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."

Monday, August 27, 2012

Weekly Australian Health IT Links – 27th 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

There are some interesting news items this week. What surprises me is, again, all the different initiatives we are seeing outside the NEHRS / PCEHR program.
Clearly the Government deciding to help defray the time costs for GPs with the NEHRS is big as well - as is the Audit Reports on HealthSMART and Myki.
I especially liked this quote from the MyKi report:
“THE former state Labor government failed to properly investigate other smartcard ticket systems around the world when preparing to introduce myki, leading to a costly underestimation of the project's complexity, a state inquiry has heard.” Remind you of something?
And on HealthSMART this was a ripper:
“The proposal for Victoria's abandoned $500 million e-health system was cavalier and more of a concept than a properly developed business case, a senior bureaucrat says.”
Oh dear - it seems the lessons are never learnt!
Lastly - Vale Neil Armstrong. I remember the black and white pictures and more so the sense of awe at what had been done - as well as sense that most things were possible. I wonder have we lost our way a little since those heady days?
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Online chat offers new help for suicide prevention

Date August 23, 2012

Dan Harrison

A NEW service which uses online chat to prevent suicides is providing support to people in distress who are unwilling to use telephone counselling services.
Launching Lifeline's Online Crisis Support Chat service yesterday, the Federal Minister for Mental Health, Mark Butler, said the service would be of great benefit to men and younger people, who were less likely to seek help in person or over the phone, and people in areas where conventional services were not available. Four in five Australians were using the internet to seek health information, he said.
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Mater Health Services Uses InterSystems HealthShare to Create an eHealth Record for Mothers
Breakthrough Healthcare Information System, Meeting Federal EHR Standards, Was Delivered in Just Nine Months
SYDNEY, Aust. - August 23, 2012 - InterSystems Corporation, a global leader in software for connected care,  today announced that Mater Health Services has used the InterSystems HealthShare™ healthcare informatics platform to rapidly develop an eHealth Record for expectant mothers.
By offering an electronic alternative to the paper-based Pregnancy Health Record currently issued by Queensland Health to public maternity hospitals, the new system is already benefiting both patients and clinicians. In a recent example, when a pregnant woman was rushed to Mater's Pregnancy Assessment and Observation Unit, Mater staff were able to expedite her critical treatment by having immediate access to the patient's obstetric record and latest test results due to her private obstetrician electronically sharing the information through his practice system.
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InterSystems deployed to create eHealth records for mums

Queensland’s Mater Health Services has used a system from global healthcare systems provider, InterSystems, to rapidly develop an eHealth record for expectant mothers.
Mater's Chief Information Officer, Mal Thatcher, said that by offering an electronic alternative to the paper-based Pregnancy Health Record currently issued by Queensland Health to public maternity hospitals, the new system was already benefiting both patients and clinicians.
According to Thatcher, in a recent example, when a pregnant woman was rushed to Mater's Pregnancy Assessment and Observation Unit, Mater staffs were able to expedite her critical treatment by having immediate access to the patient's obstetric record and latest test results due to her private obstetrician electronically sharing the information through his practice system.
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Doctors agree to update practices to share e-health data

Date August 24, 2012

Mark Metherell

Mark Metherell is health correspondent

THE long-awaited e-health scheme has locked in the support of doctors, but full operation of the electronic record system is still months away.
The government has won the agreement of big doctors' groups, including the Australian Medical Association, to new arrangements that will allow doctors to claim as much as $100 from Medicare for collating health records with their patients. But as part of the agreement the government has also agreed to postpone the deadline for doctors to meet e-health capability requirements until next May, after originally proposing February.
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Government unveils $5m telehealth project in South Australia

The mental health project includes 100 new videoconferencing units.
A $5 million telehealth project aims to enhance delivery of mental health care in South Australia. The project, announced today, is funded by the Commonwealth and the South Australian government under the $20 million digital regions initiative.
The mental health project includes more than 100 new videoconferencing units to upgrade call and image quality for more than 80 sites around the state, the Department of Broadband, Communications and the Digital Economy said. The project aims to reduce patient travel time, enable online access to health services, connect patients with family members living far away and “deliver rount the clock emergency triage and liaison services,” the department said.
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HCN Launches Integration Framework for Medical Director

HCN Launches Integration Framework for Medical Director

Health Communication Network (HCN), the developers of market leading clinical software, Medical Director, have today announced the launch of an Integration Framework for Medical Director.  The launch will take place at the Hyatt in Sydney today.
The framework manifests as the MD Sidebar in Medical Director. Partner companies can now develop Widgets (applications) which can be downloaded by Medical Director customers from the Widget store.  The MD Sidebar will be launched to Medical Director customers in a November 2012 release.
Australia’s eHealth strategy has created a real need in the market for robust, supportable communication and information sharing mechanisms.  The Integration Interface launch today is about collaboration and creating a real opportunity for clinicians and health care organisations to improve this information sharing and through those mechanisms make a real difference in patient care.  On the other side of this is the time poor clinician who needs tools and information at their fingertips, it needs to be fast, secure and reliable. 
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BREAKING NEWS: MBS item for PCEHR

23 August, 2012 Megan Reynolds
The AMA has welcomed the government's announcement that doctors will be paid for transferring patients to the PCEHR scheme.
Full details of the new arrangements can be seen on the Medicare website here.
According to the site:
The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:·
Reviewing a patient's clinical history, in the patient's file and/or the PCEHR, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
Preparing an Event Summary for the episode of care.
Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time.
MBS rebates are not available for creating or updating a Shared Health Summary as a stand alone service.
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E-health billing gets green light

23rd Aug 2012
GPs have finally been given clear permission to bill Medicare for the time they spend organising a patient’s e-health record, with new explanatory notes added to the MBS that doctors’ groups have hailed as a breakthrough.
Health Minister Tanya Plibersek originally announced GPs would be able to bill for the preparation of shared health summaries on the new system, but the item number billed had to be justified on the basis of the complexity of the consultation.
Last night, speaking at the AMA’s annual parliamentary dinner in Canberra, the minister announced e-health billing would now be time-based instead and that the e-health PIP would be extended until May 2013.
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Doctors to be paid for e-health work

  • AAP
  • August 22, 2012 9:09PM
THE Gillard government has relented to a demand by doctors that they be paid for helping to set up patients' electronic health records.
Health Minister Tanya Plibersek announced on Wednesday that GPs will be able to receive Medicare payments for preparing shared health summaries and event summaries as part of a consultation.
"In deciding which item to bill, GPs will only have to consider the reasonable time it would take - not the complexity of the consultation," Ms Plibersek said in a statement.
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PCEHR infrastructure finished

The national infrastructure for the PCEHR has been completed, with the final components allowing doctors to upload and view ehealth records.
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GPs may be forced to use PCEHRs

21 August, 2012 Sarah Colyer
Federal bureaucrats have recommended mandating GPs’ use of the national e-health record system, after finding many senior GPs are opposed to the system.
The advice is contained in a report released under Freedom of Information this month, which was prepared by the Department of Health and Ageing last November before the system was ‘soft launched’ in July this year.
Based on a survey of 800 GPs, the report said most GPs were “generally positive” about the Personally Controlled Electronic Health Records Scheme (PCEHR), but that 21% remained “unconvinced”.
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Victoria takes e-health national

A Victorian government-funded electronic health service will be offered to every Australian with a chronic illness
A Victorian government-funded electronic health service will be offered to people with chronic illnesses across Australia, following the announcement that 10,000 patients had signed up for the service.
Victorian health minister David Davis announced that the Collaborative Care Cluster Australia (CCCA) is now a national program that “empowers patients to work collaboratively with their GPs, specialists, pharmacists and other healthcare professionals to manage their own health issues using a new online capability.”
Davis was referring to the CCCA’s Chronic Disease Management Network (cdmNET), an online system that links patients with their own care plan and helps an entire healthcare team share information.
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Chronic disease care goes online

21 August, 2012 Michael Woodhead
An online support site has been launched to help GPs caring for patients with chronic diseases such as diabetes.
Chronic Disease Management-Net (cdmNet), enables patients, GPs and allied healthcare professionals to develop care plans, share medical histories, test results, updates on patients’ conditions, send referrals, and set appointment reminders, says Professor Leon Piterman of Monash University.
 “What cdmNet has done is provide an efficient clinical information system that makes health records available and accessible electronically,” Professor Piterman said.
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New technology helps sufferers

TELECONFERENCING at Hervey Bay Hospital is helping combat breast cancer and manage its treatment.
Leading surgeon Clement Wong said new technology meant regional cancer sufferers had access to expert opinion without having to travel to larger centres.
"If you asked me what is the best sort of cancer to have I would have to say 'breast cancer'," Dr Wong said.
"Treatments now include surgery, radiography, chemotherapy and hormone treatments.
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Identifying Humans

Posted on August 24, 2012 by Grahame Grieve
The third requirement for interoperability is good identification policies. And the most common problem in healthcare identification is identifying people.
Identifying humans, especially patients, is stupefyingly hard. Even after too many years of healthcare interoperability, I still can’t believe how hard it is. One of the reasons it’s so hard to grasp is because as humans, we are intrinsically good at identifying other humans. But it just doesn’t scale when it comes to successfully identifying humans in distributed systems with more than a few people who must perform the identification.
Many people look to biometrics to solve this problem. The common candidates are finger prints, retinal patterns, some form of phenotyping and most of all, genetic sequences.  But all these suffer from problems (and see particularly http://www.schneier.com/essay-019.html).  Given the expense and reliability problems associated with biometric markers, most healthcare institutions rely on social identifiers. These typically are a selection taken from the candidates listed in the following table, which briefly discusses the issues associated with them.
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Sue Ieraci: IT doubts

THERE has been a lot of discussion recently about the Personally Controlled Electronic Health Record, particularly concerns about whether it is ready and who will manage it, privacy risks and potential errors.
However, overall there seems to be agreement that this is a step in the right direction.
It’s easy to get swept up in the enthusiasm for new technology. But can we be confident that the new is always better than the old? Is electronic always better than manual?
There are lessons from the live information system experiment that has been ongoing in Australian hospital emergency departments (EDs) since the early 1990s.
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HealthSMART system cavalier: Vic auditor

14:14 AEST Tue Aug 21 2012
The proposal for Victoria's abandoned $500 million e-health system was cavalier and more of a concept than a properly developed business case, a senior bureaucrat says.
The HealthSMART rollout began in 2003, costed at $360 million under the previous state Labor government, but is fully operational at just four health services across Victoria.
The coalition government scrapped it last May after $500 million had already been spent.
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Vic e-health system difficult: hospital

  • AAP
  • August 23, 2012 10:34AM
VICTORIA'S abandoned multi-million-dollar e-health system implemented in just a handful of hospitals was overly ambitious and has not improved patient safety, an inquiry has been told.
The HealthSMART rollout began in 2003, costed at $360 million, under the previous state Labor government, but is fully operational at just four health services across Victoria, including Melbourne's Royal Eye and Ear Hospital.
Hospital chief executive Ann Clark said it would have been better to have different information technology systems to suit individual hospitals but develop a set of common rules so information could be shared.
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ALP 'did not investigate myki problems' in planning stage

Date August 22, 2012

Adam Carey

THE former state Labor government failed to properly investigate other smartcard ticket systems around the world when preparing to introduce myki, leading to a costly underestimation of the project's complexity, a state inquiry has heard.
The myki ticket system was initially supposed to be running by March 2007, but more than five years later it is still being introduced at a total cost of $1.52 billion - more than half the cost of NASA's recent Mars mission.
Transport Ticketing Authority chief executive Bernie Carolan said the authority and the former government should have looked more closely at the problems other systems had struck. ''There wasn't so much effort, with hindsight, in taking jurisdictional soundings … either elsewhere in Australia or overseas to canvass the pitfalls of implementing a new smartcard system,'' Mr Carolan told a hearing at State Parliament.
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Melbourne researchers rewrite Big Bang theory

Date August 21, 2012 - 9:52AM
Melbourne researchers believe they may be on the brink of rewriting the history of the universe.
A paper being published in a US physics journal suggests it may be possible to view "cracks" in the universe that would support the theory of quantum graphity - considered to be the holy grail of physics.
The team of researchers from the University of Melbourne and RMIT say that, instead of thinking of the start of the universe as being a big bang, we should imagine it as a cooling of water into ice.
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Neil Armstrong, first man on the moon, dies at 82

Date: August 26, 2012 - 7:47AM
Tributes are flowing in for Neil Armstrong, the quiet, self-described nerdy engineer who became a global hero when he stepped on to the moon.
“As long as there are history books, Neil Armstrong will be included in them, remembered for taking humankind's first small step on a world beyond our own”
Armstrong died on Saturday aged 82 from complications following heart surgery earlier this month.
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Enjoy!
David.

AusHealthIT Poll Number 133 – Results – 27th August, 2012.


The question was:

Will The NEHRS Make A Success Of Displaying Medicare Information?

For Sure 26% (15)
Probably 17% (10)
Possibly 31% (18)
No way 26% (15)
Total votes: 58
Very interesting response. About half say it will be a success and just a few more say possibly not.
Again, many thanks to those that voted!
David.

Sunday, August 26, 2012

Sorry - Aus News Blog Published Early. Out Tomorrow!

David.

What I Want To See Is The Modelling On The Costs Of Paying GPs For NEHRS Activities. There Will Be Unintended Consequences I Suspect.

A couple of days ago the AMA responded to the offer from the Government to provide certainty as to the payment that were available to GPs with regard to the NEHRS.

Government delivers PCEHR incentives for doctors

Health Minister Tanya Plibersek tonight provided important policy clarity and greater incentives for GPs to become fully engaged more quickly with the Personally Controlled Electronic Health Record (PCEHR).
The AMA is a strong supporter of a quality workable shared health summary and has been in discussions with the Minister and the Department of Health and Ageing for some time seeking further clarification on how GPs could confidently provide PCEHR services for patients under existing Medicare Benefits Scheme (MBS) arrangements.
AMA President, Dr Steve Hambleton, said that the Government has listened to the AMA’s concerns and delivered an outcome that will encourage doctors to become actively involved in the implementation of the PCEHR.
“The Government has clarified that additional time spent by a GP on a shared health summary or an event summary during a consultation will count towards the total consultation time, and that the relevant time-based GP item can be billed accordingly,” Dr Hambleton said.
“The Minister has tonight fully explained how doctors can now safely and confidently provide new PCEHR clinical services such as a shared health summary under current MBS items.
“The Minister has also delayed the PCEHR e-health practice incentive payment (PIP) capability requirements until May2013.
“The AMA strongly welcomes both announcements.
The full release is found here:
Here is one of the better pieces of press coverage which includes a link to the Medicare rules.

BREAKING NEWS: MBS item for PCEHR

23 August, 2012 Megan Reynolds
The AMA has welcomed the government's announcement that doctors will be paid for transferring patients to the PCEHR scheme.
Full details of the new arrangements can be seen on the Medicare website here.
According to the site:
The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:·
Reviewing a patient's clinical history, in the patient's file and/or the PCEHR, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
Preparing an Event Summary for the episode of care.
Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time.
MBS rebates are not available for creating or updating a Shared Health Summary as a stand alone service.
More here:
Parenthetically this was clearly big news - with even coverage in the Cowra Community News!

GPs to be paid for e-health work

THE federal Government has relented to a demand by doctors that they be paid for helping to set up patients’ electronic health records.
Health Minister Tanya Plibersek announced yesterday (Wednesday) that GPs will be able to receive Medicare payments for preparing shared health summaries and event summaries as part of a consultation.
“In deciding which item to bill, GPs will only have to consider the reasonable time it would take – not the complexity of the consultation,” Ms Plibersek says in a statement.
Lots more here:
What seems to have escaped people is just what all this might cost in terms of actual costs for Government and time available for servicing community needs. Additionally there is also the issue of just what the cost benefit outcomes of all this might be.
Let’s think about the implications. First on costs. If we assume say 20% of the population eventually are using a NEHRS which is updated twice a year with an average bill of $50 for that service.
Doing the maths that is 4.4 million people by $100 per annum. That comes to $440 million per annum.
Second on available time for GPs. What this is suggesting is that (at 15 mins average - the AMA figure) we are losing 8.8 million patient encounters. If we assume a GP sees 6 patients per hour for 8 hours per day  for 5 days a week. we are having a GP service 11520 encounters per year (48 week work year).
That works out at a need for 760 or so additional GPs unless filling in NEHRS records actually reduces patient attendances, which is just possible.
From here we can see there are presently about 25,000 GPs. 760/25000 means a loss of 3% of the effective GP workforce or more than were added in the whole last year.
So the bottom line is that this is a pretty real impact on the availability of GP services and we don’t have a single word about the assumptions underpinning this investment and just how cost effective and beneficial it will be.
Why do I get the feeling this is just one of those times where the Government has decided to ‘kick the can down the road’ and try to stave off the ultimate fate of the NEHRS by throwing money at the problem - with no real evidence of cost and impact.
Proper modelling of these announcement should have been done and it should be public.
David.