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."

Wednesday, August 29, 2012

More Of The Ugly Truth Seems To Have Leaked Out About HealthSMART. It Was Not Run Well!

The following appeared a few days ago.

HealthSMART system cavalier: Vic auditor

  • From: AAP
  • August 21, 2012 2:18PM
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.
Victorian Auditor-General's Office performance audit director Paul O'Connor said the HealthSMART business case lacked implementation detail.
"I would say it was more of a concept brief rather than a fully written business case in terms of how we are going to implement this," Mr O'Connor told a Victorian parliamentary inquiry into the delivery of major infrastructure projects on Tuesday.
"One of the problems that has occurred in Victoria is that some business cases with very large amounts of money have been quote cavalier perhaps in the way they've been constructed but they've received large amounts of funds and seemingly very little oversight.
Some good reporting also came from The Age.

Auditor scorns 'slack' officials

Date March 21, 2012

Melissa Jenkins

DELUDED, lazy bureaucrats in Victoria don't give ministers the advice they need, and large projects are retrofitted to match political announcements, the state's auditor-general says.
Auditor-General Des Pearson and his colleague Paul O'Connor delivered a scathing assessment of the relationship between the public service and the government in giving evidence to a parliamentary inquiry into infrastructure projects.
They argued no effective mechanisms were in place to stop hundreds of millions of taxpayers' dollars being tipped into dodgy rail and road projects.
Dr Pearson said government agencies were too reliant on external advice and often accept it without scrutiny.
Departmental staff often base their advice around what has been announced by a minister and don't take other alternatives into consideration.
''Often, when we're talking to departmental staff, they are sort of saying 'oh, the government announced' and they're using that as what I call a get-out-of-jail card not to provide frank and fearless advice,'' he told the Public Accounts and Estimates Committee.
More here:
There was also some commentary about a lucky Hospital that got an early installation.

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.
She said the hospital faced significant complexities integrating HealthSMART with its outsourced pathology system.
More here
Some quotes from the actual testimony of the Auditor General are just wonderful.
“Finally, I thought some contextual considerations were relevant, and again I pose a few questions there. Is adequate benchmarking and baseline data available to underpin the various projects we embark on? The next one is: are we punishing ourselves for cost overruns and not adequately managing expectations? There I relate — and we refer in our written submission — to the research by Professor Bent Flyvbjerg in 2009. Just to refresh your memory, he researched worldwide project outcomes and found for construction project budgets between 10 million and 150 million euros, the norm was a 50 per cent overrun and in IT projects it was up to 500 per cent on the target projects. In quoting that I am not saying it is all right to overrun, but it is a recognition that we are not alone in experiencing this problem. In my reading of his research, there are lessons to be learnt there of key lead indicators and issues to be addressed up-front in what I would call purposeful management.”
and here:
“I am very interested in Dr Flyvbjerg’s research, which you have referenced in your submission. It is quite frightening when you read that this is not just a Victorian phenomena, it is an international phenomena in terms of public sectors’ inability to deliver projects on budget and on time. I am particularly interested in what your views are of some of the propositions that have been adopted in other jurisdictions, specifically having peer-reviewed business cases or costings of projects, like they do in the UK with the National Audit Office. I also note Dr Flyvbjerg’s suggestion that there should be strong penalties, including criminal sanctions perhaps, for those who underforecast the cost of projects. And finally, I would be interested in your general comments around cultural change. What is it? Is it optimism bias? Is it that we have built the wrong political incentives and therefore that leads to the wrong bureaucratic incentives? What, culturally, do you think, would signify the greatest circuit break and give us more legitimate grounds for what you describe as purposeful management?”
The full transcript is here:
I have to say I think the comments are relevant to both HealthSMART and the NEHRS.
I think we may be kidding ourselves if we think that just because it is a Federal Project all will be well.
Reading Professor Bent Flyvbjerg’s 2011 paper in the Harvard Business Review is Highly Recommended - especially for DoHA and NEHTA if they have not already done so!
See here:
Enjoy or cringe!
David.

Consultation On Guidelines on e-Health Privacy By Australian Information Commissioner.

I had this nice e-mail today from the Office of the Australian Information Commissioner.
-----
I wanted to draw your attention to some guidelines on ehealth privacy that the Office of the Australian Information Commissioner has released for consultation.
We are conducting a public consultation on the ‘Personally Controlled Electronic Health Records System – Enforcement Guidelines for the Information Commissioner 2012’.
As you would know, the PCEHR Act provides that the Information Commissioner is the independent privacy regulator for the ehealth record system and gives the Commissioner the power to investigate alleged contraventions of the Act and pursue enforcement mechanisms that are appropriate in the circumstances of the case. The Act also requires the Commissioner to make guidelines relating to the exercise of his enforcement powers under the PCEHR Act.
The draft Guidelines set out the Commissioner’s general approach to the exercise of enforcement and investigatory powers under both the PCEHR Act and the Privacy Act.
We are seeking public comments on the Guidelines by 18 September 2012.
Next week we will also be releasing for public comment ‘Mandatory Data Breach Notification in the eHealth system: A guide to mandatory data breach notification under the PCEHR System’. We are expecting that this document will be available on the OAIC  website next week.
If you think these matters are something that your readers would find interesting please pass the information on. Details on how to make a submission can be found on our consultation webpage above.
Kind regards
Leila Daniels | Deputy Director Corporate and Public Affairs |
----- End E-mail.
Can I encourage all readers to have a look at what is proposed and comment as per the webpage.
David.

Tuesday, August 28, 2012

Currently Reporting On the NEHRS Is Not Painting A Good Picture. Transparency On What Is Happening Would Surely Help.

Today we have had two articles on the NEHRS / PCEHR appear.
First we have:

Canberra admits PCEHR delays

THE Gillard government has confirmed that key components of the personally controlled e-health records program missed the crucial June 30 deadline, but says the entire system has now been "implemented".
Some items have yet to be properly tested, which means complete rollout will take a few more months.
The opt-in PCEHR scheme allows consumers to enter personal information, medical history and medication details. They can choose which healthcare organisations can see and edit their record, and view a log of those who have accessed and added information to the record.
One of the biggest benefits of the system is that consumers can share their health information with healthcare professionals from a central online system.
Although the program's national infrastructure partner, Accenture, missed the deadline to provide a working solution for a slew of offerings, the Department of Health and Ageing refused to say if the company would be penalised.
The department declined to respond when asked whether the Accenture contract provided for any damages or penalties -- other than delays in payment -- for missing deadlines.
Lots more here:
Second we have:

Threat to privacy in e-Health records

PATIENTS who want to keep private a visit to a psychiatrist, the use of a mental health medicine or an abortion under the new e-Health online system will have to ensure Medicare and pharmaceutical subsidy data is not linked to the new record.
The only other way to keep the information private would be to pay the full cost of the treatment and refuse Medicare and pharmaceutical subsidies - or use a fake name, a privacy expert said yesterday.
Consumers who set up an e-Health record will be asked if they want to attach their Pharmaceutical Benefits Scheme records and Medicare general patient information such as medication and doctors provider information.
Macquarie University ethics and legal expert Julie Zetler said the "last bastion" of privacy was a health record.
But there were major concerns about how private information would be under the new Personally Controlled e-Health Record (PCEHR) rolled out on July 1.
The information will reveal past or planned abortions, or mental health consultations, and could be viewed by doctors or other health professionals such as nutritionists and complimentary health care providers.
More here:
All this mainstream media commentary on the problems with the NEHRS Program is really only going to be calmed down if we see a great deal more transparency as to what is happening with the overall program and what the ‘real’ plans and probable deliverables are.
No amount of spin from the legions of paid spinners in DoHA and NEHTA will work in my view.
I found this interesting in this context.

Departments splurge $10m on monitoring the media

FEDERAL government departments and agencies are spending more than $10.3 million a year checking what is said about them in the media.
The hefty monitoring bill from external companies would pay for more than 100 full-time staff each earning $100,000 a year.
An analysis by The Australian revealed the Department of Health and Ageing ploughs more than any other department or agency into monitoring -- with a bill of $940,000 for press clippings and transcripts in 2011-12.
Lots more here:
Right now these people are not advising their masters properly as to how to give the program a decent image and obtain / regain consumer and provider trust.
David.

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?
-----

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.
-----
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.
-----

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.
-----

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.
-----

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. 
-----

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.
-----

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.
-----

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.
-----

PCEHR infrastructure finished

The national infrastructure for the PCEHR has been completed, with the final components allowing doctors to upload and view ehealth records.
-----

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”.
-----

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.
-----

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.
-----

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.
-----

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.
-----

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.
-----

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.