Data Mining and Big Data Are Combining with Some Interesting Outcomes.

We had two interesting and related reports appear recently.

First we have:

http://www.fiercehealthit.com/story/start-ups-want-help-hospitals-harness-big-data/2012-03-13

Start-ups want to help hospitals harness big data

By gshaw

Created Mar 13 2012 - 12:12pm

As the healthcare industry wakes up and smells the potential of big data, hospitals are experimenting with ways to harness it--and two new start-ups want to help them do so.

Charité University of Medicine Berlin, Europe's largest university hospital, is using increasingly large stores of complex information not only to improve quality and aid clinicians and researchers but also helps improve senior management processes, according to a case study [1] in Forbes magazine.

Deputy CIO Martin Peuker told Forbes that more than 700 hospital employees have access to a central data warehouse that holds both financial and operational information. Every senior manager has ready access to data about operations, scheduling, patient care, and patient records. The entire repository of information stored by the hospital exceeds 1.6 petabytes.

A McKinsey Global Institute report released last year said that effective and creative use of big data could create more than $300 billion in value for the U.S. health system every year. Two-thirds of that would be in the form of reducing US healthcare expenditure by about 8 percent, according to the report [2].

All that big data potential has inspired Cincinnati Children's Hospital Medical Center to create a new startup, QI Healthcare, according to MedCity News article [3].

QI Healthcare's first product is called Surgical Outcomes Collection System (SOCS). The application aggregates data from various hospital systems, including electronic medical records, to enable "institution-wide analyses of cases to identify opportunities to improve patient care," according to a QI statement [4].

"The real power of this software is in the ability to analyze every significant patient case," Frederick Ryckman, professor of surgery and senior vice president for medical operations at Cincinnati Children's, said. "Before SOCS we spent countless hours manually gathering data. SOCS improves the process through automation and enhanced analytics--and it frees up clinical resources to focus on quality improvement."

.....

To learn more:
- read the Forbes magazine case study [1]
- see the McKinsey report [2] on the potential of big data
- see the MedCity News articles on QI Healthcare [3] and Health Care DataWorks [5]
- read the QI Healthcare announcement [4]
- read the PC Magazine article [6] on the problems with big data
- get more info on Chopra's talk [8] at GigaOM

And second we have this work reported in Nature:

Drug data reveal sneaky side effects

Mining of surveillance data highlights thousands of previously unknown consequences when drugs are taken together.

• Heidi Ledford

14 March 2012

An algorithm designed by US scientists to trawl through a plethora of drug interactions has yielded thousands of previously unknown side effects caused by taking drugs in combination.

The work, published today in Science Translational Medicine¹, provides a way to sort through the hundreds of thousands of 'adverse events' reported to the US Food and Drug Administration (FDA) each year. “It’s a step in the direction of a complete catalogue of drug–drug interactions,” says the study's lead author, Russ Altman, a bioengineer at Stanford University in California.

Although clinical trials are often designed to assess the safety of a drug in addition to how well it works, the size of the trials needed to detect the full range of drug interactions would surpass even the large, late-stage clinical trials sometimes required for drug approval. Furthermore, clinical trials are often done in controlled settings, using carefully defined criteria to determine which patients are eligible for enrolment — including other conditions they might have and which medicines they can take alongside the trial drug.

Once a drug hits the market, however, things can get messy as unknown side-effects pop up. And that’s where Altman’s algorithm comes in.

“Even if you show a drug is safe in a clinical trial, that doesn’t mean it’s going to be safe in the real world,” says Paul Watkins, director of the Hamner–University of North Carolina Institute for Drug Safety Sciences in Research Triangle Park, North Carolina, who was not involved in the work. “This approach is addressing a better way to rapidly assess a drug’s safety in the real world once it is approved.”

Lots more detail here:

http://www.nature.com/news/drug-data-reveal-sneaky-side-effects-1.10220

It looks to me that these two trends are gaining some real momentum and that their use can only grow. Well worth following the links to see the variety of things that are now being done.

David.

Now It Is Clear Just Why We Are Seeing The E-Health Policy Nonsense That Is Happening At Present.

This very interesting report appeared a day or so ago.

Public servants' online muzzle

• by: Natasha Bita, Consumer editor
• From: The Australian
• April 18, 2012 12:00AM

PUBLIC servants have been gagged from criticising Gillard government policies on blogs, Facebook and Twitter -- even if they use an alias.

The Australian Public Service Commission has warned bureaucrats they risk the sack if they post "inappropriate" comments on social media.

"APS employees must still uphold the APS values and code of conduct even when material is posted anonymously or using an alias or pseudonym," it states in a new circular.

"Employees should not rely on a site's security settings for a guarantee of privacy, as material posted in a relatively secure setting can still be copied and reproduced elsewhere.

"As a rule of thumb, irrespective of the forum, anyone who posts material online should make an assumption that at some point their identity and the nature of their employment will be revealed."

Commonwealth Public Sector Union national secretary Nadine Flood said yesterday the muzzling of public servants was "excessive", and might be overturned in an industrial tribunal.

The new edict would ban bureaucrats from commenting in a private capacity on issues of public interest, such as the carbon tax or asylum policy, she said.

"Any citizen should be able to participate in social media and express their personal views without risk to their employment," Ms Flood said.

More here:

http://www.theaustralian.com.au/national-affairs/public-servants-online-muzzle/story-fn59niix-1226330772919

Well this really does explain a lot.

It explains just why so many Anonymous contributors comment on the blog and why the comments often seem to be so well informed.

It explains why a policy as conceptually stupid as the present design of the NEHRS is still, seemingly, being fully supported by DoHA despite the fact so many within DoHA know just how big a ‘dog’ they are stuck with and the mess that is going to be left after the whole thing is quietly shelved.

It explains why there is no properly informed debate in the public domain on the NEHRS initiative.

The terror which the Government feels in the face of well-informed criticism is pretty clear from the spin applied to various e-Health events. I almost choked on those infamous Wheaties when I discovered the Stakeholder Forum held by NEHTA last week had the amazing sobriquet of “NEHTA Stakeholder “Super Summit”  - “Rallying the eHealth Champions””. What an inspiring event that must have been for all the brainwashed converted.

That this spinning has been going on for ages becomes clear when you read here:

http://aushealthit.blogspot.com.au/2010/02/what-fun-nehta-lets-its-health.html

It is very sad that what should be a really non-controversial e-Health strategy gets corrupted and distorted by a combination of lack of public discussion and review - remember how the initial release of the National E-Health Strategy was just a summary rather than the details - and spin.

The reasons why are just a little bit clearer.

David.

It Looks Like The Medical Software Industry Association Has Put NEHTA on the Back Foot.

The following page turned up on the NEHTA web site a few days ago.

Clinical Safety

The national eHealth system will improve clinical outcomes, and to do that it needs clinically safe and efficient foundations. That’s why the clinical safety and integrity of NEHTA’s products guides everything NEHTA does as an organisation.

There are three key clinical quality and safety processes in NEHTA, the Clinical Safety Unit; the Clinical Safety Working Group and the Clinical Governance Review Board, each ensuring safety.

• The Clinical Safety Unit comprises clinicians with specialist training and experience in eHealth and risk management as well as system safety.
• The Clinical Safety Working Group works with the clinical and programme leadership for the PCEHR and for products and solutions constituting the component infrastructure of the PCEHR. Their work is to validate the evidence that forms the ‘Clinical Safety Case’ for the PCEHR. This includes identifying risks, recommending the controls to address the potential risks and evidencing these in operation.
• The Clinical Governance Review Board has an advisory role to support existing NEHTA product development and implementation and provides expert and systemic clinical and safety advice.

NEHTA works with organisations such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the University of New South Wales Centre for Health Informatics to ensure the clinical safety and governance of the PCEHR and eHealth products.

NEHTA Submission Australian Safety and Quality Goals for Health Care (148.12 KB)

See here:

http://www.nehta.gov.au/ehealth-implementation/clinical-safety

It is interesting that this little addition to the e-Health Implementation Section of the web site comes when so little has been updated in the last year and in many cases since 2010!

I reckon all this is a delayed response to the critique of NEHTA at the public hearings at the Senate PCEHR Enquiry in February by the MSIA among some others.

What amazes me is that we still have not seen this amazingly secret PCEHR Clinical Safety Case. Where is it and why is it not public? Blowed if I know other than the most likely reason that is doesn’t yet exist.

Clinical Safety in Health IT is not just a phrase. What it requires is that systems are actually formally tested in very complex ways - on paper through process control and review during development and then by careful evaluation of staged limited implementations of proposed systems before extensive roll out.

Safety in clinical systems is also multifactorial involving user training, system functionality and controls, system and interface design and a whole lot more.

If you want to find coverage of the variety of ways things can go wrong there are two useful resources.

This blog from last year points to an Institute of Medicine Report and some issues that flowed.

See here:

http://aushealthit.blogspot.com.au/2011/11/recognition-is-dawning-health-it-needs.html

Second is Scot Silverstein’s blog where many of these issues are raised among some other topics.

http://hcrenewal.blogspot.com.au/

NEHTA claims it understands but until we see the actual details of the work they have done that is just so much ‘hot air’. This is confirmed when we have their clinical lead suggest a good deal more work and transparency is needed.
I cannot but agree. The treating the health community and public like mushrooms (kept in the dark and fed excrement)  is just obscene and really needs to be condemned.

David.

NEHTA Gets Carried Away With Spin And Looses It Utterly It Seems. They Are In Fantasy Mode On What They Have Achieved.

A day or so ago NEHTA published a February 10 dated submission on the Australian Safety and Quality Goals For Healthcare.

The consultation period is now closed. Here is the request for submissions. Apparently a report went to Health Ministers in late March, 2012

Australian Safety and Quality Goals for Health Care

Consultation period has commenced

The Australian Commission on Safety and Quality in Health Care has prepared a draft set of Australian Safety and Quality Goals for Health Care and is currently seeking comment on these via a consultation discussion paper.

The purpose of the Australian Safety and Quality Goals for Health Care is to describe high priority areas that should be the basis of coordinated national action to improve the safety and quality of care and achieve better outcomes for patients and a more effective and efficient health system.

You are invited to make a submission on one, or all, of the draft Goals, or any other aspect of the consultation paper.

A copy of the consultation paper is available to download here. (PDF 275 KB)

Submissions, marked ‘Australian Safety and Quality Goals for Health Care’, can be made by post or email, or by using an online survey.

Post: GPO Box 5480, Sydney NSW 2001
Email: goals@safetyandquality.gov.au

Online survey: https://www.surveymonkey.com/s/ACSQHCGoalsConsultation

All submissions should be received by close of business on Friday 10 February 2012 to be considered in the consultation process.

All submissions will be published on the Commission’s website, including the names and/or organisations making the submission. The Commission will consider requests to withhold part or all of the contents of any submission made.

Copies of this paper can be obtained from the Australian Commission on Safety and Health Care. Contact details are:

Phone: (02) 9126 3600

Email: mail@safetyandquality.gov.au

Here is the link to the page and further information.

http://www.health.gov.au/internet/safety/publishing.nsf/content/ASQGHC

More information on the broader initiatives is here:

The Australian Commission on Safety and Quality in Health Care (ACSQHC) is a government agency which was established by the Commonwealth, with the support of State and Territory governments.

We lead and coordinate national improvements in safety and quality in health care across Australia.

Here is the link:

http://www.safetyandquality.gov.au/

I thought the NEHTA submission might make for some interesting reading.

You can find it here:

http://www.nehta.gov.au/component/docman/doc_download/1464-nehta-submission-australian-safety-and-quality-goals-for-health-care

Sadly I have to say what I found was what could be safely described as a ‘puff piece’.

On page 1 we read:

“The Personally Controlled Electronic Health Record (PCEHR) System is the next step in using eHealth to enhance the healthcare system. The PCEHR System enables the secure sharing of health information between an individual’s healthcare providers, while enabling the individual to access their own health information held in their PCEHR and control who else can access it.

The PCEHR will build on the range of eHealth products and services already developed by NEHTA, including the Healthcare Identifier Service, Secure Messaging, the National Authentication Service for Health (NASH), eReferrals, ePrescriptions, specialist letters and discharge summaries.”

I am sure it will come as a surprise to many to know NEHTA has all these products and services out there. They have written a few documents and have had Medicare put in place an IHI service which is still awaiting significant use after almost 2 years. The rest is just hopeful spin as far as I can tell.

On Page 2 we read:

“NEHTA is charged with delivering the Australian Government’s eHealth solutions that will underpin the secure electronic exchange of relevant clinical information across the health sector. The agenda for eHealth is moving beyond a singular focus on the delivery of information communications technology (ICT) solutions to focus on ensuring the safe, effective use of these tools in the real world of healthcare.”

One asks just solution NEHTA has delivered? I can’t see much as yet after almost six years.

If anything is being delivered it is by Accenture and its partners and the local health software industry. How long is it since we knew NASH was needed?

Page 3 contains even more fun:

“For Australians who choose to have one, the information in a PCEHR will be able to be accessed by themselves, their selected carers, and their authorised healthcare providers. With this information available to them, healthcare providers and consumers themselves will be able to make better decisions about the consumer’s health and treatment. Consumers will also be able to contribute their own information and add to the recorded information stored in their individual PCEHR via Consumer Entered Notes.

The PCEHR is not a duplicate or replacement for local clinical records; it will complement local records by allowing access to key information from other providers. As the PCEHR becomes more widely available consumers will be able to access their own health information anytime they need it, from anywhere in Australia and overseas where connection to the internet is possible.

Based on an in-depth review of international eHealth studies, shared electronic health records , such as the PCEHR have the potential to contribute to improvements in healthcare quality and safety through enhanced access to and use of best practice guidelines, reducing errors (e.g. medication prescribing errors) and enhanced public health planning outcomes. They can also generate efficiencies by reducing duplication of effort, facilitating timely access of information to chosen providers and generating wider indirect effects e.g. timely discharge results in better information to the General Practitioner (GP) resulting in less repeated admission to hospital. Together, these have the potential to result in a healthier population, reduced demand on both primary and acute care, and saved lives.”
I really wonder just where the evidence is for all that. Not in this document and given the architecture of the NEHRS is unique in the world as far as I know they are just making it up!

On page 8 we read the following:

“Strong clinical leadership in the development of the PCEHR and on-the-ground support throughout its implementation will ground this reality of personal control in better and patient centred health delivery.

NEHTA's Stakeholder Reference Groups comprise a range of organisations representative of Australia’s healthcare sector. These organisations join jurisdictional representatives to provide their input to NEHTA’s work program and importantly provide information back to their members.”

This is really just not true. The PCEHR concept was dreamed up by some IT people in NEHTA / DoHA and just dropped on the unsuspecting clinicians. It is the worst of all possible shared record types as far as clinician needs are concerned.

We also read the following:

“Potential enhancements to the PCEHR

The PCEHR will be available for registration from 1 July 2012. However, provider capability and uptake will develop over time, as evidenced in other local and international eHealth implementation projects of this nature. The National E-Health Strategy proposed that the PCEHR System rollout be undertaken via an incremental approach, with the capabilities of the system being expanded over a four-year implementation period.”

Given the National E-Health Strategy is a 2008 document that framed a totally different implementation approach this statement is just insulting to the authors of that strategy. It has been funded and ignored and now 4 years later suddenly another 4 years is needed.

This document is spin city gone mad. The benefits are grossly overplayed, adoption is not really encouraged and the one system for the docs and one for the patients is just rubbish no matter how you look at it. Worse still this mad intervention has sucked the life out of some practical, sensible initiatives which were underway.

Pretty sad.

David.

Weekly Australian Health IT Links – 16th April, 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

A really big week with lots of debate on e-Health regulations and mechanisms for payment of those who will be doing the work.

Secondly we also see some controversy around Orion in NZ - a major supplier to the PCEHR Program.

Next we see that Government is spending more on shredders rather than responding to Freedom of Information Requests and we also have some material on the cloud and some of its implications.

Last it was good to see the NEHTA Malaysian Junket seems to have been called off. Sensible in such tough economic times! 

This week looks like being caught up in the Safety Debate with discussion of just how much effort is being put in by NEHTA and DoHA to ensure what is being done first does not do any harm and secondly actually works as intended to reduce clinical errors and maximise patient safety. Of course with the way the NEHRS has been architected they already have removed a lot of the potential for benefit in such areas as interactive clinical decision support (CDS).

Blogs posted this morning will get you started and there is more to come during the week.

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http://www.theaustralian.com.au/australian-it/e-health-lead-rollout-sites-lacking-patients/story-e6frgakx-1226322310135

E-health lead rollout sites lacking patients

• by: Karen Dearne
• From: The Australian
• April 10, 2012 12:00AM

THE three lead sites for the personally controlled e-health record rollout are yet to recruit patients for trials scheduled to end on June 30.

The Gillard government's PCEHR system is supposed to be operational from July 1.

But the National E-Health Transition Authority has revealed "activity in the e-health sites to date has focused on recruitment of (GP) practices and connection to the (Medicare-operated) Healthcare Identifiers service".

Three former GP divisions (now rebadged as Medicare Locals) -- in Brisbane North, Hunter Valley, NSW and in Melbourne East -- each received $5 million in mid-2010 to implement software supporting the PCEHR system and to trial the use of records by doctors and patients. "Those (lead) sites that are operating local repositories will commence operations over the coming weeks," NEHTA said in answers to questions put by senator Sue Boyce and released last Thursday. "NEHTA specifications are being used in the point-to-point exchange of clinical documents in the e-health sites. However, it is impossible to count how many of these documents are being exchanged."

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http://blogs.crikey.com.au/croakey/2012/04/13/ehealth-records-too-important-to-muck-up/

Ehealth records: too important to muck up

April 13, 2012 – 7:52 am, by Melissa Sweet

In 2009 the National Health and Hospitals Reform Commission recommended that by 2012 every Australian should be able to have a personal electronic health record that they would own and control.

The PCEHR (personally controlled electronic health records) system is due to launch on July 1.  The plan is for everyone to have the option of registering for an eHealth record and choosing who will be able to access it, and to what level.

But we have been warned not to expect any whizz bang launches or ambitious targets. As DOHA secretary Jane Halton has made clear, the last thing the Government wants is a rush of registrations.

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http://www.theaustralian.com.au/national-affairs/health/ama-secretary-general-francis-sullivan-demands-regulations-be-changed/story-fn59nokw-1226323273493

AMA secretary-general Francis Sullivan demands regulations be changed

• by: Sue Dunlevy, Patricia Karvelas
• From: The Australian
• April 11, 2012 12:00AM

HEALTHY patients who go to their doctor simply to get their e-health record set up will not receive a Medicare rebate.

The decision has outraged doctors and comes as the body in charge of the personally controlled e-health records has pulled out of a taxpayer-funded roadshow to Malaysia next month to show the system to Australian surgeons at a conference in Kuala Lumpur because of the "tight fiscal environment".

The National e-Health Transition Authority, which has a multi-million-dollar travel and entertainment budget, had announced on its website it was planning to send four doctors to the Royal Australasian College of Surgeons conference in the Malaysian capital to promote the scheme.

NEHTA has a Model Healthcare Community, a mock up of how the e-health computer system is meant to work, that it planned to take to the surgeons' conference in Malaysia.

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http://www.medicalobserver.com.au/news/health-department-reversal-on-pcehr-liability

Health department reversal on PCEHR liability

12th Apr 2012

Mark O’Brien

The health department will rewrite the “unfair” conditions of registration for the personally controlled e-health records (PCEHR) system which required practices to assume all liability and grant unrestricted access to premises and records.

The draft conditions were panned by health insurers and industry experts after MO last week broke the news that the AMA had warned the health department that the “unfair” requirements would “deter every medical practice in Australia from participating”.

MDA National president Associate Professor Julian Rait said any lawyer would say the condition requiring access to a practice’s premises, IT systems, records and staff was “a dealbreaker”.

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http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=950:doctors-will-not-be-liable-for-pcehr-breaches-doha&catid=16:australian-ehealth&Itemid=327

Doctors will not be liable for PCEHR breaches: DoHA

Written by Kate McDonald on 13 April 2012.

The terms and conditions for healthcare provider participation in the PCEHR will not require them to assume all legal liability for breaches of the system, according to the Department of Health and Ageing (DoHA).

The Australian Medical Association (AMA) had rejected an early draft of the PCEHR participation agreement, saying it appeared healthcare providers would be liable for failures and breaches of the PCEHR and that health department officials would demand access to medical practices and records.

The AMA said the proposed registration conditions “place extraordinary obligations on healthcare provider organisations for matters that are largely out of their control”.

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http://www.australiandoctor.com.au/news/latest-news/gps-face--extreme-obligations--with-e-health

GPs face 'extreme obligations' with e-health

12 April, 2012 Sarah Colyer

GPs would be forced to open up their practices and hand over records to health department investigators under draft powers to police the national electronic health records system.

The conditions, circulated for comment this month, would be mandatory for any practice wanting to take part in the personally controlled electronic health records (PCEHR) scheme due to commence on July 1.

The success of the system is dependent on GPs agreeing to create and manage patient health summaries on the records.

But the AMA has warned that the conditions create such "extraordinary obligations" that they would deter every medical practice in Australia from taking part.

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http://theland.farmonline.com.au/news/state/agribusiness-and-general/general/ehealth-not-just-a-flick-of-a-switch-for-overworked-doctors/2519640.aspx

E-health: not just a flick of a switch for overworked doctors

13 Apr, 2012 04:00 AM

THE Rural Doctors Association of Australia (RDAA) has cautioned the Federal Government that the Personally Controlled E-Health Record (PCEHR) system will fail unless doctors and practices are fairly compensated for the time and risk involved in establishing and maintaining e-health records for their patients.

RDAA has joined a range of other medical organisations in calling for better support for doctors and practices in implementing the new system.

“RDAA strongly supports the PCEHR system—it will bring enormous benefits to patients and the health system, and we want to see it work” RDAA president, Dr Paul Mara, said.

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http://www.abc.net.au/news/2012-04-13/hunter-e-health/3947766/?site=newcastle&section=news

E-health set to roll despite software hiccup

Updated April 13, 2012 08:34:27

First patients being recruited for E-health system

The Hunter GP organisation delivering a new electronic health system for the region says the program is on track despite problems with the national software rollout.

Newcastle, Melbourne and Brisbane are the lead sites for the E-health system that the Federal Government intends to eventually roll-out across the country.

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http://www.theaustralian.com.au/national-affairs/health/gps-want-cash-for-e-health-input/story-fn59nokw-1226322351621

GPs want cash for e-health input

• by: Sue Dunlevy
• From: The Australian
• April 10, 2012 12:00AM

THE doctors who underpin the Medicare Locals system say the government will have to provide incentive payments to GPs if they want them to write the records for the $467 million e-health system.

The Australian General Practice Network says the Gillard government's approach of paying for the records to be set up when patients visit a GP is "piecemeal" and won't facilitate solid as well as rapid enrolments.

AGPN chairman Emil Djakic says the government should provide service and practice incentive payments to establish the records for the Personally Controlled e-Health Record system.

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http://ama.com.au/media/ama-sets-its-own-items-managing-shared-health-summary-personally-controlled-electronic-health-

AMA sets its own items for managing a shared health summary for the Personally Controlled Electronic Health Record (PCEHR)

10 April 2012 - 9:50am

The AMA has introduced its own items for preparing and managing a shared health summary for the Personally Controlled Electronic Health Record (PCEHR).

AMA President, Dr Steve Hambleton, said today that the Government had not created new items for doctors’ time and work with patients on the PCEHR and had not allocated any new funding in the Medicare Benefits Schedule (MBS) to cover this new clinical service to be provided by doctors.

“The public announcements from the Government suggest that patients will only get a Medicare rebate if the shared health summary is prepared as part of an existing MBS consultation,” Dr Hambleton said.

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http://www.medicalobserver.com.au/news/ama-proposes-pcehr-consult-items-and-fees

AMA proposes PCEHR consult items and fees

10th Apr 2012

Mark O’Brien

GPs have been advised to charge each patient up to $210 when preparing a shared health summary for the government’s personally controlled e-health record (PCEHR) system, which will be rolled out from 1 July.

AMA president Dr Steve Hambleton said government had not created any new MBS items, and had not set aside any new funding, to remunerate GPs for the work they would put into creating shared health summaries.

“The public announcements from the government suggest that patients will only get a Medicare rebate if the shared health summary is prepared as part of an existing MBS consultation,” Dr Hambleton said.

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http://www.zdnet.com.au/ama-prices-e-health-record-creation-339335623.htm

AMA prices e-health record creation

By Suzanne Tindal, ZDNet.com.au on April 10th, 2012

The Australian Medical Association (AMA) has laid out a payment scheme for how it thinks doctors should be compensated for creating a patient's health-record summary.

A health-record summary is a quick fact sheet of a patient's health that their GP will create and keep up to date. The health summary is a key element of the government's personally controlled electronic health record (PCEHR) scheme, which the government is starting from 1 July.

GPs have been concerned about the amount of time it will take to manage the shared e-health summary, and are looking for compensation for the time that they will spend on updating them. At the end of last month, Health Minister Tanya Plibersek said that the government will accede to this wish by providing funds to GPs for managing the records.

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http://www.nehta.gov.au/media-centre/nehta-news/964-australia-leads-the-way-in-health-products-management

Australia leads the way in health products management

3 April 2012. National E-Health Transition Authority (NEHTA) CEO, Mr Peter Fleming has recognised Australia’s National Product Catalogue, for being the most comprehensive of its type in the world, during a speech at the 21st Global GS1 Healthcare Conference held in Sydney from 20-22 March.

Mr Fleming said Australia’s world-leading National Product Catalogue (NPC), is one of the first in the world to focus exclusively on the needs of the healthcare industry, while meeting the needs of healthcare purchasers by allowing for provision of data about products from other sectors, and is endorsed by all state, territory and federal health departments.

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http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=941:nehta-and-gs1-to-host-npc-webinars&catid=16:australian-ehealth&Itemid=328

NEHTA and GS1 to host NPC webinars

Written by Kate McDonald on 10 April 2012.

GS1 Australia and the National E-Health Transition Authority (NEHTA) are holding webinars each day next week to help suppliers understand how to use the National Product Catalogue (NPC).

The 'Realise the Efficiency of the NPC' webinar will show how to use the NPC to bring new business efficiencies to their organisation and provide essential information on how to get involved, the organisers said.

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http://www.theaustralian.com.au/news/health-science/electronic-alert-to-end-abuse/story-e6frg8y6-1226325207322

Electronic alert to end abuse

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

THE suicide of James - from an overdose of prescription morphine and diazepam he obtained during daily runs to various GPs and pharmacies - proved one tragic death too many for Victorian coroner John Olle.

Unusually, Olle has used his powers to recommend the state introduce a real-time prescription monitoring and alert system within 12 months to reduce the deaths and harm caused by such doctor-hopping or prescription-shopping by vulnerable patients.

At present, state and territory governments rely on monthly submissions of paper-based records of controlled (Schedule 8) drugs prescribed by doctors and dispensed by pharmacists. A move from manual to electronic recording, and then real-time reporting, will give providers the information needed to make clinically appropriate prescribing decisions.

But some critics fear a national alert system being developed by the Gillard government may not deliver the desired outcomes.

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http://www.odt.co.nz/lifestyle/health/205007/concerns-over-breast-screening-software

Concerns over breast screening software

By Elspeth McLean on Thu, 12 Apr 2012

In January, the Otago Daily Times revealed systems failures in the national breast-screening service BreastScreen Aotearoa, discovered in 2009, resulted in delayed routine two-yearly screening mammograms for 241 women, five of whom were found to have cancer. Documents released under the Official Information Act reveal more about the issues, as Elspeth McLean reports.

The report on the 2009 discovery some women were waiting too long for breast screening invitations brings to light concerns about the performance of software provider Orion Health at that time.

The 2010 report, released under the Official Information Act, shows BreastScreen Healthcare (BSHC) was dissatisfied with Orion's performance and sought legal advice on its contract. It was advised it had "limited options" to address performance.

BSHC, which covers Otago and Southland, expressed concern at Orion's "lack of responsiveness. Testing has shown many gaps/risks".

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http://www.getthewordout.com.au/20120410287/news-room/dca-and-communicare-forge-alliance-to-accelerate-community-ehealth-initiatives.htm

DCA and Communicare forge alliance to accelerate community eHealth initiatives

Tuesday, 10 April 2012 18:05

Two of Australia’s leading healthcare solutions organisations, DCA and Communicare, are joining forces to support health and community services organisations to improve the quality of service to healthcare consumers.

“The acquisition is a strong strategic fit for DCA,” said Declan Ryan, DCA’s Chief Executive Officer. “Communicare provides further expansion into the community services sector and a strong presence in Western Australia. It’s also an excellent fit with DCA’s existing health and community services business division and enables both companies to increase their service delivery capability”

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http://www.smh.com.au/national/health/video-spares-patients-as-it-assists-students-20120408-1wjm8.html

Video spares patients as it assists students

Amy Corderoy

April 9, 2012

ASHLEY ALLUM has seen a lot of doctors. But if there's one thing more unnerving than hospital tests it is having them watched by a roomful of students.

Ms Allum has cerebral palsy and recently also developed a gastrointestinal disorder which has meant a drastic change in diet and numerous medical appointments.

But the 24-year-old was totally relaxed during her most recent trip to Blacktown Hospital's clinical school - partly because instead of having students in the room, the consultation was beamed live to their class, a couple of doors away.

"It meant I was able to forget about that, really," she said. "I was able to feel comfortable".

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http://www.rustreport.com.au/issues/latestissue/australian-data-breach-costs-rise-to-2-16-million-per-incident-in-2011/

Australian data breach costs rise to $2.16 million per incident in 2011

April 10, 2012

The average cost of a data breach reported by Australian organisations has risen steadily for the third consecutive year, reaching $2.16 million in 2011, according to research released  by Symantec Corp. (NASDAQ: SYMC) and Ponemon Institute. The study also found that malicious or criminal attacks were the most common cause of data breaches and the most expensive type of breach overall for Australian businesses. The 2011 Cost of Data Breach Study: Australia report is based on the actual data breach experiences of 22 Australian companies from ten different industry sectors.

“The large volume of data breach incidents occurring over the last year has put data breaches high on the agenda for Australian executives,” said Craig Scroggie, vice president and managing director, Pacific region, Symantec. “As local organisations embrace new technologies, businesses need to focus on processes, policies and technologies that improve their ability to prevent and detect data breaches. Taking steps to keep customers loyal and repair any damage to reputation and brand after a data breach has occurred, can help to significantly reduce the cost of a data breach”.

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http://www.smh.com.au/opinion/political-news/reform-on-foi-bogs-down-20120408-1wjof.html

Reform on FOI bogs down

Philip Dorling

April 9, 2012

FEDERAL freedom of information reforms have stalled, with government spending on high-performance shredding machines easily outstripping funding for public servants to handle requests for information.

A review of published government contracts by The Age has revealed that government agencies spent close to $10 million on new shredding machines over the past three years.

By comparison, annual freedom of information reports show that the government spent only $764,000 in the same period training public servants to process freedom of information applications from the public. The understaffed FOI watchdog, the Office of the Australian Information Commissioner, is facing budget cuts.

There is also a growing backlog of FOI decision reviews, a state of affairs that is being exploited by agencies seeking to delay the release of sensitive information.

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http://www.smh.com.au/technology/sci-tech/matrix-magic-makes-veterinary-surgery-less-intimidating-20120409-1wl4a.html

Matrix magic makes veterinary surgery less intimidating

Deborah Smith

April 10, 2012

THE ''patient'' has no head and no limbs, but her belly is creepily realistic to the touch, thanks to the special effects company that also created the gooey pod scene in The Matrix.

Sophie Moffat, a final-year veterinary student at the University of Sydney, carefully makes an incision in the pink, three-layered ''skin'' of this life-like model of a dog's abdomen.

She begins to search inside for the uterus and ovaries. ''They're not easy to find,'' she explains, probing around near the bladder.

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http://www.smh.com.au/digital-life/hometech/risks-of-putting-digital-life-in-cloud-20120403-1w9zs.html

Risks of putting digital life in cloud

April 13, 2012 - 7:04AM

Don't let a cloud burst leave your data all washed up, writes David Braue.

Later this month Google will close the shutters on Picnik.com, a popular online photo-editing site that Google bought in 2010 and is now being absorbed into the web giant's Google+ social-networking venture.

Picnik's users, many of whom have built up significant portfolios of work created with Picnik's Flash-based image editing tools, have been exhorted to download their images using Picnik Takeout – a feature that compresses all of a user's images into a compressed, downloadable .ZIP file. It's a one-time offer: once the site goes dark on April 19 (US time), every picture stored in the service will be gone.

Picnik isn't the first cloud service to close its doors, but it's a textbook example of the risks inherent in entrusting too much of your digital life to cloud-computing services. Web-based services like Apple's iCloud; file-sharing site DropBox; Adobe's Photoshop Express; Microsoft's new Office 365 apps and Windows Live services; photo-sharing sites like Facebook, Yahoo's Flickr and Smugmug; and Google Docs and related apps – these, and hundreds of other online services, are built around the idea that the software providers will look after your data for you, forever.

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http://www.voxeu.org/index.php?q=node/7867

Migration to the cloud ecosystem: Ushering in a new generation of platform competition

Chaim Fershtman   Neil Gandal
13 April 2012

Cloud computing – services that are accessed directly over the Internet – is the new ‘game-changer’ in the information technology world. Yet cloud computing is still in its infancy. This column explores what it might mean for competition among service providers.

Cloud computing – services that are accessed directly over the Internet – is the new buzzword in the information technology world. The ‘cloud’ label comes from the fact that the computing infrastructure is not in your hands; it is located far away ‘in the clouds’, as it were. The device in your hands (personal computer, tablet computers, mobile devices, etc) is akin to an old-fashioned computer ‘terminal’ linked to a mainframe. (Readers who finished university after the 1980s will need to look this up on Wikipedia.)

Cloud computing is often called a 'game-changer', something that will dramatically change the industry, yet there is virtually no research on the economics of it. The literature that exists has primarily focused on the technical aspects of cloud computing (Ambrust et al 2009).¹ Another branch of the literature focuses on the macroeconomics effects: creation of jobs, changes in output, etc (Etro 2009).

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http://www.zdnet.com.au/us-cloud-firms-should-get-off-the-soap-box-339335906.htm

US cloud firms should get off the soap box

By Suzanne Tindal, ZDNet.com.au on April 13th, 2012

A recent US report on trade barriers has revealed a hissy fit by US companies about the Australian government's caution on cloud.

The report (PDF), released last month by the Office of the United States Trade Representative, says that US companies have voiced concerns that various Australian government departments are "sending negative messages about cloud computing services to potential Australian customers in both the public and private sectors, implying that hosting data overseas, including in the United States, by definition entails greater risk and unduly exposes consumers to their data being scrutinised by foreign governments".

Departments that the report singled out as being the bad eggs included the Department of Defence, the National Archives of Australia, the Department of Finance and Deregulation, the Australian Government Information Management Office (AGIMO) and the Office of the Victoria Privacy Commissioner.

The report goes on to say that many of these concerns, when directed at US firms, "appear based on a misinterpretation of applicable US law, including the US Patriot Act and regulatory requirements".

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Enjoy!

David.

AusHealthIT Poll Number 117 – Results – 16th April, 2012.

The question was:

What Proportion Of The Population Do You Think Will Have An Active NEHRS (PCEHR) Record Two Years After System Start Up?

10% or less

- 33 (78%)

11-20%

- 5 (11%)

21-30%

- 1 (2%)

31-50%

- 2 (4%)

51-75%

- 1 (2%)

76-100%

-  0 (0%)

Votes: 42

A pretty clear outcome - The vast majority see a  less than 10 % adoption of the NEHRS in the next two years.

Enough said.

Again, many thanks to those that voted!

David.

NEHTA Is Really Being Called On Its Efforts In Patient Safety. Even From Their Clinical Lead!

The following appeared this morning.

Concern for patient safety with e-records

Mark Metherell

April 16, 2012 - 12:07AM

PATIENT safety under the proposed electronic health records system cannot be guaranteed less than three months before it is scheduled to start.

Safeguards to prevent and correct snafus with doctors' software, such as medication mistakes, have yet to be provided for in the national e-health scheme beginning on July 1.

The warning has come from three experts, including Mukesh Haikerwal, chief clinical adviser to the e-health transition agency.

They warn that the lack of a national clinical safety system to deal with glitches in doctors' desktop computers and electronic devices such as iPhones and iPads means that "it is not yet possible to make any definitive statement about whether the personally controlled electronic health record is safe or not".

"There is no guarantee that harm events will be rapidly identified or remediated when it is in operation," they write in an editorial, published in the Medical Journal of Australia today.

Their warning is the latest challenge to confront the e-health plan, which has attracted growing criticism about security and privacy concerns spurred by the uncertain performance of the body responsible for the e-health rollout, the National e-Health Transition Agency.

Lots more here:

http://www.smh.com.au/national/health/concern-for-patient-safety-with-erecords-20120415-1x1sn.html

The original paper is here:

A call for national e-health clinical safety governance

Enrico W Coiera, Michael R Kidd and Mukesh C Haikerwal

Med J Aust 2012; 196 (7): 430-431.

doi:  10.5694/mja12.10475

The benefits of technology should not be overshadowed by avoidable patient harm

Sadly this paper is behind a paywall so it won’t get the full coverage it deserves. Here are the principles is recommends. (Prof Coiera has just let me know anyone who wants a copy can e-mail him to obtain a copy. He is findable via UNSW)

Principles for national e-health clinical safety governance

•  E-health clinical safety governance must be national but independent of government or industry, to avoid conflicting interests that may lead to resisting change for commercial, professional or political reasons. It must be expert-based rather than organisationally representative.
• Safety is an emergent property of a whole system. Certification of individual components does not guarantee that the whole system is safe.
• E-health clinical safety governance should integrate with mainstream patient-safety processes. Harms arise from sequences of events involving both technical and non-technical elements.
• Governance must assure all components are safe, both alone and in combination with pre-existing elements. Standards and regulatory processes such as accreditation should underpin this, with full legislative backing.
• The safety of the whole system must be monitored in routine use to detect potential risks and actual harm events, as well as clusters. Open disclosure should be paramount.
• Governance must build defences against harm, including safety processes, system redundancies and training, to minimise unsafe use or the creation of unsafe settings.
•  Any governance body must have a capability to investigate, analyse and act upon significant risks in the system.

I have to say it would be hard to argue with any of those. How many of these do you see NEHTA following at present?

They are in pretend mode as far as I can tell. Their heads are planted firmly in the sand.
Again we see the lack of leadership and governance in the Australian e-Health effort is being seen for what it is - utterly inadequate.
More evidence on all this over the next few days.

David.

An Alert On Potential Emerging Problems With Mobile Devices and E-Health.

The following appeared very recently.

Clinical software on personal mobile devices needs regulation

Juanita I E Fernando

Juanita Fernando says clinicians need some legal certainty around phone and tablet use

The regulation of clinical software for personal mobile devices (PMDs) has increased in relevance for physician practice.1 The plausible benefits of using software such as iStethoscope, Flipboard, Skype or MedCalc on smart phones and tablets include up-to-date access to health data, support for distributed health care and improved quality of interactions with patients. Recent World Health Organization (WHO) survey findings confirm that use of PMDs by clinicians offers tangible patient-care benefits including the integration of mobile health into existing services regardless of geography, connection to an electrical grid and income level. And yet, the legal vacuum in guidelines governing smart phone and tablet use is a key implementation barrier in upper-middle income regions such as Europe (reported by 56% of countries) and the Americas (50%).2 Increasingly, governments overseas are at least thinking about, if not acting upon, this challenge — but Australian governments remain silent.

Software on computers, and portable memory, such as USB sticks, share several security risks associated with software on a PMD that are not addressed by legislation. These include transmission of user log-ons and address-book details, message interception and activity tracking. Professional self-regulation has begun to fill legislative gaps but does not guide the clinical use of PMDs.

One security risk related to PMDs concerns “root-kits” — software applications that are hidden by manufacturers to monitor program performance or installed by attackers for malicious purposes. Unknown to the person using a PMD, root-kits can log key-presses and user locations and can receive messages without notification. They often transmit data in unprotected clear text, too.

Another danger concerns the mix of more than 600 000 software applications, both personal and professional, that people, including physicians, install on mobile devices. Almost 70% of American doctors have downloaded and installed 1500 types of clinical software applications, and Australian physicians are close behind.

Much more with references found here:

doi: 10.5694/mja11.11390

The paper will be available at www.mja.com.au on Monday 16^th April.

Author details

Juanita I E Fernando Grad Cert BusSys, MA, PhD Researcher, Mobile Health Research Group,1 and Chair, Health Sub-Committee2

1 Faculty of Information Technology and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC.

2 Australian Privacy Foundation, Canberra, ACT.

juanita.fernando@monash.edu

I think Dr Fernando has an important set of points here - especially around the need for some clear accountability as to who needs to be accountable for regulation of this area - especially if we start to see any patient harm or privacy breach result from device use.

Well worth a browse.

David.