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."

Tuesday, August 21, 2012

New Zealand Seems To Be Really Moving On Health Information Exchange. And It Is Costing Peanuts Compared With the NEHRS.

I had the following e-mail during the week from Tom Bowden the CEO of HealthLink.

122 successful CareInsight lookups in a single week, in one region!

Dear Colleague,
When a patient arrives at a hospital emergency department it is probably one of the most distressing experiences they will ever have.  So it is essential that we do everything to ensure that each and every emergency department visit goes as well as possible.  By having information about a patient’s existing medical conditions, current treatment plan and medication history ED staff get a “running start” in terms of getting their emergency care underway.  CareInsight is the system that makes that possible. 
The CareInsight system is a world first in its field.  It is an online system that hospital and after-hours clinicians use to obtain important information about ED patients, directly from their general practices and pharmacies’ medical records systems.  CareInsight provides an instant window into the patient’s relevant medical details and provides hospital ED staff with the totally reliable and up-to-date information that they need to make the right interventions and get urgent treatments underway swiftly and confidently.
Last week in the Hawkes Bay District Health Board region, ED staff performed 122 successful CareInsight lookups.  Usage has been growing steadily over the past year but this is a new record.
Now in day-to-day use for over a year, CareInsight is really proving its worth and has become an essential ED tool.  Five regions have now implemented CareInsight or are in the process of rolling out CareInsight.  It is interesting to dwell on the proposition that if the results gained in the Hawkes Bay were extrapolated across New Zealand*, more than  6,000 Lookups would have occurred last week
To learn more about CareInsight please connect to this link to a video we have produced about the service and refer to the attached Privacy Impact Assessment to learn more about how it works.
Note:  *Hawkes Bay is home to 2% of New Zealand’s population.
Once looking at this video you can see the other things with e-referrals and so on that are also now being progressively rolled out.
I am happy to send the report to people on e-mail request  (it does not seem to be online) but it is probably easier to read about what is being done from this link:
The great thing about this system is that it is being implemented in a ground up, incremental way learning as people go to minimise the problems and maximise clinical benefits.
Just saying this is so much more like what we should be doing - and costing ourselves so much, much less in the process. Here is a working system delivering what the NEHRS hoped to do and it is all working, and being used, here and now!
This is the promise of e-Health that sadly NEHTA and DoHA just don’t get or if they do they are just going about things the wrong way. Better to travel slowly and learn along the way than what we have seen in the last two years.
As confirmation of that see here:

Sharing your health information

The way information about our health care is shared is improving. By the end of 2014 the Government’s aim is for all New Zealanders and the health professionals caring for them to have electronic access to their health information.
-----
It is really good to see how calmly and carefully the NZ team are going about all this. The chances of success are looking more reasonable than what we are presently doing I reckon.
Great stuff.
David.
Late Alert: Here is the link you need to all the material.
http://www.healthlink.net/resources/CareInsight.pdf
The document then has a link to the privacy assessment and video.
D.

Monday, August 20, 2012

Now What On Earth Is Going On Here? More Stuffing About It Would Seem. Talk About Tiny Steps Forward.

Just got this when I tried to access my NEHRS:

National eHealth Record System Provider Portal Login

ENTER

Ensure you have a valid NASH Token connected.

The NASH (National Authentication Services for Health) is a digital credential for healthcare professionals.
Here is the link:

Given NASH does not exist - it is clear clicking that did not work. Going back things were back to routine!
As mentioned, later we were back to normal and I got into my NEHRS.

I checked on the integration and got this!

                       22-May-2012 Medicare/DVA Benefits Report DHS Medicare
                       22-May-2012 Medicare/DVA Benefits Report DHS Medicare

                         22-May-2012 Medicare/DVA Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare
                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare
                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

Each drug gives you this:

Pharmaceutical Benefit Items

Generic Name        ALLOPURINOL
Brand                     PROGOUT 300
Prescribed             Sat May 05 00:00:00 EST 2012
Supplied                Sun May 06 00:00:00 EST 2012
Form and Strength TABLET 300MG
Quantity                60
Repeat Number     2

At last I found the summary screen and guess what it was 3 months out of date! I filled repeats in June, July and I think August. Of course the times are just nonsense - a date would do!

Medicare Overview

The information below is provided from Medicare and may be incomplete. To find out more or to change your preferences, go to Medicare Information Preferences.

Prescription information - PBS & RPBS

Generic name
Brand
Prescribed
Supplied
Form & Strength
Quantity
Repeats
Code
MELOXICAM
MOXICAM 15
05-May-2012
06-May-2012
TABLET 15MG
30
2
08562P
ALLOPURINOL
PROGOUT 300
05-May-2012
06-May-2012
TABLET 300MG
60
2
02604C
TELMISARTAN
MICARDIS
05-May-2012
06-May-2012
TABLET 80MG
28
5
08356T
MELOXICAM
MOXICAM 15
05-May-2012
06-May-2012
TABLET 15MG
30
3
08562P
OMEPRAZOLE
ACIMAX TABLETS
05-May-2012
06-May-2012
TABLET 20MG (AS MAGNESIUM)
30
5
09110L

Australian Childhood Immunisation Register - ACIR

Immunisations

No information available

Cancelled Vaccinations

No information available

Australian Organ Donor Register - AODR

No information available

Medicare Services - MBS & DVA items

Date
Number
Description
Service Provider
In Hospital?
22-May-2012
66602
Red cell folate + serum B12
DR XXX XXXXX
No
22-May-2012
66608
Vitamin D
DR XXX XXXXX
No
22-May-2012
65129
Coagulation - 4 or 4+ tests
DR XXX XXXXX
No

What to say? We have old, incomplete and very clumsy records that no doctor could love. Given I know the medication records are close to 3 months out of date it is hard to really believe this would hardly help much - some, but not what was needed. Definitely a start but jinx a lot of work is needed on interface, utility and so on.
Personal note: These medications are for hypertension, arthritis, gout (family history) and so on so be not concerned - they are not a secret and many over 60 are on such meds. Seeing what we are being offered in the NEHRS is more vital so people can form a view on what is being done. To anyone who wonders all the meds are working well and all my parameters are fabulous now! e.g My blood pressure is 110/70!

Hope this helps others to set up a record and see for themselves.

It seems to me utterly clear that no clinician was involved in the design of this or we would not see what we have been given. This is incompetent rubbish compared with what was possible with some consultation and effort!

David.

Weekly Australian Health IT Links – 20th August, 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

All in all a very interesting week with all sorts of e-Health initiatives happening separate from the NEHRS -PCEHR which has gone spookily quiet as feverish work goes on in the background. (I am told having Medicare information in the record is happening ‘real soon now’. It had not apparently happened on Sunday 19th August which is when I last checked. (At least everything else seemed to be working!)
I continue to be amazed by the Martian rover Curiosity. This really is an amazing feat that shows just what extraordinary capacities exist in the world. I for one really does wish there was more focus on the positive rather than negative uses of what we can now do!
-----

Cool response to online health record scheme

Date August 14, 2012 - 9:38AM

Fran Molloy

Despite more than 15,000 patients having consented to a shared e-health record in one Brisbane test area alone, only 5000 people have registered with the government's eHealth scheme nationally.
Despite more than 15,000 patients having consented to a shared e-health record in one Brisbane test area alone, only 5000 people have registered with the federal government's eHealth scheme nationally.
The scheme went live on July 1 with little fanfare because the department responsible for it opted for a soft launch that would allow bugs to be ironed out. By yesterday, 5029 Australians had registered for the personally controlled electronic health record (PCEHR), with 89 per cent of them registering online, despite triple that amount consenting to a shared record via GP clinics attached to Brisbane Metro-North Medicare Local initiative.
The Queensland initiative was one of three national wave sites trialling the new health record system since February 2011.
-----

Lack of e-faith: hospitals snub identifier system

13th Aug 2012
THE rollout of the national e-health system has hit another barrier, with the hospital sector unlikely to embrace the individual health identifiers (IHIs) allocated to Australians two years ago.
The news comes as the government found itself under further scrutiny as it works to achieve its goal of 500,000 patient sign-ups in the first year with Fairfax papers reporting that just 5029 Australians were so far on board following the system's launch last month.
Coalition e-health spokesman, Andrew Southcott, was quoted as saying that at that rate, the government would achieve just 60,000 of its half-million sign up target by July 2013.
-----

Learning from the “pioneers of ehealth” in general practice

, by Melissa Sweet
It is fitting that the “pioneers of ehealth” – more than 55 general practices involved in an eCollaborative project around chronic disease care and self management – are using online tools such as wikis and Twitter chats to share what they’re learning along the way.
If you’re interested to hear more, you could always join their Monday night TweetUp, using the #ecollabs hashtag.
In the article below, Samantha Smorgon, Program Officer for eHealth, Quality Improvement and Practice Management at the Inner North West Melbourne Medicare Local, and colleagues describe some of the complexities and challenges of the ehealth agenda.
-----

Hospital doctors failing to follow up thousands of tests, says study

Date August 15, 2012

Amy Corderoy

Health Reporter

TENS of thousands of hospital tests are not being followed up by doctors, research has revealed.
A review of one major Sydney hospital found that over four months more than 20,000 tests went unchecked when patients left hospital.
And about half of the tests were still unchecked two months after the patients had left hospital.
The study leader, Enrico Coiera, said the lack of follow-up would have serious health implications for some patients, as well as being a waste of money in an already overstretched system.
-----

Government report backs PCEHR incentives

17 August, 2012 Michael Woodhead
A government report on GPs’ readiness to adopt the PCEHR has backed the profession’s concerns about an increased workload and the need for reimbursement to cover the time spent preparing and explaining the new records.
The results of a 2011 survey of more than 800 GPs show that while most are broadly supportive of the PCEHR concept, there are uncertainties about the details and concerns about the quality and workability of the system
One of the main concerns was with the time required to implement the new system, with  73% of GPs believing  it will take at least 15 mins to explain the PCEHR to patients and 52% believe it will take at least 15 minutes to set one up.
-----

Chronic disease e-health record successfully launched

17th Aug 2012
A GOVERNMENT-backed electronic health record specifically designed for patients with chronic disease has been launched today with the promise of keeping patients, doctors and allied health workers in the loop.
Chronic Disease Management-Net or cdmNet, is due to go national today after being tested by 10,000 chronic disease patients, 1000 GPs and 3000 allied health practitioners, the collaboration behind it, the Collaborative Care Cluster, said.
The partners behind the program include Monash University, CSIRO’s e-Health Research Centre, Baker IDI, Southern Health, Royal District Nursing Service, Dandenong-Casey GP Association, Bupa, Diabetes Australia and the Royal Australian College of General Practitioners.
-----

Healthcare that works for the Facebook and Skype era

17 August, 2012

With Victorian Health Minister David Davis MLC

At The Alfred Centre, Monash University Lecture Theatre, Level 5, 99 Commercial Road

Fed up with explaining your medical history over and over again? Sick of waiting rooms? Can’t remember the name of the drug you had a reaction to? Lost your referral letter? Does your aging father keep forgetting when to have his health checks done?
These are just some of the problems being solved, thanks to a new e-health program that works. It’s been tested by 10,000 chronic care patients, 1,000 GPs and 3,000 allied health practitioners and the results speak for themselves.
This Friday the project – known as Collaborative Care Cluster Australia – will go national, with a call to action for GPs, patients and allied health professionals to get onboard and online to streamline the management of chronic illness and tackle a $60 billion healthcare burden.
-----

Penny Browne: Minimising record risks

The public debate in the lead up to the launch of the Personally Controlled Electronic Health Record (PCEHR) has missed a crucial point ― the quality of doctors’ medical records will always be critical to the delivery of high-quality and safe patient care.
Clearly a key element likely to impact on the success, or otherwise, of the PCEHR is the quality of the health summaries uploaded by the nominated health practitioner (usually the GP).
Any risks to patients (and medicolegal risks to doctors) resulting from interaction with the PCEHR will emerge slowly (in line with the expected uptake) so the extent of the risk to doctors is difficult to predict so early in the rollout.
-----

IT helps beats tyranny of distance

BY the time David Glance joined the University of WA's Centre for Software Practice in 2001, life had already handed him a number of rewarding experiences.
After finishing a doctorate in physiology in the mid 1980s, Glance shifted his focus to the intersection of high finance and high technology and started designing the digital innards of trading room technology for London firms. A few years later, with the dotcom bubble deflating, he found himself in the US headquarters of Microsoft in Redmond, Washington.
But he considers working with health workers in remote northwestern Australia for the past five years "the single most significant project I've worked on".
Put simply, the project enables doctors, nurses and other health workers to co-ordinate the care of about 26,000 mostly indigenous patients across the vast distances of the Kimberley, by accessing medical records online.
-----

Primary scoffs at 'barely profitable' claim

15 August, 2012
Updated on 15/08/12 at 3.45pm
Primary Health Care has rubbished claims its medical centres are “barely profitable” because of the millions it outlays recruiting new doctors.
The company has come under attack for its accounting methods, with an article in the Australian Financial Review on Monday noting that more than $60 million in up-front payments to GPs - who get up to $500,000 to join the medical centres - are not reported as a cost and therefore not included in Primary’s profit and loss statement.
The article claimed some analysts viewed the issue as so serious they considered the medical centre business was “barely profitable”.
Note: Primary Health Care presently owns Medical Director.
-----

HCF keeps members healthy with big data

Summary: HCF has invested in IBM analytics systems to tackle big data, using them to analyse claims.
By Suzanne Tindal | August 12, 2012 -- 21:31 GMT (07:31 AEST)
As part of an ongoing core systems upgrade, HCF is looking to big data analytics to help keep its members as fit and healthy as possible.
Over the past five years, HCF has been replacing parts of its core systems, which are up to 20 years old.
"Parts of it work very well. Some parts are getting very clunky," HCF CIO Patrick Shearman said.
Within the course of these upgrades, the company had implemented the ILOG, SPSS, Cognos and Lombardi products. All of these products have been bought by IBM in the last five years. According to Shearman, it was a logical step to consolidate the agreements in a formal fashion with the new parent company, as well as enlisting IBM's help on the core systems transformation. Consequently, the company has just signed a multi-million dollar deal that will see IBM help HCF with its IT transformation, with a focus on improving analytics.
-----

NEHTA Clinical Documents: Exclusion Statements

Posted on August 14, 2012 by Grahame Grieve
This is the first of a series of posts looking at implementation issues associated with NEHTA clinical documents. These are based on the common questions I get from implementers. The focus of the first few posts is going to be the “Medical History” Section in the SHS, and the related sections in other documents. But before I can consider those sections in detail, I need to talk about Exclusion Statements in general.
-----

PM's $150m spin doctor brigade

TAXPAYERS are spending about $150 million a year on an army of spin doctors to sell the Gillard government's policies to voters.
Figures obtained by The Australian reveal there are about 1600 staff employed by federal government departments and agencies in media, communications, marketing and public affairs roles.
The Australian Taxation Office, Defence and departments of Human Services, Immigration and Health employ more media and communications staff than any other departments or agencies.
A further 60 media advisers are dedicated to federal ministers and parliamentary secretaries.
The total number of public affairs staff in government is more than five times the estimated 300 journalists -- including reporters, photographers, camera crew and support staff -- in the Canberra press gallery.
Note: Health And Ageing Department have 72 spinners
-----

Billing just got easier with this time-saving phone app

14th Aug 2012
LIKE all GPs Dr Jane Ramsey has more useful things to do with her time than spend it thumbing through the MBS searching for appropriate items to bill.
So as a regular user of a free app simply called MBS Search, she is only too happy to recommend it to her colleagues as a time saver and helpful resource that allows GPs to locate billable items – including some they may not have thought of.
“You can search for any parameter and then put in your favourite categories so I use it for my theatre billing,” Dr Ramsey told MO.
-----

Firms lag on BYOD security

  • by: Fran Foo
  • From: Australian IT
  • August 17, 2012 9:25AM
ORGANISATIONS that don't take a holistic security approach to bring-your-own-device (BYOD) programs do so at their own peril, an industry expert warned.
A survey by Forrester Research Australia found that most companies were effectively outsourcing BYOD security to employees.
According to the study, almost 50 per cent of companies viewed user passwords/PIN as the primary method of securing BYOD devices. These smartphones and tablet computers are allowed to connect to corporate networks and access sensitive or commercial information.
-----

iAwards recognise finest Australian ICT talent

August 13, 2012
iAwards honours list
ICT leaders and innovators across 25 categories were honoured at the Annual national iAwards ceremony held in Melbourne last Thursday. Now in its 18th year, the iAwards is one of Australia’s leading technology awards program recognising the most innovative companies and leading individuals across 25 categories.
In the E-Health space these people won the award
-----

Australian Medicare Local Alliance Launched

Joint Release

The Hon Tanya Plibersek MP

Minister for Health

The Hon Mark Butler MP

Minister for Mental Health and Ageing

Minister for Social Inclusion

Minister Assisting the Prime Minister on Mental Health Reform

16 August 2012
Australians can look forward to more effective and cohesive primary health care with the launch of a new national body to lead the network of Medicare Locals.
Minister for Health Tanya Plibersek and Minister for Mental Health and Ageing Mark Butler today attended the launch of the Australian Medicare Local Alliance in Parliament House, Canberra.
Ms Plibersek said the Australian Medicare Local Alliance will play a key role in ensuring Medicare Locals function effectively and efficiently and work as a cohesive group, responsive to changing Government priorities.
Note - Supporting E-Health is a major role of the Alliance.-----

NCTIS Newsletter

Edition:       Edition 6
Date:            10th of August, 2012

NCTIS Newsletter

Welcome to Edition·6 of our NCTIS Newsletter of 2012. We have exciting news about recent and upcoming events as well as information about recent product releases to share with you.
-----

Curiosity ready to hit the Mars road

  • by: LEIGH DAYTON, science writer
  • From: The Australian
  • August 17, 2012 12:00AM
THE Curiosity rover is flexing its technological muscles, testing its wheels and has had its software upgraded in readiness for its first test drive on the Red Planet.
"It's fair to say that the scientists, not to mention the rover drivers, are itching to move," said Curiosity's deputy project scientist Ashwin Vasavada, with NASA's Jet Propulsion Laboratory in Pasadena, California.
He said the test drive is tentatively scheduled for early next week. If all goes well, Curiosity will then begin its two-year search for the geological and chemical signatures of past, even present, microbial life on Mars.
-----
Enjoy!
David.

UNSW Centre For Health Informatics Information Evening - September 11, 2012

I had the following e-mail today. There may be some readers interested.
-----
The Centre for Health Informatics (CHI), located within the Australian Institute for Health Innovation, UNSW, will be holding a PhD information evening on Tuesday 11 September, 2012,  between 5-7pm.  The evening will be an opportunity for potential PhD candidates to gain valuable information about the research the Centre is involved in and meet key people within the Centre.
The evening is designed to be informal and relaxed. People are encouraged to drop by our offices between the hours of 5pm to 7pm to learn more the career opportunities on offer at CHI.
To assist with spreading the word, would it be possible to email this flyer around to your associates, employees, members and students and where possible place the attached flyer on notice boards.
For further information relating to this evening, please feel free to contact:
Denise Tsiros
Business Manager
Centre for Health Informatics
Or
Dr Miew-Keen Choong
Centre for Health Informatics
-----
Here is a link from which you can find all the background you need.
Or the home page here:
Sorry I can’t find a link to the brochure. I am sure you can have it e-mailed to you using this e-mail address (the Admin. Assistant).
David.

Sunday, August 19, 2012

I Think This Is All You Need To See To Know The NEHRS Is Doomed In The Longer Term. This Is Just Unbelievable.

As many readers will be aware DoHA has been tendering for assistance with the NEHRS.
You can read all about this Tender here:
As part of the process NEHTA have sent out some responses to questions from possible providers.
Two answers really amused me.
First we had this question and answer response from DoHA:
Q. What is the average skill level required by personnel working under this tender?
A. The average skill level is expected to be equivalent to the Department’s Executive Level 1 ranking. Positions of this level carry significant responsibility and therefore require a higher level of knowledge/qualifications, technical expertise, precision, accuracy and attention to detail. Work is carried out with a clear understanding of the impacts of performance and service delivery for the Department.
Given the importance of these roles to success I has assumed great seniority:
I am assured not so:
“EL 1 is just about the lowest of the low. When I worked at xxxx. the EL1 I worked with was an amateur who couldn't (wasn't allowed) to make decisions and even the Directors were a bit sus. And EL2s come between EL1 and Director.”
Some research reveals the salary level for EL1 being presently advertised is $95,000 to about $105,000. Really hardly a senior level and below all the Senior Executive Service etc.
Even more astonishing we have this:
Q. What is the eHealth Organisation structure?
A. See chart below.
(Sorry it is a bit blurred - you can actually make out most of the text of you expand the image by clicking on it. Using browser increase size also works!)
It is hard to know what to say about this chart. It seems this project is now consuming a vast number of people and if ever there was a Government out of its depth in delivering an e-Health project this has to be it.
The micro management of every aspect, and the apparent duplication of roles with what is being done by NEHTA and all the Contractors must mean a level of difficulty in getting things actually done would be very tricky indeed. They would all be tripping over each other.
Just read through the job roles and ask yourself how many people are in the Australian Public Service who could claim significant expertise in all these roles.  We just don’t have them as far as I know and that just adds to the overall risk in my view. You can be sure there are a huge number of generalists just stumbling along and many of them being out of their depth.
Sorry DoHA, this is just not the way to deliver either a Health Program or an IT Project.
As another correspondent said when asked about the chart - ‘Sorry, its doomed’. I can’t but agree.
David.

Request For Feedback On NEHRS Changes. Medicare Integration Said To Be Complete.

Well informed sources are suggesting that integration with Medicare Data Bases with the NEHRS has now been delivered and that we will soon see our Medicare Data under the relevant tab.

I checked earlier today - and while the screen has changed there is still no information in my record. There really should be some PBS records in mine if it was working I reckon.

I would be keen to have NEHRS watchers check from time to time and see if anything has yet changed with their record.

David.