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."

Friday, March 09, 2012

An Interesting Report on the iPad and the Clinical Environment. There Are Some Wrinkles To Be Solved Yet!

This summary of a very interesting report appeared a little while ago.

Physicians: iPad Not Ready For Clinical Use

Most doctors still use desktops because iPads lack speech processing capabilities. One expert, however, says iPad EHRs are coming.
By Ken Terry,  InformationWeek
February 02, 2012
Eighty percent of physicians in a recent survey said they believe that the Apple iPad has an "exciting future in healthcare"--but they doubt it is ready for clinical use.
The survey of 100 "early adopter" physicians by Spyglass Consulting Group in Menlo Park, Calif., also found that 83% of the respondents used desktop computers to access clinical information, whether they were in the hospital, in the office, or at home. Some physicians said they used mobile devices to retrieve healthcare data when they were traveling. Description: AdTech Ad
Pretty much the same could have been said of physicians five years ago, when many of them used reference tools and calculators on personal digital assistants (PDAs) and smartphones, but few doctors looked up clinical information on those devices. Some physicians used tablet computers with their EHRs, and some used tablets or PDAs for e-prescribing, charge capture, or both.
One barrier to clinical use of iPads today is the attitude of hospitals. "Seventy-five percent of physicians interviewed reported that hospital IT [staff] was resistant to supporting personal mobile devices on the corporate network," the Spyglass release said. "Hospital IT believes personal devices are insecure, less reliable, and more expensive to deploy, support and maintain than desktop computers."
That finding jibes with other recent studies. But as the Spyglass report acknowledges, hospital security concerns are not the major obstacle to iPad use in clinical work.
"Significant software innovation will be required to realize the vision for anytime, anywhere clinical computing," Gregg Malkary, managing director of Spyglass, said in the announcement. "Clinical applications must be rewritten and optimized to take advantage of the native capabilities of the Apple iPad and other mobile devices including gesture-based computing, natural language speech recognition, unified communications, and video conferencing."
Malkary told InformationWeek Healthcare that, although Epic and Allscripts are both experimenting with iPad-native EHRs, he doesn't expect the vendors to go into production on these innovations anytime soon. The big barrier, in his view, is not the technology, but the vendors' reluctance to "redesign their applications from the ground up with a focus on patient-centric care."
The full article is here:
It seems to me that the security issue is really a furphy. There is no way it is not possible to render and iPad device attached to a hospital network just a secure as any other remote terminal.
The killer issue is how to create an iPad based data entry capability that works as well as the key board and mouse. Whether this will be with some voice based technology or other approach I can’t say but to be an EHR/EMR front-end there really does have to be a slick data-entry capability.
For information lookup what we have now is fine - but it really is only half the story!
David.

Thursday, March 08, 2012

Kaiser Permanente Just Seems To Be Kicking EHR Goals One After Another!

The recent HIMSS Conference again showed what was possible with Health IT if you are serious about the issue.
First we have this:

HIMSS: Kaiser Permanente Receives Davies Award for Organizational Excellence and Stage 7 Health IT Awards

Justin
The Healthcare Information and Management Systems Society (HIMSS) has awarded Kaiser Permanente with two awards; the Davies Award for Organizational Excellence and a Stage 7 award for “Excellence in Health IT” for its Moanalua Medical Center in Honolulu, Hawaii.
The Davies Award recognizes “excellence in the implementation and value derived from health information technology,” with Kaiser Permanente named 2011′s sole winner.  ”The implementation of our world-class electronic health record, Kaiser Permanente HealthConnect, has shaped and improved how our physicians and care teams treat patients,” said Phil Fasano, executive vice president and chief information officer, Kaiser Permanente.  ”The Davies Award recognizes the important role of health IT in improving care and the overall patient experience, the same goals we had in mind when beginning the KP HealthConnect project almost 10 years ago.”  Kaiser currently has the largest private-sector EHR system in the world.
More here:
and to really top it off we have this report.

Kaiser Permanente’s Big EHR Bet Paying Off

If the move toward digitizing the health system has been characterized by fits and starts, Kaiser Permanente’s multi-year, multibillion dollar effort to create an enterprise electronic records system is nothing if not persistent.
During a session at HIMSS12, Kaiser Permanente Senior Vice President and CIO Phil Fasano said with $4 billion spent thus far on the project, the gravity of the undertaking is evident. “Our CEO bet the company on EHRs,” he said. “This is a life-critical system that required a whole other level of attention from our I.T. organization.”
The system is known as KP HealthConnect and is based on software from Epic Systems Corp. A good part of the time and money spent of the project revolved around building an infrastructure to support it. Fasano proudly noted that KP data centers have won awards for their uptime, no small matter considering the anytime/anywhere nature of EHRs. “Investing in infrastructure is something that you can’t overlook,” he said.
Although the company finished implementation of the ambitious program last year, it will remain a work in progress. Fasano’s team continues to tweak and upgrade the system to accommodate new requirements such as mobility.  Nonetheless, the company can already point to some impressive metrics stemming from its EHR deployment, such as a 50 percent decrease in hospital stays for diabetics.
More here:
There is a lot more, but the bottom line in all this is that we are seeing even a huge investment in Health IT return benefits for the overall finances as well as the quality of care of the organisation that has deployed it.
This shows it can be done. Now how about Australia - which is only twice the size of KP in terms of population served - actually getting on with it!
All I needs is decent leadership and governance - and some money!
Dream on David.
David.

Wednesday, March 07, 2012

Here Is A Fun Rumour I Keep Hearing. I Wonder Is It True?

People are telling that the PCEHR is about to be renamed.
Apparently it is to now be called - get ready - the:

E-Health Records System.

Some wag has already suggested that EHRS is a bit close to Errors when said quickly. Maybe a re-think of that is needed.
Take this for what it is worth. The implications are fascinating regarding funding timing, deadlines and all sorts of other issues.
I look forward to comments from any who can confirm / deny this!
David.

It Will Be Interesting To See Where This Idea Actually Leads. A Simple Approach To Summary Care Records From The US.

The following appeared a little while ago.

Get Ready for Metadata in Meaningful Use Stage 2

MAR 1, 2012 11:45am ET
The Office of the National Coordinator for HIT’s proposed rule for Stage 2 of the electronic health records meaningful use program begins the process of including use of metadata as criteria for compliance.
In December 2010, the President’s Council of Advisors on Science and Technology called for metadata to be part of Stage 2. The ONC rule, in its current non-published version on pages 34-35, pushes limited use of metadata.
.....
In the proposed rule, ONC calls for adoption of the Consolidated CDA standard for summary of care records, which essentially is a revamped Continuity of Care Document. This standard includes several metadata elements, including two that are proposed for use--data provenance and the ConfidentialityCode. Provenance gives information about the history or origin of data, like a date/time stamp. The ConfidentialityCode describes what kind of data is being electronically sent--N for normal, R for restricted and V for Very Restrictive.
The full article is here:
The article provides a link to an article with some explanations of what is planned:
The article is available here at no cost.
Here are the first few paragraphs of a detailed discussion of the area and why it now matters for the US.

Metadata and Meaningful Use

By Allison Viola, MBA, RHIA, and Shefali Mookencherry, MPH, MSMIS, RHIA
It should come as no surprise that when in August 2011 the Office of the National Coordinator for Health IT (ONC) issued an advance notice of proposed rulemaking on the use of metadata standards the health IT community expressed a collective gasp. Despite so many health IT and healthcare reform initiatives under way, ONC indicated it was considering recommendations to add the use of metadata-tagged data elements in stage 2 of the meaningful use program.
ONC issued the notice in response to a December 2010 report released by the President's Council of Advisors on Science and Technology. In that report PCAST outlined strong recommendations to speed the growth of health information exchange through the use of metadata tags.
The PCAST report called for a universal language for exchanging health data, an extensible markup language (such as a variation of XML) where health data would be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by mandatory metadata tags or minimal standards that describe the data and the patient's preferences for the data's uses, security, and privacy protections. Such a solution would enable healthcare providers to share health information reliably and effectively.
What's more, PCAST urged the federal government not to wait. ONC "should signal now," PCAST wrote, that EHR systems must have the ability to exchange health data in a universal manner based on metadata-tagged data elements by 2013 in order to qualify for use in the meaningful use program.
In principle, the healthcare industry agrees on the value of greater metadata use. A range of entities have recognized that metadata tagging has the potential to increase the usefulness and integrity of data for health information exchange by better describing the information being shared. However, PCAST's recommendation that ONC "move boldly" is too bold for many. In responding to ONC's advance notice, commenters cited multiple barriers to the quick implementation of metadata requirements.
The release of the proposed rule on stage 2, expected this month, will be the first test of how quickly ONC intends to include metadata in the meaningful use program. But ultimately the question of applying metadata to discrete pieces of health information is a matter of when, not if.
The full long article is here:
So there you have it - an improved Clinical Summary Sharing Document supported by embedded information of the information provenance and sensitivity.
At a high level it sounds pretty good to me! This again follows the KISS principle rather better than the PCEHR proposals.
David.

Tuesday, March 06, 2012

If Ever There Was An Argument That Simple Is Good In Health Information Sharing This Is It. It Is Cheap and Seems To Work!

This appeared a week or so back.

Wales makes good progress with IHR

24 February 2012   Rebecca Todd
More than 300 GP practices have switched on access to the Individual Health Record in Wales, making about 2m summary patient records available to emergency care providers.
Approximately 3m people live in Wales. But the IHR is now available in every health board area, following the go-live of the Abertawe Bro Morgannwg University Health Board at the start of the year.
The IHR is the Welsh version of the Summary Care Record in England. It allows secure access to a summary GP record for doctors and nurses working in an out-of-hours services or medical assessment units.
The record is only available to other clinicians working within the local health board of the patient’s GP and with the patient’s consent.
The record includes basic demographic information, medications and allergies.
Clinicians can also see any medical problems that the patient has seen their GP about over the previous two years and the results of any tests or x-rays from the previous year.
The £4.7m service was funded by the Welsh Assembly Government and developed by the NHS Wales Informatics Service in partnership with clinical systems suppliers.
More here:
Here is the link to the home page:
The latest release is interesting in terms of the contents of the IHR.

Individual Health Record availability increases further

About two million GP patient records can now be viewed by out of hours medical staff.
Patient's from 305 practices now have an Individual Health Record (IHR), which is a summary of the GP record, that out of hours Doctors, in their area, can see while treating them.
The IHR contains only information that would be helpful in treating patients and does not contain sensitive details.
It will have:
  • Your name, address and contact details
  • Details of your current GP practice
  • What medication you’re taking or have been taking
  • Medical problems you’ve seen your GP about
  • Recorded allergies
  • Results of any recent tests you may have had, for example, blood tests and x-rays
  • Only the last two years of medication history and one year of test results will be shown.
It will not include details on: 
  • Sexually transmitted diseases
  • HIV / AIDS
  • Human fertility and embryology
  • Terminations
  • Gender reassignment
  • Any private discussions you have had with your GP
Find out more at www.wales.nhs.uk/individualhealthrecord including the option for patient's to opt out.
The release is here:
The key features of a basic data set, opt-out and access only for clinicians who need the information makes this - to me - a much smarter route than the nonsense we are undertaking with the PCEHR.
The cost also is so small as to be a rounding error in the health budget - even if multiplied by 10!
Even better this record might make a real difference quite quickly!
Go Wales!
David.

Monday, March 05, 2012

Weekly Australian Health IT Links – 5th March, 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

Really  a quite big week - with the PCEHR legislation passing the House of Representatives.
Other than that there are some very interesting things happening all over the country - see the discussions on WA Aboriginal E-Health, Chronic Fatigue Syndrome, skin cancer apps and so on.
The PCEHR is also being quite hotly debated by different interest groups with little overall clarity yet to emerge. The week after next may very well see the debate re-ignite with the release of the Senate Enquiry. We are, I suspect, in the calm before the storm!
-----

E-health bill passes lower house

  • From: AAP
  • February 29, 2012 3:04PM
LEGISLATION to establish a national, personally controlled electronic health system has been passed by the House of Representatives.
The bill, which the federal government says will bring the management of health records into the 21st century, passed with the support of the coalition despite the concerns of some MPs.
Liberal MP Andrew Laming said Australia must learn from the experiences of the US and Britain where similar electronic records systems have been implemented.
-----

Plibersek rejects PCEHR blow-out claims

Written by Kate McDonald on 01 March 2012.
Minister for Health Tanya Plibersek has rejected claims in The Australian newspaper that the budget for the PCEHR had blown out by almost $200 million.
During a debate yesterday in which the PCEHR bill was passed unopposed by the House of Representatives, Ms Plibersek said the newspaper seemed to have double counted some of the sources of funding for the PCEHR and the National E-Health Transition Authority (NEHTA).
“The two main sources of funding for the eHealth agenda are the personally controlled electronic health records allocation and the COAG approved funding,” Ms Plibersek said.
-----
1 March 2012, 2.20pm AEST

Everything you need to know about Australia’s e-health records

Author

From July 1 2012, Australians will be able to register for their own Personally Controlled Electronic Health Record (PCEHR). At least this was what Rosemary Huxtable, deputy secretary of the department of health and ageing has reaffirmed to a parliamentary senate committee. At that point, $467m will have been spent on the project.
To say that the project has its doubters and critics would be an understatement. The Medical Software Industry of Australia (MSIA), the Australian Medical Association (AMA) and the Consumers e-health Alliance are among the many groups that spoke to the senate committee about their concerns regarding the implementation of the PCEHR. Their complaints are varied and range from privacy, to governance and liability, through to doubts about whether anyone would actually use the system.
Interestingly, advocates and critics both agree on the potential usefulness of electronic health records to improve patient outcomes and increase the potential efficiency of health services – even though evidence is scant that electronic health records, in and of themselves, improve the quality of care.
-----

Internet trial’s impressive results for chronic fatigue

1st Mar 2012
A SMALL trial of an intensive Internet-based intervention for adolescents with chronic fatigue syndrome has had impressive results in getting participants back to school and functioning normally, researchers say.
The study conducted in The Netherlands involved cognitive behavioural therapy (CBT) and psychoeducation delivered online with e-consults available from psychotherapists.
The study analysed 67 patients, aged 12 to 18 years, who were assigned to the internet program, called Fatigue In Teenagers on the Internet (FITNET), compared to a control group of 64 who received ‘usual care’ including group rehabilitation, physical training and face-to-face CBT.
-----

Behind the news

28th Feb 2012
The PCEHR is a hot topic. MO asks the experts for their thoughts.
JUST 5% of GPs understand how the government’s personally controlled electronic health record (PCEHR) system will work and what will be expected of them when it is rolled out on 1 July, while only a quarter think the system will help with consultations.
The widespread lack of faith in the system was revealed in a Cegedim survey of 150 GPs, conducted on behalf of MO, which also found 76% of GPs had concerns over the lack of remuneration on offer to compensate for the time they spent curating the electronic records.
The survey also showed how many GPs were worried about other issues related to the PCEHR, including the reliability of information (76%), privacy or security (67%) and medico-legal issues (71%).
-----

NSW Health to implement medical supply and inventory system

The service aims to provide a national uniform set of data around medication
The National e-Health Transition Authority (NEHTA) has confirmed NSW Health will implement a medical supply and inventory system some nine months after it was trialled in the ACT.
The Master Catalogue Information Service (MCIS) aims to provide a national uniform set of data around medication. It will assist different health departments and jurisdictions automate validation, integration and synchronisation of the National Product Catalogue (NPC) data (published by suppliers), with the departments’ internal systems.
A spokesperson from NSW Health told Computerworld Australia the state has signed on to implement the MCIS but could not provide further detail about when implementation would commence.
-----

Free app a smart way to check skin

March 2, 2012
A new iPhone app designed to help Australians check their skin for potential cancers and other damage is available.
The free program teaches users how to monitor their skin and know when to see their doctor.
-----

UGPA calls for incentives to use PCEHR

Written by Kate McDonald on 02 March 2012.
The heads of the major general practice associations have called on the federal government to properly fund and support GPs to assist in the smooth implementation of the PCEHR.
At a meeting in Canberra yesterday, United General Practice Australia (UGPA) expressed concern about the lack of preparation for the practical implementation at practice level of the PCEHR, which is due to be introduced on July 1.
-----

MDOs join call for e-health delay

27th Feb 2012
MEDICAL defence organisations have added to the chorus urging the government to delay the launch of the personally controlled e-health record (PCEHR) and warned GPs will have to overhaul their practices to comply with the system’s data security provisions.
MDA National president Associate Professor Julian Rait said the government had not properly considered the “very serious data security issues” involved because it was trying to rush the system out by its 1 July launch date.
“We think there has been an excessive amount of political pressure put on the people that are doing this without all the proper tests and checks required to do it properly and safely,” he said.
-----

AMA calls for hospital IT funding

Kate Hagan
February 27, 2012
TECHNOLOGY is urgently needed to replace paper-based records that are compromising patient care in public hospitals, doctors say, as the state government continues to defer any decision on the future of Victoria's troubled HealthSMART program.
In a state budget submission, the Australian Medical Association has called for $310 million over four years to provide technology for public hospitals, including systems for managing patient medications.
The funding would also link public hospitals with GPs and aged-care facilities so they could share patient information for better continuity of care and adherence to treatment.
AMA Victoria president Harry Hemley said GPs and nursing homes received only sketchy written information, if any, about a patient's medications and treatment following a hospital stay.
-----

The Model Healthcare Community Roadshow is Coming to You

24 February 2012. The use of technology in the provision of health services will improve the quality and safety of healthcare to individuals. The Model Healthcare Community (MHC) is the most prominent eHealth engagement tool currently available in Australia. It is an interactive and dynamic display that showcases the NEHTA eHealth foundations and solutions and highlights the investments by the Governments of Australia in a national eHealth system. An MHC installation is on permanent display at the RACGP offices in Melbourne. Another installation is taken to peak stakeholder conferences around Australia. A third installation was on site at The Canberra Hospital, Calvary Hospital and DOHA in December/January 2011/12.
-----

Accenture: Australia behind on healthcare IT adoption

Monday, February 20, 2012
By Anne Widjaja
A new Accenture study on healthcare IT reveals that Australia’s physicians are behind in their adoption and use of healthcare information technology.
The Accenture study, ‘Connected Health: The Drive to Integrated Healthcare Delivery’, analysed how eight countries’ health systems are utilising healthcare IT and creating ‘connected’ systems of efficient healthcare delivery. The countries surveyed included Australia, Canada, England, France, Germany, Singapore, Spain and the United States.
The findings were the result of over 160 interviews with health leaders and a survey of 3700 physicians across the eight countries (500 in Australia), supplemented by extensive secondary research.
-----

Fletcher: Governments can't dictate technology adoption

Attacks NBN and e-health records.

Liberal MP and former Optus executive Paul Fletcher has delivered a stinging attack on the ambitious technology projects of the Labor Government, arguing Australia has not learned lessons from numerous failed IT projects in the private and public sector.
Fletcher savaged the National Broadband Network (NBN), the Personally Controlled Electronic Health Record (PCEHR) project, and the ‘one PC per student’ Digital Education Revolution in a speech to a conference of technology journalists on the Gold Coast Sunday.
He compared these schemes to – among others – the UK’s failed e-health project, the cash flow problems and subsequent Leighton buyout of Nextgen Networks, SingTel’s write-off of Optus’ HFC Network losses and the collapse of mobile telco One.Tel.
-----

Tim Donovan & Nigel Armfield: A tele future

TELEMEDICINE — the use of information and communications technology to provide health care at a distance — has evolved significantly in the past 2 decades.
Now, with the introduction of Medicare Benefit Schedule (MBS) item numbers for video-based GP-to-specialist consultations, the use of telemedicine is spreading from the public hospital setting to the private sector. MBS items provide an incentive for clinicians to make better use of telemedicine services.
Neonatal care exemplifies the healthcare impediments of distance and time and the advantages telemedicine may provide.
In Queensland 54% of all livebirths and 82% of all high-risk births occur in hospitals more than 50 km from the state’s three tertiary hospital nurseries. The mean time to reach a sick infant is 2 hours, during which time support has traditionally been provided by telephone alone.
-----

Jumping on the telehealth bandwagon

28th Feb 2012
There’s a $6000 telehealth rebate waiting for you – so why aren’t you claiming it? Mark O’Brien looks at how to get started.
WHEN it comes to telehealth, West Australian GP Dr Mike Civil is what you might call an early adopter.
Since putting together a video-conferencing unit for about $2000 last year, Dr Civil’s Stirk Medical Group at Kalamunda has claimed about 300 consultations under the telehealth MBS items rolled out by the government last year.
-----

Mobile health records connect outback communities

The Kimberly Aboriginal Medical Services Council has introduced an electronic health record to provide continuity of care for indigenous populations scattered over a vast geographical area.
The Challenge: To maintain continuity of care for a highly mobile population scattered over a wide geographical area.
The Approach: Create an electronic medical record accessible by clinicians, specialists and nursing staff.
The Outcomes: Information is easily shared between clinicians, making it easier to deliver high quality, continuous care.
The Lessons Learned: Without an electronic record, a clinician visiting a remote community is flying blind without a patient’s history. The record turns the lights on.
-----

Health data cache helps war veterans

February 28, 2012
Emma Connors
Armed with a treasure trove of patient data, researchers have worked with doctors and pharmacists to improve the quality of life for many war ­veterans and their families.
Seven out of 10 war veterans are over 75 and, like others their age, most have multiple chronic health conditions and so are big users of health services.
Veterans are also entitled to free healthcare and most have agreed to let the government centralise their medical records in a single database.
-----

Leap year blamed for HICAPS stumble

CHRIS ZAPPONE
29 Feb, 2012 11:26 AM
Today's extra day in February has caused the payment system used by the health industry to crash, preventing 150,000 customers from using private health care cards for medical transactions.
National Australia Bank-owned Health Industry Claims and Payments Service (HICAPS) warned customers they may encounter troubles with the terminals used at medical and insurance offices today.
“Due to a software issue you may be experiencing difficulty with your terminal today,” the company said.
The HICAPS failure follows problems at Commonwealth Bank, which saw its ATMs and eftpos systems fail earlier today.
-----

Unfinished business: student perspectives on disclosure of mental illness

Read the full text

Fears of stigma or prejudice prevent many Australian students from reporting their mental illness - they want to be treated like any other student, according to this National Centre for Vocational Education Research (NCVER) study.
In stark contrast, the study shows that teachers believe students should disclose their mental illness to receive the right support.
-----

Care quality at risk in hospital cost-cutting

  • by: Adam Cresswell, Health editor
  • From: The Australian
  • March 03, 2012 12:00AM
A HOSPITAL funding expert has warned the new activity-based funding system due to be introduced in July will compromise standards by encouraging hospitals to offer services that are cheaper rather than those that cost more but work better.
The funding system, a key component of the government's health reform program, aims to align hospitals' budgets more closely to the work they do, but also to encourage efficiency by setting a national benchmark "efficient price" for each service.
The theory is that inefficient hospitals that need more money to provide care similar to other hospitals will have new incentives to improve their performance. But a discussion paper put out by the government body in charge of introducing the new system, the Independent Hospital Pricing Authority, has triggered concerns among some experts that it will encourage hospitals to cut corners that please the accountants and not the patients or their doctors.
-----

One step closer to quantum computing

KENNETH CHANG
March 1, 2012 - 7:50AM
IBM is jumping into an area of computing that has, until now, been primarily the province of academia: the quest to build a quantum computer.
A computer that took advantage of the oddities of quantum physics could solve in seconds certain problems that would occupy present-day computers for billions of years.
But for now, it is impossible to build such a computer because the bits of information it would need for the calculations fall apart before a calculation can be completed. The problem is, in essence, like trying to knit a sweater with yarn that unravels before the first purl.
-----
Enjoy!
David.

AusHealthIT Poll Number 111 – Results – 5th March, 2012.

The question was:
Taken Overall Is The PCEHR Program The Right Strategic Direction For Australian E-Health?
Yes - Definitely
- 6 (16%)
Possibly
- 7 (18%)
Possibly Not
- 6 (16%)
No - The Wrong Direction
- 18 (48%)
Votes: 37
An interesting outcome with about ½ thinking the direction is wrong and a clear majority concerned.
Again, many thanks to those that voted!
David.

Sunday, March 04, 2012

What Is The Opposition Up To In E-Health? Right Now The Signals Are Confused. I Wonder What They Really Think?

As reported a day or so ago in the press we had the e-Health PCEHR legislation waved through the Lower House of Federal Parliament.
Here is a report:

E-health bill passes lower house

  • From: AAP
  • February 29, 2012 3:04PM
LEGISLATION to establish a national, personally controlled electronic health system has been passed by the House of Representatives.
The bill, which the federal government says will bring the management of health records into the 21st century, passed with the support of the coalition despite the concerns of some MPs.
Liberal MP Andrew Laming said Australia must learn from the experiences of the US and Britain where similar electronic records systems have been implemented.
"And to go down the same path and make the same mistakes is what makes this (opposition) side of the chamber so determined to ask the right questions about electronic health records," Mr Laming said.
.....
The Personally Controlled Electronic Health Records Bill 2011 and the related Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 were both passed at the third reading on the voices.
The full report is here:
A day or so previously we had Liberal MP Paul Fletcher speak out on the matter:

Fletcher: Governments can't dictate technology adoption

Brett Winterford

Attacks NBN and e-health records.

Liberal MP and former Optus executive Paul Fletcher has delivered a stinging attack on the ambitious technology projects of the Labor Government, arguing Australia has not learned lessons from numerous failed IT projects in the private and public sector.
Fletcher savaged the National Broadband Network (NBN), the Personally Controlled Electronic Health Record (PCEHR) project, and the ‘one PC per student’ Digital Education Revolution in a speech to a conference of technology journalists on the Gold Coast Sunday.
He compared these schemes to – among others – the UK’s failed e-health project, the cash flow problems and subsequent Leighton buyout of Nextgen Networks, SingTel’s write-off of Optus’ HFC Network losses and the collapse of mobile telco One.Tel.
......
Health
Fletcher continued this line of argument to criticise the Government's $467 million PCEHR, an electronic infrastructure for shared health summaries.
He argued that doctors need to be enthusiastic adopters of the system to ensure its take-up by citizens, which has yet to play out.
The Government expect 500,000 trial patients to be signed up for the e-health record by the time the project goes live to the public on July 1 this year. However, it has been hit by concerns around take-up from GPs and patients, as well as numerous setbacks to project timelines.
“The goal [of the PCEHR] is a pretty sensible one," he said. "The question is whether the hardware and software will be used at the degree we want."
His history in the private sector taught him to “beware of the big bang". he said.
“There are plenty of horror stories for new IT billing systems being abandoned after millions of dollars were spent," he said.
The UK Government spent £11 billion on e-health but ultimately failed to deliver a functional system, he said.
“Often an incremental approach is more prudent.
“As you in the industry well know, you can lose a lot of money betting on technology.”
Lots more here - especially on the NBN and the private sector role:
From these links you can review Hansard where a good few opposition members spoke:
Here:
and here:
Here are a few remarks from the Liberal speakers:
Ms Marino - Forrest:
“I also believe that the government is ignoring the broader cyber risk. Cyberattacks cause direct financial losses to consumers and businesses from the theft of information or through extortion. The information in electronic health records has to be protected. It has to protect the rights and privacy of the patient. We know that hackers have been able to breach some of the world's most secure internet sites.”
“Given the collective and individual value of health records, how will the government ensure that the private health records of Australian citizens remain totally secure. What responsibility will the government accept when an inevitable breach occurs? This bill appears to impose all of this responsibility on health organisations and none of it on the government itself.
Breaches will be possible at all stages, both directly through unauthorised access and through sophisticated hacking.”
Mr Fletcher - Bradfield:
“Let me turn to the second serious concern I want to identify, which is that this government is seeking to make a big bang change in information technology applicable to the health system and to do so in a huge rush. The near universal view in the sector is that the timetable for implementing these reforms is absurdly and unbelievably tight. The date which has been specified, 1 July 2012, is widely considered to be ludicrous. We have seen this government make this error in area after area. They impose a deadline so that they can announce it in a media release, without thinking through the complex implementation issues. We have every reason to suspect that the same error is going to be made again. I note, for example, that the Medical Software Industry Association, whose members include Cisco, Microsoft and iSOFT, made a very critical submission to the Senate inquiry, noting that the government's approach on this issue has not followed normal business practices in the IT industry and that the documents issued by the National E-Health Transition Authority to software developers were manifestly inadequate.
So if one issue is the unrealistic timeframe, a second issue which compounds that is the naive belief that we can create here a brand new system which will completely transform everything: 'This is going to be year zero. This new system will solve every problem.' That error has been made time after time when it comes to the application of information technology in both the public sector and the private sector. We are well on the way under the approach embodied in this bill to making the same error again.
Why is it that when the government's consultants, Deloitte—commissioned by the Australian Health Ministers' Advisory Council in 2008 to develop a plan to guide the national approach to e-health—recommended 'an incremental and staged approach', they proposed seeking a specific application which was manageable and achievable and which would deliver early benefits. The one they proposed was an electronic prescriptions transfer service between health carers and pharmacies. In their view, a quick win could be delivered at relatively low risk.
They argued that the first step was to connect the care providers, the next was to enable key information flows and only then to go to the third step of building repositories to accumulate the information contained in those information flows. Unfortunately, this government has chosen to reject that very sound advice.”
Mrs Bishop - Mackellar
“Whilst the idea of utilising electronic data collection can certainly be attractive to one in thinking, it is the examination by people who are involved in this sphere that puts up the sorts of worries that people have about a start date of 1 July 2012. I think this is a major sticking point for the opposition—that the whole process is being rushed. One of the things that seems to be driving that rush is the fact that the funding for it—an agreement under the COAG arrangements—runs out at that date, and there is no certainty about any further funding for it.
There are many issues that are of concern to people on this side of the House. We are a conservative party. We are conservative on this side and therefore we are cautious about the way in which we would go forward in order to bring about change. On the government side there is this overuse and indeed abuse of the word 'reform' when really what they are talking about is change, and sometimes it can be change for change's sake or rushed change without adequate work having been done to prepare for it and to look at what the consequences may be.
It was said in the course of the debate that one can have no confidence to date that the records to be accessed will be complete, that they will be up to date, that they will be reliable. Where are the questions being addressed as to who would be liable for damages for acting on records which are not complete, which are out of date, which have not been properly kept? We all know that in our hospital and health system there are many errors.”
Mr Laming - Bowman
“The holy grail of an electronic health record is something that most developed economies are working towards. In summing up this side of the debate on the Personally Controlled Electronic Health Records Bill 2011 and cognate bill, I just want to make the observation that this nation will have an electronic health record. It is going to happen. There is a graveyard of good intentions in other developed economies, and they are lessons from which we can learn. The minister will be aware that there have been enormous expenditures in the UK and in the US. To go down exactly the same path and make the same mistakes—that is what makes this side of the chamber so determined to ask the right questions about electronic health records.
The contributions to this debate have been effectively divided in two. One is the significant upside of having a functional electronic health record, and there is no doubt about that. There is no doubt that we can see great savings and potential in the idea of having electronic information transmissible between the people who need to know. That is a no-brainer. And we know on the other side as well that there are significant concerns about privacy that have to be met. If I can distil it into a single sentence: we need to make sure that we move this project forward at the speed which current technology allows.
I do not want this to be something in between pink batts and the NBN, but we have genuine experience from around the world that shows that there is every possibility that that can occur. Today's debate really should be about how we prevent that occurring. How do we work carefully? How do we focus on the areas where gains can be made undoubtedly? And how do we acknowledge the areas where we are effectively doing little more than tipping money into some omnivorous money-eating machine that is a concept developed and controlled by public servants, from which politicians have effectively abrogated their responsibility, in the hands of fractured and separated private providers who accept contracts not knowing if they can deliver, at risk of forfeiting, at risk of going broke and at risk of not delivering? That is not made up. Those are direct quotes from what happened in the NHS. We can learn from that, but we do not if we have blind contributions in this chamber that focus on nothing but the upside of an electronic health record.”
There is a lot more in the same vein in the two links above. The question is, for me then, just why did the Coalition wave this Legislation through when a Senate enquiry was due in a couple of week and when they clearly have a large number of reservations about a range of risks.
The answer is that, honestly, I have no idea and I wish I did. It seems very odd indeed to me. My only suggestion is that they feel they have ‘bigger fish to fry’ and have not spent the time to carefully, as a party, consider the matter. It is clear some Liberal members and Senators are interested so I believe it is time for them to work out and announce a clear position - given this will be a decade long project and it is likely that for some of that period they will be in Government.
David.