and want their physicians to use them, but a large percentage also see a dark side to EHRs when it comes to data privacy and security, according to a report from the National Partnership for Women & Families.
The 76-page report, "Making IT Meaningful: How Consumers Value and Trust Health IT," contains results of a survey conducted by Harris Interactive and overseen by veteran privacy researcher Alan Westin. Conducted online last August, the survey had responses from 1,961 adults. More than half (nearly 59%) said their physicians use electronic records.
A high percentage of patients surveyed reported having favorable opinions about EHRs.
When asked how useful EHRs could be in boosting quality in seven different care "elements," between 80% and 97% indicated an EHR would be useful, the report said.

ICD-10 inches closer to delay, ICD-11 in the wings

By Tom Sullivan, Government Health IT
Created 02/16/2012
WASHINGTON – The case for leapfrogging ICD-10 and holding out for ICD-11 just got a lot more curious. And though it’s not here yet, when ICD-11 is ready, it will be something ICD-10 cannot be: A 21st Century classification system.
Now that HHS Secretary Kathleen Sebelius has thrown her department’s hat in the ring, saying late Wednesday that HHS intends to delay ICD-10, the most pertinent question is how long will HHS push back compliance?
“My opinion is that CMS won't be able to announce three months or six months of delay for ICD-10,” says Mike Arrigo, CEO of consultancy No World Borders (pictured above). “They will need to announce a delay from Oct. 1, 2013 to at least Oct. 1, 2014 because of CMS fiscal planning calendars.”
Others in the industry are suggesting that even one year is not enough to lighten the burden on physicians, providers and payers to make the transition smoother.
“I have a gut feeling they’ll go for two years, who knows?” speculates Steve Sisko, an analyst and technology consultant focused on payers and ICD-10. “Maybe January 2015?”
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Lack of standardized EHR interface delaying interoperability

By mdhirsch
Created Feb 14 2012 - 11:34pm
The lack of a standardized application programming interface (API) for electronic health records is hampering the growth of information networks, according to a recent poll [1] conducted by health IT strategy and research firm Gantry Group, which recently surveyed health plans and EHR vendors on the topic.
Gantry found that 96 percent of health plans and 88 percent of vendors surveyed said that a standard API is needed to support data exchange among EHR systems. Without a single standard method for EHRs to use to communicate, the industry won't move forward with large-scale data exchange, despite the government's pumping of resources into HIT.
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Researchers: One-way sharing of data from EHRs to immunization registries risky for patients

By mdhirsch
Created Feb 14 2012 - 11:24pm
Requiring only communication from electronic health records to immunization registries, but not from the registries back to the providers, impedes data exchange and renders Meaningful Use requirements "incomplete," researchers from the University of Michigan concluded in a recent article [1] published in the American Journal of Preventive Medicine, reported about [2] in EHR Outlook.
The authors noted that Stage 1 of Meaningful Use requires providers to attest only that their EHR has successfully sent a test message to a state or regional immunization information system (IIS). However, since there is no requirement for a provider's EHR to receive any information in return from the IIS--something not likely to be a requirement under Stage 2 of Meaningful Use--the exchange of data falls short.
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Friday, February 17, 2012

Five Things To Watch at the HIMSS12 Conference

As the 2012 Annual HIMSS Conference & Exhibition opens on Feb. 20, attendees will find familiar and new education, exhibition and networking opportunities. This year, the conference comes to Las Vegas, a first for the Healthcare Information and Management Systems Society. The conference will be held at the Venetian Sands Expo Center from Feb. 20 through Feb. 24.
In my 12 years as president and CEO of HIMSS, I've found that attendees have a definite objective when they arrive at the conference -- whether it's identifying a new health IT or management systems solution or attending education sessions on a certain topic, or maybe both. With much to absorb in these five days, here is my checklist of what to watch in the week ahead.
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91% of small healthcare organizations suffered a data breach in the last year

By danb
Created Feb 17 2012 - 2:17pm
Nearly all small healthcare organizations and practices responding to a recent survey said they've suffered some sort of data breach in the past year, the Ponemon Institute announced this week. Overall, 91 percent of responding facilities with 250 employees or less said they had suffered at least one data breach, with 23 percent of respondents saying that their organizations experienced at least one patient medical identity theft in that time span.
What's more, three-fourths of respondents said that organizations lacked sufficient funding to prevent such breaches; 48 percent, meanwhile, said that less than 10 percent of their organization's annual budget was used on data security.
Major factors for such breaches included negligent employees and an inability to meet compliance requirements, according to the study's authors. Mobile device use and social media activity were considered to be areas of particular vulnerability.
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Medical imaging 'mega-cloud' in the works

By danb
Created Feb 17 2012 - 12:08pm
Efforts to create a medical imaging mega-cloud are in the works, according to an article [1] published this week in The Register. Researchers at Peake Healthcare Innovations (a collaborative venture between Johns Hopkins University and Harris Corp.), VMware, and Intel are teaming up on the project, which ultimately could become a nationwide central warehouse.
The Johns Hopkins hospital system essentially will serve as a testing ground for project prior to a nationwide rollout, according to The Register. A full private cloud version of PeakeSecure--Peake's medical records cloud--will be rolled out at Johns Hopkins next month, with a public version set for completion by in the next several months, according to Jim Philbin, Peake's chief technology officer. Philbin also serves as co-director of the Johns Hopkins Center for Biomedical and Imaging Informatics.
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Do Health IT Hires Need A Clinical Background?

The debate on which qualifications an IT job candidate needs to work in a hospital or medical practice rages.
By Paul Cerrato,  InformationWeek
February 16, 2012
If you've kept up with the news in recent months, you're aware of the shortage of qualified IT professionals to fill positions in hospitals and medical practices. The U.S. Bureau of Labor Statistics predicts that jobs in health informatics will jump by 18% by 2016 and expects there will be shortage of about 50,000 health IT workers over the next five years.
Few people challenge those statistics, but what's upsetting job candidates is that many health IT managers only want people with a clinical background. AdTech Ad
Essentially, the debate revolves around this issue: Is it easier to teach an IT generalist the clinical principles needed to work in a hospital or practice, or teach a clinician the general IT principles?
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How long before providers take the privacy rap?

By Joseph Conn
I'm sure many of you, like me, are in HIMSS mode right now. So, I'm going to interrupt your packing for the Las Vegas meeting of the Healthcare Information and Management Systems Society for only a minute.
A line jumped out at me from a report by the National Partnership for Women and Families released Wednesday: "Making IT Meaningful: How Consumers Value and Trust Health IT,". It summarized the responses from some 1,900 patients surveyed online by Harris Interactive and was overseen by veteran privacy researcher Alan Westin.
It found that patients are well aware that the current level of privacy and security protections in electronic record-keeping, quite frankly, stinks.
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Microsoft Insists on Staying Healthy

The tech company's joint venture with GE, which provides a suite of services for doctors and hospitals, gets a name

Say what you will about Microsoft, the company sure has some incredible resolve.
On Monday, Microsoft and General Electric revealed that Caradigm will be the name of their health-care joint venture. The new company should come to life sometime in the first half of this year, employing about 750 people in the Seattle area. Caradigm will take a stab at modernizing health care through applications that help hospitals, doctors, and patients manage health records and the information pouring in from various machines and databases. The general idea is to give health-care providers a way to see tons of information with one log-in and to start gathering huge amounts of information in a way that could illuminate insights about patients.
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HHS: Hospital EHR use more than doubles

Posted: February 17, 2012 - 4:15 pm ET
The percentage of hospitals that use electronic health-record systems more than doubled from 2009 to 2011, according to the results of a new American Hospital Association survey that HHS Secretary Kathleen Sebelius touted at an event in Kansas City, Mo.
More than one-third of hospitals (35%) had adopted EHRs as of 2011 versus 16% that had done so in 2009, according to the survey. In addition, about 2,000 hospitals and more than 41,000 physicians have received a share of $3.1 billion in incentives for their meaningful use of EHR systems, according to an HHS news release issued in conjunction with Sebelius' visit to Metropolitan Community College-Penn Valley Health Science Institute.
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12 trends for mobile health in 2012

By: Brian Dolan | Feb 14, 2012
Last week MobiHealthNews hosted its first webinar of 2012. During my presentation I shared my 12 trends for 2012. Our co-presenter, Aaron Kaufman from Kony Healthcare Solutions also shared his take on the year ahead. Check out the complimentary, hour-long webinar on demand right here.
1.) The Adoption of Smartphones and Tablets. This is by far the most obvious trend because it has been so steady for the past few years. It is still an important one to consider. By the end of 2011, Nielsen expected half of the US population to own a smartphone. At the end of 2011 62 percent of 25 to 34 year olds had smartphones. About 53 percent of 35 to 44 year olds did. The fastest growing age group for smartphone adoption in the past year was the 55 to 64 year old age group. Adoption among this group went from 17 percent to 30 percent a year later. Similarly the iPad has had the fastest adoption rate of any consumer electronics device in history. We know that now more than 80 percent of physicians in the US have smartphones. Between 30 percent and 50 percent have tablets now depending on who you ask.
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ONC gets $5M bump up in proposed 2013 budget

By Mary Mosquera
Created 2012-02-14 11:40
The Office of the National Coordinator for Health IT would receive $66 million, or $5 million more than the current year, under President Barack Obama’s proposed budget for fiscal 2013.
ONC’s budget would increase 8.2 percent to advance the progress in creating a nationwide health IT infrastructure, including further accelerating the adoption of electronic health records (EHRs) and their meaningful use by physicians.
ONC’s spending is part of the president’s request for $76.7 billion, or 0.4 percent more than 2012, for the small part of HHS spending that is discretionary in his budget released Feb. 13.
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Infonaut Signs Contract with University Health Network to Test Disease Surveillance System, Hospital Watch Live

February 14, 2012 (Toronto, ON) - Toronto-based health technology company Infonaut Inc. today announced it has signed a contract with the University Health Network to test its real-time disease surveillance system to control and stop hospital acquired infections, Hospital Watch Live.
Designed to assist hospitals in controlling and stopping the spread of infectious organisms, Hospital Watch Live has been installed on the multi-organ transplant unit, an area of the hospital where all of the patients are on therapies to prevent organ rejection, which also suppresses their immune systems.
Response from staff on the unit has been enthusiastic because they believe that the data generated by the system will help them increase hand hygiene compliance, track equipment throughout the unit, respond to infectious disease outbreaks, conduct studies on techniques to increase quality and better protect staff from exposure to infections. This work should also reduce overall costs to the hospital.
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PHRs will need more than data to flourish

By Government Health IT Staff
Created 2012-02-13 08:58
A bit slow on the uptake, perhaps, but the business model for Personal Health Records is taking off. And the venture capital seeded in 2011 – an amount ranking second only to the vast health information management category – is set to yield new products and bolster existing ones. But will they really be ready for patients?
Raj Prabhu certainly thinks so. As managing partner of Mercom Capital Group, Prabhu explains that the investment money, some $83 million across a dozen deals, is being injected into fledgling PHR companies thinking of new ways to advance digital healthcare record keeping, taking personal health records in new directions to avoid going the way of Google Health.
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Open Health Tools, HIMSS to collaborate on open source standards

By Mike Miliard, Managing Editor
Created 02/14/2012
CHICAGO – Open Health Tools, a multi-stakeholder group of open source advocates, has partnered with HIMSS to help spur the development of open source technology in healthcare.
Open Health Tools (OHT), whose chief health informatics officer is Robert M. Kolodner, MD, the former national coordinator for health IT, seeks to build a "ubiquitous ecosystem where members of the health and IT professions can collaborate to build interoperable systems." Its members include government agencies from the U.S., U.K and Canada, as well as vendors large and small.
OHT and HIMSS have agreed to collaborate on several fronts, including the use of open source technology, conferences and resources, such as whitepapers and webinars. This partnership will result in a new effort to deliver healthcare industry-specific guidance and non-proprietary solutions that aid in enabling the national vision of secure and seamless exchange of health information, officials say.
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The Future of High-Tech Health Care — and the Challenge

By STEVE LOHR
| February 13, 2012, 1:16 pm1
Demos, talks and a paper-plate dinner buffet were the fare last Friday evening at the Computer Museum in Mountain View, Calif., and the subject was the high-tech future of health care. The gathering was hosted by FutureMed, a health-care program that is part of Singularity University, a networked organization dedicated to exploring how disruptive technologies can sweep across whole industries and society.
The technologies on display were impressive, often inspiring — like the wearable-robots, or mechanical exoskeletons, made by Ekso Bionics, to enable people with spinal cord injuries to walk again; or I.B.M.’s Watson question-answering computer that is being morphed into a doctors’ smart assistant.
Dr. Daniel Kraft, executive director of the FutureMed program, pointed to a series of fast-changing technologies including biotechnology, nanotechnology, robotics, artificial intelligence and the surge in new data to mine for insights, or Big Data. “Exponential technologies are all around us,” Dr. Kraft said.
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Overcoming the documentation challenges of ICD-10

By kterry
Created Feb 11 2012 - 2:02pm
Healthcare system managers know that the hardest part of moving to ICD-10 will be training physicians to document their work in ways that facilitate appropriate coding. Physicians are not necessarily motivated to change their workflow to justify more granular codes. And, with only a year-and-a-half to go before the October 2013 deadline, healthcare organizations have to begin engaging doctors now to spur more complete documentation before the number of diagnosis codes explodes.
The reluctance of doctors to change their documentation habits is a major reason why the American Medical Association [2] recently asked Congress and the U.S. Department of Health & Human Services to stop implementation of ICD-10. While the Medical Group Management Association has not gone that far, MGMA continues to cite [3] a study showing how much ICD-10 will cost practices in terms of lost productivity.
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Tackling Healthcare Priorities with Technology

Edward Prewitt, for HealthLeaders Media , February 14, 2012

Our fourth annual Industry Survey, comprising the views of over 1,000 healthcare executives from a cross-section of organizations across the country, shows technology as a fairly low priority—sixth out of 12 concerns. Health IT, EMR, clinical technology, and other types and uses of technology are a top priority for only 29% of leaders. Move along, nothing here to see?
Yet when you examine executives' highest priorities, technology isn't far under the surface. The top priority listed in our survey is patient experience and satisfaction. While the actions of physicians and nurses most directly affect patient care, caregivers today rely on technology to get their jobs done.
Obviously, clinical technology such as informatics is important in this instance, but healthcare IT also has a big impact. Electronic health records can play an enormous role in improving patient experience. Is anything more powerful in caring for a patient than comprehensive health information delivered quickly?
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Health IT Factors Into Leapfrog's Hospitals Rankings

Leapfrog Group's 2011 list of 65 top hospitals in U.S. highlights facilities that use health IT to prevent deadly dosing mistakes.
By Marianne Kolbasuk McGee,  InformationWeek
February 10, 2012
The Leapfrog Group has named the nation's top hospitals for 2011, and the list shines a spotlight on how health IT can help improve patient care--even preventing medical errors that can lead to adverse drug reactions and deaths.
Leapfrog, a consortium of employers and public and private healthcare purchasers, bases its annual ranking on a survey of hospitals' processes, quality of care, and patient safety. Its evaluation includes "stringent IT requirements," said Leah Binder, Leapfrog CEO in an interview with InformationWeek Healthcare. AdTech Ad
Approximately 1,200 hospitals--or about one quarter of U.S. hospitals-- participated in the 2011 Leapfrog survey. Sixty-five facilities earned Leapfrog's Top Hospital designation.
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Data breaches put patients at risk for identity theft

By Robin Erb, Detroit Free Press

DETROIT – Walk into a doctor's office and chances are that some of your most private information -- from your Social Security number to the details of your last cervical exam and your family's cancer history -- is stored electronically.
Your doctor might access the information on a cell phone that could slip into the wrong hands. The staff might take it home on a laptop or a flash drive.
As Detroit-area health care providers take multimillion-dollar steps toward electronic records, they're talking about more than efficiency and better care. They're talking security, too.
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Indiana health exchange taps AT&T to scale up

By Bernie Monegain, Editor
Created 02/10/2012
INDIANAPOLIS – Billed as the nation’s largest health information exchange organization, the Indiana HIE (IHIE) is poised to scale up and to expand its business plans, which includes the launch of a new professional services organization to serve other HIEs.
The HIE counts 10 million patients, more than 19,000 physicians, more than 80 facilities among its stakeholders. IHIE is responsible for what its executives call "an ocean of information.” That means more than four billion pieces of clinical data in the repository. The exchange delivers three million health transactions daily.
IHIE works with hospitals, long-term care facilities, clinics and physician practices throughout Indiana to ensure health information is where it needs to be, when it needs to be there to help improve care coordination and patient outcomes.
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CIOs Need To Engage Docs In ICD-10 Transition

Focus group suggests that CIOs need to get clinicians enthusiastic about the new diagnostic coding system, but they don't know how to make that happen.
By Ken Terry,  InformationWeek
February 10, 2012
Healthcare systems preparing for the ICD-10 transition are still not devoting enough attention to preparing physicians for the clinical documentation that will be required when the number of diagnosis codes jumps from 14,000 to 68,000 next year. That's one of the conclusions that Heather Haugen, corporate vice president of the Breakaway Group, a health IT consulting firm, and Breakaway CEO Charles Fred reached after they conducted a CIO focus group.
"The number-one finding was the lack of attention being paid to clinical documentation," Haugen told InformationWeek Healthcare. "The CIOs understood issues related to vendor readiness, their own application readiness, and coder training. But under 5% mentioned provider readiness and clinical documentation improvement." AdTech Ad
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Don't Squander Your EHR Investment

Why spend all that money on an office-based electronic health record system and not take full advantage of its features?
By Paul Cerrato,  InformationWeek
February 10, 2012
Despite the fact that more than 50% of office-based physicians have implemented EHRs, most practices aren't making full use of many of the most useful features, according to Rosemarie Nelson, a principal with the Medical Group Management Association Health Care Consulting Group. Nelson, who was cited in a recent American Medical News report, said neglected features include patient portals, e-prescribing, and electronic appointment scheduling.
Why the hesitation? For some medical practices, it's probably about cost because some EHR vendors require additional fees to take advantage of the plug-ins. For other practices, it might be that their already overworked staffs just don't have time to learn and deploy the features or maybe they don't fully appreciate what these features can bring to a practice. AdTech Ad
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Electronic tools can help reduce radiation risks from medical imaging

By danb
Created Feb 13 2012 - 2:23pm
Electronic tools that track the details of medical imaging procedures and clinical decision support tools integrated with a computerized physician order entry system can reduce the risk of radiation, according to an article [1] in the journal CA: A Cancer Journal for Clinicians.
Specifically, electronic records of imaging procedures could help reduce unnecessary repetition in testing, the authors wrote. For example, in a retrospective review of medical records for 459 patients who underwent CT and MRI exams in Washington state, more than a quarter of the tests were deemed inappropriate. What's more, only 24 percent of those inappropriate tests led to positive follow-up care.
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Enjoy!
David.

Friday, February 24, 2012

What Impact Will All The Political Ructions Have On E-Health? It Seems There Was Some Real Disagreement and Turmoil in Health.

It seems the present war between PM Gillard and Former PM Rudd is flushing out all sorts of material.
Examples include the following:

Roxon attacks Rudd over health reform

Former health minister Nicola Roxon has launched a scathing attack on Kevin Rudd, accusing him of ignoring cabinet over "very big decisions" on health reform during his three years as prime minister.
Ms Roxon, now attorney general, spent four years in the health portfolio attempting the biggest reforms of the system since the introduction of Medicare.
But in an interview with the ABC World Today program on Thursday she said there were "big components of health reform" which she and Mr Rudd disagreed about.
"I think that there was a point in the [Rudd] prime-ministership where a proper cabinet process was not used," she claimed.
"Some very big decisions were being contemplated, in health in particular, that's of course the closest experience that I had, that often there was an inclination to want to go and announce those things without there being proper cabinet discussion or consideration of the downsides rather than just some of the political or potential upsides."
She added: "Now I've chosen not to go into this sort of detail before and I don't really want to go into it now. But I don't want [Labor MPs making the decision who should lead the party], without having their eyes open about the sort of government we would go back to if Kevin was the leader."
Ms Roxon who will supporting Julia Gillard in the expected leadership ballot next Monday, was asked whether it was true that health reform was Mr Rudd's "abiding passion" as he claimed.
More here:

Roxon warning: Rudd is not the 'messiah'

23rd Feb 2012
NICOLA Roxon has slammed ousted prime minister Kevin Rudd for his leadership style during her time serving as health minister in his cabinet, as the former PM heads toward a showdown to regain the Labor leadership next week.
With a ballot set to take place on Monday morning next week, the now Attorney-General Ms Roxon said Labor MPs needed to get over the idea that Mr Rudd is the "messiah" who could win the next election.
Ms Roxon, who was charged with the task of seeking sweeping health reforms for the Rudd and subsequent Gillard governments – and is a strong supporter of Prime Minister Julia Gillard – says Mr Rudd has many strengths and achievements but his recent conduct has been extremely unhelpful.

"We need to get out of this idea that Kevin is a messiah who will deliver an election back to us. That is just, I think, fanciful," she told ABC TV.

It wouldn't be good for the country to have Mr Rudd as prime minister again, Ms Roxon said.

"He was very difficult to work with. There were a lot of challenges," she said, referring to Mr Rudd's time in the top job and his rolling by Ms Gillard 20 months ago.

"People might say that we were too polite ultimately about the way we did it. We didn't air all our dirty linen. I don't really want to air it now, but the truth is that decision was made for very strongly-held reasons that are just as important now.

"Government has to be able to function properly so we can deliver for the community."
More here:
The PCEHR was announced in the 2010 budget which was released May 11,2010.
PM Rudd was deposed on the 24 June, 2010 so it looks like the PCEHR program was conceived and budgeted for when cabinet government was out the door and according to the then Minister Roxon just was not working. This from the above article seems typical.
"Some very big decisions were being contemplated, in health in particular, that's of course the closest experience that I had, that often there was an inclination to want to go and announce those things without there being proper cabinet discussion or consideration of the downsides rather than just some of the political or potential upsides."
I wonder is the reason we have this rushed, ill-considered mess anything to do with the surrounding chaos we have now become aware of?
A look at this page (expanded) shows how much fantasy was in the original announcements.
It looks to me like there is a real chance the Government processes really were not working when we were gifted the PCEHR and that is why it was so ill considered and under-consulted upon. I wonder how much Cabinet time was spent on it?
Fun to consider!
This link is also fun - where Ms Roxon claims Rudd wanted to rush to a referendum on the Federal Takeover of the Health System.
See here:
http://www.medicalobserver.com.au/news/rudd-wanted-referendum-on-federal-health-takeover

For the future - we really need it to be totally different to what has happened in the past in my view! 
It also seems pretty unlikely we will see the outcome of the PCEHR enquiry  on Wednesday. At least 1/2 of the Committee will have other things on their minds for a while.
As for what is now going on in Canberra I think it is awfully serious and I am concerned about all our futures unless what finally emerges is a rational and unified Federal Government  of either stripe. Right now it is a bit hard to see that happening any time soon!
David.

Thursday, February 23, 2012

Now Here Is An Approach That Might Actually Make A Difference! Fascinating Stuff.

The following appeared a few days ago.

Scarborough first with TPP record viewer

9 February 2012   Rebecca Todd
Emergency physicians at Scarborough Hospital say introducing a GP clinical record viewer has been like “turning on a light."
Lead A&E consultant Dr Andy Volans says staff can barely remember how they coped before TPP’s new CRV went live on 25 January.
The viewer allows hospital clinicians to access a read-only view of the patient’s full electronic record held by a TPP practice. It is currently being used in A&E but will be rolled out to other departments.
Dr Volans said the viewer was especially useful when dealing with the area’s large nursing home population.
In the past, elderly patients would often arrive in A&E with no GP letter, nobody from the nursing home to explain why they were there, and unable to communicate their own medical conditions and medications.
“Consequently you’re working a bit blind, so we’re particularly targeting those patients so we know what the GP knows about them,” he explained.
Staff must use their role-based smartcards to access the viewer.
Admission, Discharge and Transfer (ADT) messaging is used to communicate between the CRV and the hospital's patient administration system, which, at Scarborough, is iSoft's iPM.
When a patient is registered on the PAS, a message is sent to the CRV, so the hospital can retrieve the patient's SystmOne record, subject on their giving consent.
A template pulls down relevant information, including most recent acute illnesses, any chronic illnesses, acute drugs, blood pressure readings, and the last three attendances or clinical interactions with a GP.
More here:
This is an astonishingly good story and makes a it makes great deal of intuitive sense that such a system could really make a difference in a local area. The concept of an access only view makes a great deal of sense as does the smartcard access control.
Of course there are always caveats - and here they come from across the Atlantic from the example above.

5 Considerations for Hospitals Releasing Medical Records to Patients Electronically

Written by Sabrina Rodak | February 13, 2012
In September the Office of the National Coordinator for Health Information Technology launched the Consumer e-Health Program to encourage individuals' engagement in their healthcare. One of the major goals of the program is to provide patients with easy access to their medical records. To accomplish this goal and others, ONC created the Healthy New Year Video Challenge and is developing an animated video to explain the value of health IT to consumers, among other initiatives.
Hospitals are also encouraging patients to take a more active role in their care by providing easy access to patients' lab reports and other medical information. Jan McDavid, general counsel and compliance officer, and Steve Emery, director of product management, at HealthPort share five considerations for hospitals when providing patients with electronic access to their medical records.
1. Compliance. Whenever dealing with patients' protected health information, hospitals need to ensure compliance with HIPAA and other applicable federal laws. HIPAA requires patients' records to be provided within 30 days of their request, barring certain exceptions. For instance, if a physician decides providing the full record is not in the best interest of the patient, the physician may withhold certain parts of the record.
Hospitals also need to be aware of laws of the state in which patients' medical records are located. Ms. McDavid says in general, that when federal and state laws differ, hospitals should follow whichever set of laws is stricter. She suggests hospitals' privacy and security officers constantly educate themselves on updates to the law and the specific facility's policies regarding patients' medical records. Policies may include requiring documents with confidential information to be shredded, prohibiting the sharing of passwords, and mandating training on HIPAA.
2. Security. Hospitals releasing medical records to patients need to consider both the physical and electronic security of the records. For example, Ms. McDavid says hospital officials should ensure restricted areas are enforced if a computer containing patient records is located there. In addition, computers with screens that can be seen by patients may need privacy screens. Hospitals may also need to develop policies on where to store patients' charts, which are typically placed outside the patients' doors and are easily accessible to unauthorized individuals.
Furthermore, computers and the hospital network need to be electronically secure to prevent viruses and people from accessing information. A best practice for securing medical records is encryption. While encryption is not required by law, it lessens the reporting requirements if breaches occur, Mr. Emery says. Another best practice for securely releasing medical records to patients is two-factor identification. For example, the hospital would send the patient an email with a link to a website that hosts medical records. The patient would then have to authenticate his or her identity with personal information and a password to access the records.
3. Content.
4. Format.
5. Portal.
Learn more about HealthPort.
More here:
Again this is a fascinating discussion of the issues you face when opening access up to the EMR for the patient. In the UK you are at least giving access to another clinician who will typically ‘get’ what is said! It might be just that much harder with patient access!
As I have said before we really do live in some exciting and interesting times and I have to point out that this sort of innovation rather makes the PCEHR so 1990’s!
David.

Wednesday, February 22, 2012

Senate Estimates Hearing - NEHTA - Wednesday 15 February 2012. Transcript and Comments.

Here is the relevant part of the transcript with some comments in italics.

Community Affairs Legislation Committee - 15/02/2012 - Estimates - HEALTH AND AGEING PORTFOLIO - National E-Health Transition Authority

National E-Health Transition Authority

CHAIR: I suggest that we move to e-health, outcome 2, and then we will go from there.
Senator BOYCE: Is Mr Fleming here?
CHAIR: I hope he is, because I have a statement to make for Mr Fleming. I will put a statement on the record first with Mr Fleming.
During a recent hearing that we had on the e-health legislation I actually made comments on record which stated that Mr Fleming and NEHTA had not returned questions on notice in time. Mr Fleming, I received your letter, I was incorrect and I want to put it on public record that my statements were incorrect and that your responses were on time. They may not have been to the satisfaction of everybody who was receiving them, but absolutely they were on time and I was wrong. I want to make sure that people know that that has now been retracted publicly.
We will move on to questions. Could we have the officers and NEHTA together? Do we have enough space for the officers and NEHTA to be at the table together?
Ms Halton : Why not start on the questions and then we will decide who can fit.
Senator BOYCE: The questions go to the issue of the standards that are being used by the PCEHR. Perhaps I should also, Mr Fleming, make a short statement pointing out that the error about the timeliness of responses in fact came out of my office. We have looked at this very closely, of course, having received your letter from the chair. It appears to be a process issue where we thought we were asking questions of NEHTA but they were, in fact, transferred over. Our log of answers from NEHTA was different from where, in fact, the answers were coming from.
Ms Halton : So the wrong box was ticked or flicked or crossed?
Senator BOYCE: We were not aware that the questions were being transferred. We were still waiting for responses from you, when in fact they were from elsewhere, as I understand it.
I think we started out with over 500 standards being intended for the PCEHR; is that correct?
Mr Fleming : I have with me Mr David Bunker who heads up our architecture group. That standards team is part of David's, so I might ask David to go into more detail, if required, and also Dr Chris Mitchell, who works in the clinical change and adoption side of the team is here.
The standards are actually grouped into 23 separate bundles. There are a number of components within there, so we tend to talk more in terms of the 23 specific bundles of activity that are attached to the work that we are doing. David, did you want to comment?
Senator BOYCE: I appreciate there are 23 bundles. I understand that we started with a situation where you were expecting up to 500 standards and I think you are down to 17 now; is that correct?
Mr Bunker : I am the head of architecture at NEHTA. I am also responsible for standards and security and also our reference-platform-demonstrator-environment software developers. It is probably worth separating specifications and standards so that we are clear. Certainly, NEHTA wants to make use of standards wherever they exist. During the process of understanding the relationship of standards to the design of the PCEHR, and certainly e-health more broadly, what we have done is identify the standards that we can make use of that exist in the marketplace and that exist and are common in Australia.
Senator BOYCE: How many of those are there?
Mr Bunker : In order to achieve a design for the PCEHR system that was based on standards and that would adopt an approach that would use standards and identify novel standards where required, we conducted an extensive piece of work that identified a number of areas that were specific to certain standards. So there were 140-something areas that were actually used to identify the sets of areas within the PCEHR design where standards would be relevant.
Mr Bunker : Through the process of design we have identified what specific standards can be applied. So there are obviously—
Senator BOYCE: Existing standards?
Mr Bunker : Existing standards that can be applied. In the specifications and standards plan that we put into the market late last year we described the use of those standards where there are existing ones, but importantly, also where there is a requirement for a new standard that actually describes certain components of the PCEHR—for example, the clinical information in an event summary, and how that might be moved around.
The specification bundles that were described in that standards and specification plan describe the specifications that NEHTA is producing to support the market to adopt and build to the PCEHR system.
Senator BOYCE: Is it not true, though, that if you are going to be involved in delivering services to the PCEHR you cannot use one standard and not another standard? You need the suite of standards, don't you?
Mr Bunker : That is correct. There are obviously a number of standards, including very technical standards and standardised information components, that support interactions with the PCEHR.
Senator BOYCE: What is currently in the suite of standards that people seeking to provide services or products to the PCEHR would use?
Mr Fleming : If I understand the question correctly—and tell me if I am off track—we have created a website that has all of the specifications that are involved here. In that context I mentioned that there are 23 bundles. For each bundle there are three separate groups of documents. The first group is the information requirements document, which is a high-level definition of what is required, and generally those documents are about 40 pages in length. So it is 40 by 23. Then there is a structured content series of documents. That goes into the detailed specifications and lists all that information. Generally, they are about 300 pages in length. There is a lot of information in there—and once again by 23.
Then there is a third set of documents, which we call the CDA implementation guide. They are about 450 pages in length each. What we do there is provide examples—for example, example code. So we have talked about the standards and then we provide code that shows how that would work. If I hear your question correctly, for each set of specifications, the 23 sets, there is probably over 1,000 pages of documentation that define, in various levels of detail, all those components. That is up on our website and available for all vendors to use. There are also processes that we have in place to provide education and training in that environment.
So we are talking about of the order of 20,000 pages of documentation. One really wonders how all this can be digested, interpreted and implemented. Quite a challenge!
Senator BOYCE: I will go back and then I will follow up on that. Mr Bunker, just to get this on record, how critical are those standards to the architecture, the functionality, the performance and quality of a PCEHR system?
Mr Bunker : Obviously they are critical. It is very important. Certainly NEHTA is, as I said before, committed to this process of seeing these specifications progress through the Standards Australia process. NEHTA has developed the specifications through consultation and engagement with the sector, and has described the interfaces and the design through those specifications, which make use of existing standards. But for a number of those novel requirements we have identified a number of new standards that we would seek to progress through the Standards Australia process. Obviously, we have been working with Standards Australia. They have been very supportive, as has the IT14 community, to actually help us to develop the specifications and standards plan because they are so critical.
I wonder how the IT-14 Volunteers are going to work through all this in other than geological time.
Senator BOYCE: I would like to go to the answer you gave me to question on notice 465 from the last estimates. You said there were 16 areas of standard specifications that were complete and that had been tested. You go on to say they are available on the website for vendors with guidance material on how to implement the specifications. Where are they on the website?
Mr Bunker : Mr Fleming has described what some of the key components of those specifications are. Those specifications—
Senator BOYCE: You told me there were 23 bundles and we have 16 areas.
Mr Bunker : Those specifications are available on the software development learning centre through the national change and adoption partners portal environment. That environment makes the specifications as well as a number of supporting documents available to support vendors interacting with those specifications. But it is not just the website. Obviously there is a lot of communication we have. We have regular webinars with our vendor community so that they can ask questions and get updates and information on what the development status is of different components.
Senator BOYCE: I have vendors telling me that they are not on the website and they are not in your standards catalogue. Why would that be?
Mr Fleming : I guess the only thing I can say is that if someone can look at the website you will see them there. So the answer that we have provided—
Senator BOYCE: They are openly available to anybody who wants to view them? They are not restricted in any way?
Mr Fleming : No, there is a process for logging on. We do ask people to log on so that we know who is accessing them. The reason is that as things are added and the information is made available, we can then provide prompts to let people know they are there. That information is available. As Mr Bunker mentioned, there is a regular webinar with vendors. They should all be aware of that.
Senator BOYCE: With respect to what is on that website, I will have to go back because when I am stuck or they are not there and they are not complete, as is being told to me by vendors, I have to go backwards and forwards to try and see where the truth is.
Mr Fleming : We would be very happy to sit down and show you. They are there; they are available. Clearly, in that answer, where we referred to the 16, with the information in which we indicated there was a problem with the CDA guides for five of those, that might be what is being referred to there. But that information is there, it is available and we are happy to show anyone.
Senator BOYCE: Does this mean I can use that information today if I were a software developer?
Mr Fleming : Absolutely.
Senator BOYCE: It is fit for practice?
Mr Fleming : Absolutely. I will give a couple of examples. We have a national infrastructure partner, Accenture, who are building the PCEHR system. They have used those specifications; the system is built and is being finished. Components are in test at the moment. They have done it; they are building to that. We have our wave site partners, in wave 1 and 2. They are building to those specifications with us. Clearly, we are going through lessons learnt. But that is happening today, yes.
Senator BOYCE: What about other companies that are looking to become involved in the PCEHR? Are they fit for use for those companies? Are they complete?
Mr Fleming : Absolutely. We have made it very publicly available if people wish to use them. Not only are they available to use but we would like to provide them with help, assistance and processes, if they have questions.
Senator BOYCE: You have told me that there are 23 bundles of specification and yet software vendors and others wanting to use the site say there are only two that are fit for use five months out from the launch of the PCEHR. Can you give me any reason why people would be saying that, Mr Fleming?
Mr Fleming : We have a regular meeting with the ICT forums. One of those occurred yesterday. That was stated to me and I asked if that point could be substantiated and there was no substantiation of the point. So the bundles are there.
Senator BOYCE: Doesn't that comment concern you? Did you go back and verify for yourself that it was wrong?
Mr Fleming : When that statement was made to me I said 'please explain', because as far as we are concerned not only can they be built to, but they are being built to. When I asked for examples, none were forthcoming. I am very happy for people to come to me and say, 'This is our problem', but a statement like that needs to be substantiated and no-one has substantiated it. There are people using it and building to those systems now.
CHAIR: Mr Fleming, was yesterday the first time you heard that comment? You actually said in your response when you heard that—
Mr Fleming : Yesterday was the first time I heard that comment. It was in a meeting.
Senator BOYCE: In terms of the use of the standards to develop product to be used in the PCEHR, I am using really broad terms so that I do not inadvertently narrow my inquiry field because I do not know how broad my inquiry field really should be. Accenture and the wave 1 and wave 2 people have been using these bundles of specifications and standards that you have mentioned. What is the feedback on them? Has there been any evaluation of the use of them et cetera?
Mr Fleming : Yes, there has been. I do not have that detail with me. If you do not mind, I will take it on notice to give you a more substantial discussion than I can provide here. The purpose of the wave sites has been that we can work with them. One of the things we have said quite publicly is that it is one thing for us to sit in an office and write specifications and it is another thing to see how it works in the real world. The purpose of the wave sites is to test them through. Most of the problems have not been in the technical specifications; they have been more things like: 'Okay, that's great; now how do I get that inculcated within my work flows? What does it mean if I have to register an HPIO et cetera?' It has been more in those areas. The things we have learned have been quite interesting and clearly we have adjusted our processes accordingly. But if I could take it on notice, we will provide you with a full list of those learnings.
This is a very strange exchange. I wonder why the Senator is being told information that is at such variance to what Mr Fleming is saying?
There is no doubt that July 1 will see a log-on screen. I wonder why no-one asked what you will be able to do what you have logged on!
Senator BOYCE: Would you say that the testing that has so far gone on constitutes real world testing of the products developed using the standards and specifications that you have on your website?
Mr Fleming : There are multiple components to the testing that we do, as you would expect. That includes fairly basic unit testing right through to systems testing, integrated testing, clinical testing and testing whether it is fit for purpose. The testing we are now doing, particularly with some of the earlier needed products that we are actually implementing in GP practices, is real world testing. That is occurring.
Senator BOYCE: That is the wave 1 and wave 2.
Mr Fleming : Absolutely. That is part of why we are doing this, to see what it means, with obviously a lot of hand holding because there is a learning curve that goes on.
Senator BOYCE: You had a pause there.
Mr Fleming : Absolutely. As we have learnt, there were some issues in the CDA.
Senator BOYCE: Are they back on track now?
Mr Fleming : Yes. The actual problem that was detected has been fixed and we are currently testing that. One of the things that we do, which is part of our testing, is that we build out the system ourselves. So for everything that we write a spec for we actually build. We are testing building that. We also had an external process called CCA, certification, compliance and accreditation, which we run through NATA, not NEHTA; therefore there are test labs, external labs, that are accredited through NATA. So anyone who is implementing these systems needs to go through those conformance checkpoints too. So there are very many tests as part of this process.
Senator BOYCE: The product is being developed by Accenture. Have they been subject to real world testing, Mr Fleming?
Mr Fleming : Accenture is developing the national infrastructure for the PCEHR.
Senator BOYCE: So it has not—
Mr Fleming : That build will be completed and available for registration on 1 July. We are in the process of receiving the first component of that, called 1A. We have detailed tests that we do there. We have invited a number of vendors to come and assist us through that process. It is early days for testing.
Senator BOYCE: What do you mean by that?
Mr Fleming : It is one thing for us to test but it is also another component to get vendors in to test their systems against the specs, their interfaces, to see how that works.
Senator BOYCE: When will that testing be complete?
Mr Fleming : There is a test program that will run through right into late June and it is starting now.
Senator BOYCE: Late June?
Mr Fleming : And it is starting now. As you would expect with any system going live on 1 July, there will be various tests that we will do all the way through.
Senator BOYCE: The end result of this will be that the first real world testing of the Accenture system will be when this scheme becomes operational on the government's current deadline of 1 July.
Mr Fleming : Real world in the context of consumers registering for an electronic health record. However, there will be a huge amount of testing with us and with vendors to test the systems process—with the assistance, wherever possible, of our wave sites et cetera—and to test the various environments and configuration. But it will be 1 July when the system goes live that obviously—
Senator BOYCE: I am not sure that everyone is as confident that it is going to go live on 1 July.
Mr Fleming : Senator, this is a very large program, as you are aware.
Senator BOYCE: I realise that.
Mr Fleming : In that context, the types of issues, for instance, that we saw with the specifications were not good, but you expect problems in a large program. Generally, there is nothing that we see that would indicate that we will not be ready for 1 July. We are on track.
Senator DI NATALE: I suppose the first question relates to something that took up a significant amount of time in the recent inquiry—that is the no-access consumer control issue. Is it true to say that NEHTA took the decision to remove the no-access consumer control from the concept of operations? Was that against the advice of the consumer reference forum?
Ms Halton : That is a departmental issue, Senator.
Senator DI NATALE: What does that mean?
Ms Halton : You will have to ask departmental officers, not NEHTA. I am happy for them to come to the table and answer your question.
CHAIR: We are on NEHTA at the moment Senator, if there is anything particularly for NEHTA, and then we will get the officers from the department to come to the table.
Senator DI NATALE: Has NEHTA set any hard targets for consumer inclusion and adoption? Have you actually got hard targets?
Mr Fleming : There are obviously a number of groups working on this program. NEHTA is managing agent for the Department of Health and Ageing regarding PCEHR, and then you have the COAG component of the program as well. In that context one of our partners is NCAP, the National Change and Adoption Partner. They have produced a number of different scenarios as to what might happen depending on certain environmental triggers. We have not locked in any targets—nothing has been approved—but there have been various scenario mappings that indicate numbers in terms of consumers' conditions that could be achieved over time frames.
Senator DI NATALE: What are some of the assumptions that might change?
Mr Fleming : There are various assumptions. One of the assumptions we have looked at, for instance, is that the market will remain as it currently exists—no incentives et cetera—and what that might mean in terms of uptake of the program. The first assumption is: in that environment what does that mean? There are assumptions in terms of what would happen if there were certain target groups and what that might mean. There are clearly groups that would benefit significantly from this, such as those with chronic disease—
Ms Halton : Diabetes, for example.
Mr Fleming : There has been nothing locked in there. That is a policy decision.
Senator DI NATALE: And incentives? You have done some modelling around incentives?
Mr Fleming : No. Once again they are policy decisions.
Ms Halton : That is not a matter for NEHTA.
Senator DI NATALE: I am happy to move on. The suspension of the pilot e-health sites: is that something I can talk to NEHTA about?
Mr Fleming : Absolutely.
Senator DI NATALE: How long did it take NEHTA to identify the software incompatibilities that related to the suspension?
Mr Fleming : The issue we had, as I mentioned earlier when Senator Boyce was asking some questions, was that there are three types of documents that we produce. The information requirements documents were correct; the structured component documents were correct, so the real specs; it was the CDA implementation guide, so the examples, where we had some issues. What had happened was that because we have work that we are undertaking with wave 1 and wave 2 sites, we provided some early guidance to those sites back in May this year. 'Here's the draft specifications, this is what it looks like,' and then we continued to work to build those specifications out with the rest of the industry. What happened, and it should not have happened, was that we did not fully manage our change control, so that when we published the final November specification, we did not give the full change control log to the wave 1 and 2 sites.
Senator DI NATALE: Can you explain 'change control' to me in English?
Mr Fleming : Change control simply says, 'Here's version 1 and here's version 2 and this is the difference.' The difference could be anything. So we gave them a change log but not with everything in there. That was the gap. We have had to go back and update that change log to reflect those changes. For example, if you are a software builder, you have built to this early draft, you need to know what the differences are with examples so that you can change to the new specification. That was a gap. In terms of fixing that, the problem is fixed but we are going through and testing that at the moment. It has caused, in terms of the wave site, about a six-week delay on where they were at. We work very closely with those groups, as you would expect. Therefore we are working closely with them to see what we can do to continue and minimise the impact of that. It is a large program, as I mentioned, so whereas it impacts that component, it does not impact the delivery of PCEHR and the ability to register on 1 July. That is a separate—
Ms Halton : The national infrastructure, basically.
Mr Fleming : That is a separate component.
Senator DI NATALE: How much do you think the suspension cost the project?
Mr Fleming : This is a high level so we are still dotting the i's here. It does not look like it has cost anything in terms of dollars, because the work that we have to do to transition our wave sites across to the national infrastructure had to happen anyway. We have had to put a slight delay on the work. We have been able to rejig those processes. It does not look like financially it will cost us anything. Time-wise, it is probably about six weeks.
This really tests credibility - surely redoing the work to update and correct the specification must have a cost - or is the staff level so high that the extra load is able to be absorbed painlessly!
Senator DI NATALE: Can you tell me about the basis on which the nine organisations were selected to participate in wave 1 and wave 2? What were the criteria?
Mr Fleming : Twelve organisations were selected. There is a process we went through with the first three. They are groups that have had a very strong involvement in e-health from day one with amazing experience in terms of change management contracts. So they were chosen because of their experience and we knew that, no matter what would happen in terms of tenders et cetera, these were groups that had a huge amount of experience that we needed to use and learn from. They were chosen on the basis of their knowledge. The nine other sites were chosen through a tender process which followed the Commonwealth procurement guidelines. There were separate officers on there evaluating that, so it went through the full Commonwealth procurement process.
What this is saying is the Wave 1 was selected on a nod and a wink and only with Wave 2 was a proper tender process conducted.
Senator DI NATALE: On what basis were the sites chosen? What were some of the criteria that were used?
Mr Fleming : There were a number of different criteria. I will provide that on notice. At a high level, the intention was to be able to drill down into specific areas of interest and also to get a reasonable demographic footprint.
Senator DI NATALE: I have some questions about the Office of the Australian Information Commissioner, which has been nominated to conduct investigations relating to the PCEHR. It seems like a fairly substantial task. What are the additional resources that will be given to that office?
Mr Fleming : That is a policy matter for the department.
Senator DI NATALE: Again, with the intention of the department that the system operator of the PCEHR will notify consumers of breaches. Is that something you want me to put again to the department?
Mr Fleming : Yes.
Senator DI NATALE: Good. I am done.
Senator BOYCE: I have a follow-up question, for the sake of the record. How many patient records do the wave 1 and wave 2 suppliers currently have or are dealing with?
Mr Fleming : I am not sure I fully understand the question.
Senator BOYCE: They are developing EHRs, whether they are PCEHRs or PEHRs, which perhaps is the difference, but how many records have they got?
Mr Fleming : There are some high level targets for each of the groups. Once again, I will provide that on notice. Off the top of my head, as part of the wave 1 sites, there is a requirement for about 400 GP practices. It is probably best if I provide it on notice because I will give the wrong numbers.
Senator BOYCE: It is the individual records that I am after. We are talking about less than a million, aren't we?
Mr Fleming : I will provide those numbers separately, if that is all right. They are fairly significant numbers though.
Senator BOYCE: Fairly insignificant?
Mr Fleming : Significant. We spoke about wave 1 and, as you are aware, that is Brisbane, Melbourne east, Hunter et cetera. But when you start moving then into the wave 2, where you have got Medibank and quite a significant number of records there, such as the FRED project, in terms of medication management, the numbers are actually quite significant. I will provide a table with them.
Senator BOYCE: I was thinking while Senator Di Natale was asking his questions that if you have a glitch like this—which probably affects significantly under 20 per cent of the potential e-health records in Australia—with a much bigger, more complicated system which actually allows for personal control, is the likelihood not far greater for problems, glitches, to emerge?
Mr Fleming : The specifications that we are talking about were not things that are being used—
Senator BOYCE: It was a process problem really, wasn't it?
Mr Fleming : It is not things being used in production. This is early work where we were defining specifications and working through those with a number of vendors. It was not a production system. This was picked up as part of our normal—
Senator BOYCE: As you point out, the wave 1 people were in fact people with strong and lengthy experience in the area.
Mr Fleming : Correct, which is why we are working with them. Once again, in that context, this was working with them. It was not into the GP practices or with the consumers at that point in time.
Senator BOYCE: There was still a process issue which led to a six-week pause.
Mr Fleming : Yes, as we learned lessons, but that is part of a process of development. If the question was: what does that mean in terms—
Senator BOYCE: I as a lay person would have concerns, and I imagine most people would, over a glitch of this sort occurring in a simpler system without personal control with less than 20 per cent of the health records of Australia. This would perhaps send up some warning signals about a more complex, personally controlled, vastly greater system.
Mr Fleming : In this context the problem we had was with the specifications. What we are doing is writing some specifications, then building it ourselves, then building it with vendors and then, once we have got that right and we have tested it, move it into local areas and so on. The specifications were written. We are now testing with the vendors. It is very early days. It is not yet in production. That is the reason why we are doing it in those early wave sites, to pick it up and make sure it is scalable. We are not implementing a component of it; we are doing the full build with them to see how it works in a local environment and therefore how it will scale. That is the very reason why you do those early implementations, to pick that up and make sure it does not scale into—
Senator BOYCE: Thank you, Mr Fleming.
It is hard to make much sense of this also. I wonder why it is so hard to get clarity as to what is really going on and what the plans actually are?
CHAIR: There being no further questions for NEHTA, we will move to the officers of the department on e-health.
Senator DI NATALE: My question was about the no-access consumer control from the concept of operations and the fact that it was removed, against the advice of the consumer reference forum. Is that correct?
Ms Huxtable : The process of developing the concept of operations was subject to significant consultation. There were a range of issues about which there were different views. Those issues were worked through with a variety of organisations. There were a variety of views put on the table. In regard to that particular issue, as we discussed at the inquiry, there were views on both sides and at the end of the day there was a middle road found, I guess. That was the decision of government in terms of the features of the PCEHR. So that is in the addendum to the concept of operations. That issue is resolved. I could not tell you in respect of particular stakeholder groups what their particular views were. There were 165 submissions on the conops. There were targeted discussions with stakeholder organisations in addition to that. Through that process a whole variety of views were put on the table.
Translation: We consulted a few groups and made up our own mind - without providing much in the way or discussion or reasons.
Senator DI NATALE: That is fair enough. The next question relates to the Office of the Australian Information Commissioner. As I said, it sounds like a huge task. What are the additional resources that are going to be given to that position?
Ms Huxtable : That really goes to issues around future funding for the PCEHR and there is still consideration being given by government to the features of that. I do not think I am really in a position to answer that question directly. I do not know if anyone election se has more to add.
Ms Halton : Other than to acknowledge that we know it is an issue.
Senator DI NATALE: Aren't we going live in a few months?
Ms Huxtable : There is a budget between now and then, Senator.
Senator DI NATALE: I realise that. I would have thought there would have been perhaps a little bit of planning around that.
Ms Huxtable : There has been plenty of discussion.
Ms Halton : Certainly planning.
Senator DI NATALE: Are you prepared to say anything else?
Senator BOYCE: Watch this space, Senator Di Natale; that is what I think is being said. It would be fairly unusual, would it not, that the funding to just be cut off? Surely there would be forward estimates for this in normal circumstances, wouldn't there?
Ms Huxtable : The decision in respect of the PCEHR, as you will recall, was a two-year funding decision. When that decision was taken in 2010 there was $466 million allocated over the two years. So that money does end on 30 June 2012. There may be other elements—
Senator BOYCE: No-one was expecting they would need to spend another cent on the PCEHR in the next few years?
Ms Huxtable : As the secretary said, there is ongoing consideration being given to the next stage
Senator BOYCE: Are there any other programs within the department of health where there is no funding in the forward estimates despite the fact that the program is going to continue?
Ms Halton : I will take that on notice, Senator. I think there probably are.
Senator BOYCE: Where they are intended to continue?
Ms Halton : Yes, Senator.
Senator DI NATALE: Would it be fair to say that it is something that the department has given some thought to and actually has some planning in place? You are going to go live in a few months. It is hard to think, particularly initially, that there is not going to be a need for significant resources within the office.
Ms Halton : Lots of thought, Senator. We can promise you lots of thought.
Senator DI NATALE: I will be watching with interest.
Ms Halton : By the bucket load.
We have to read this to suggest that DoHA thinks more money is coming and that it will be in the Budget. Watch this space as they say!
Senator DI NATALE: Is it the intention of the department that the system operator will notify consumers of all breaches?
Ms Huxtable : I probably need to get some support on the detail of the legislation.
Ms Granger : Yes, that is in the approach to the legislation: that we will be notifying breaches.
This sound a little vague but is better than what I recall has been said previously.
Senator BOYCE: I just want to confirm this because I have some questions on telehealth and NBN. I am told it comes under you, Ms Huxtable; is that right?
Ms Huxtable : I believe telehealth would be under outcome 3. It probably depends a bit on the question. The telehealth measures are under outcome 3.
Senator BOYCE: They are around the pilot projects in Townsville, New England and Illawarra.
Ms Halton : That is the department of communications, actually. If it is the money that is being spent on the pilots which comes out of the department of communications—
Senator BOYCE: Can I perhaps flip through my questions? You can tell me 'don't worry' but I would hate to—
Ms Halton : Yes, sure. We might be able to answer some of them. Certainly, with the pilots, we do not control those funds, and they are definitely controlled by communications.
Senator BOYCE: The first question I have is: what number of diabetics must the Townsville study recruit to have sufficient power—credibility—to achieve significant findings? Is that something that the department of communications is going to be able to tell me?
Ms Halton : What I can tell you is that the department of communications has worked with us on their pilots to do with the NBN. I suspect that the best thing to do with those kinds of questions is to take them on notice. We will have a conversation and get you an answer across us and the department of communications.
Ms Huxtable : I have just been told that this is a Broadband measure, not one of our measures. I think the questions would need to be directed to them.
Ms Halton : We will put them on notice.
CHAIR: We will be able to see what engagement Health has had, because I imagine the numbers of diabetic people would have to somehow come back through some area of Health. If not, we will get them to Communications for you.
Senator BOYCE: I wanted to also ask some questions about the $20.6 million fund to conduct the trials using the NBN. Did DOHA contribute any funds to that?
Ms Halton : No. I will correct this if I am wrong, but I am sure I am not. The funding has come through Communications. When they were identifying priorities for these early rollout initiatives, there was quite a lot of dialogue with us on the kinds of things that are relevant to the practice of health: how you connect into the home et cetera, including with the consultants—I am almost loath to say that word—who were advising that department. Those consultants came and talked to a number of people, including me, about those projects. As I said, the measures, the money, is through that department.
Senator BOYCE: Through the department of communications?
Ms Halton : Yes. We will take it on notice.
Senator BOYCE: But I understood you were contributing half the funding for the telehealth trial.
Ms Halton : There is a difference. We have other things on telehealth. I think we need to see the questions in precise detail.
Senator BOYCE: What things have you got on telehealth and the NBN?
Ms Halton : We have telehealth measures.
Ms Huxtable : Incentives.
Senator BOYCE: Does that include the NBN? Are they related to the NBN?
Ms Huxtable : No, not directly.
Ms Halton : No.
Senator BOYCE: It is around the two trials that are being done with telehealth and the NBN that I am interested.
Ms Halton : The officers who can talk about telehealth more broadly are not here because that is not in this area.
Senator BOYCE: When would they be here?
Ms Halton : They should be around shortly.
CHAIR: We will make a note.
Senator BOYCE: I do not necessarily need to ask all the questions now. I just want to be sure where I should be doing this.
Ms Halton : The people from medical benefits at 5.15 can certainly talk about our engagement.
Senator BOYCE: Thank you.
CHAIR: Thank you to the officers from e-health; I think we can say we have covered that area.
----- End Transcript.
It seems like it was a rather wasted hour or so but at least we seem to have confirmation some funding will continue and breaches will be notified. Progress I guess.
It is also useful to see the Greens are taking an interest via their medically trained Senator for Victoria. I hope the Greens are going to be able to take a considered position now their numbers have reached critical mass.
David.

Tuesday, February 21, 2012

Read Closely - This is Really A Rather Odd Position To Be Adopting On The PCEHR.

The following appeared today.

Liberal MPs to vote for e-health records

LIBERAL MPs will vote to pass the Gillard government's legislation on personally controlled e-health records in the lower house, but warn they may move changes when the findings of a Senate inquiry are released.
Opposition e-health spokesman Andrew Southcott said the Coalition supported the concept of shared e-health records, but had concerns about the way the system was being implemented.
"Labor's implementation of the PCEHR since taking government in 2007 has received enormous criticism from industry for the poor management of the program's development and progress," he told the house last week.
"This legislation was introduced in the final sitting week of 2011; the opposition referred the bills to a Senate inquiry, which is due to report on February 29.
"Submissions to that inquiry have just closed. In its public hearing (on February 6), the inquiry heard testimony highlighting a number of stakeholders' concerns.
"A better approach would have been for the Health Minister and the government to defer debate on the bills until the Senate has reported its findings."
Almost all submissions raised concerns about the government's July 1 go-live date for the system, and statements that "the minister has repeatedly stated we will be able to register" for a personal record from that date.
"Unfortunately, just repeating it will not necessarily make it come true," Dr Southcott said.
"There is widespread belief by the majority of industry experts, health bodies and medical practitioners that July 1 will not bring the fanfare we are expecting."
Nevertheless, Dr Southcott said, the Coalition was committed to the concept of an e-health record, and recognised the benefits "a properly implemented PCEHR could bring to patients and practitioners alike".
"For this reason, while not opposing these bills, we do reserve our right to move amendments, pending the outcome of the Senate inquiry."
The house is in recess this week and reconvenes next Monday.
Lots more with coverage of what NEHTA says will be ready for July 1, and the comments of Senator Boyce is found here:
It is really hard to understand, in the light of the comments made by Dr Southcott, just what the Opposition is doing just passing legislation to introduce the PCEHR when, from his own comments, he has so many doubts about things related to the PCEHR.
To be passing legislation to enable a ‘concept’ rather than something tangible for which there was some evidence of value - especially when an enquiry report is due in a little over a week - seems rather odd to me.
I guess the machinations of the political mind will always remain a bit of a mystery to those on the outside.
I guess we will just have to await events!
David.