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."

Thursday, March 07, 2013

An Interesting Survey Of UK GP Attitudes To Aspects of E-Health.

This appeared a few days ago.

Netscape navigators

An exclusive eHealth Insider survey, conducted by doctors.net, shows GPs are far from ready to give patients electronic access to their records by the government’s deadline of 2015. It also shows they are less than keen on the deadline, and other crowd-pleasing ideas, such as email consultations. Lyn Whitfield reports
21 February 2013
The government has hardly made a secret of its desire to see patients get online access to their medical records.
The idea has been flagged up in any number of ministerial speeches, and took form in the NHS IT strategy published last May. Indeed, the pledge to give patients online access to their GP-held records by 2015 was one of the few firm pledges in ‘The Power of Information’.
Since then, the commitment has been reiterated in the mandate issued to the NHS Commissioning Board at the end of last year and in the planning guidance that it issued for the NHS in December.
Despite this, an exclusive survey of 1,000 GPs commissioned by eHealth Insider and conducted by doctors.net has found that almost no practices are ready to start delivering on the government’s pledge. More worryingly, it suggests that many have yet to start thinking about it.
A long way to go on access
The survey, which was commissioned to explore GP attitudes to patient-facing technology and social media, found that 43% of respondents picked “we haven’t started to address this year” when asked how ready they were to facilitate patient access to records.
A further third said their IT systems still needed work, with 15% of the total sample saying “our IT system is a long way from being ready”, 9% saying it was “nearly” ready, and 5% saying it was ready but “it isn’t live yet.” Just 4% of respondents said “our IT system is ready, and is already live.”
Meanwhile, a quarter (24%) of respondents said that they simply didn’t know how ready their practice was to give patients access to their records.
This pattern of response was consistent across most areas of the UK. Scotland, where there has been no ministerial push on patient records access, had the largest proportion of respondents (53%) likely to say “we haven’t started to address this yet.”
But even in Scotland, 4% of respondents said their practice had a system live. Meanwhile, the old NHS South Central area of England had the smallest proportion of respondents (31%) likely to say they hadn’t made a start.
But in South Central, just 1% of respondents said they had a system that was live; although 6% said their practice had a system that was ready but not live.
Lots more here:
Very interesting views on patient / doctor e-mail and patient access to their electronic records.
Well worth a read.
David.

MMRGlobal Is Certainly Being Quite Noisy



This was sent to me by Grahame Grieve who is at HIMSS. It is part of their handout at the meeting.

Gives a good idea of what MMRGlobal are up to.

Sorry about the quality - click on image to enlarge.

David.

Wednesday, March 06, 2013

Now This Is Really Interesting. Health IT Costs A Lot And Benefits Are Scarce Says One Report.

This appeared a few days ago.

HIT's Rising Cost and Dubious ROI

Edward Prewitt, for HealthLeaders Media , February 25, 2013

Our latest monthly Intelligence Report, which draws on the 6,000-plus healthcare executives who are members of the HealthLeaders Media Council, is titled "Healthcare IT: Tackling Regulatory, Clinical, and Business Needs."  Why, then, is it mentioned in our weekly finance column?

Because healthcare IT is expensive. And the report reveals that it's becoming an ever bigger drain on hospital and health system bottom lines. And that an ROI from healthcare IT will be hard to find, despite the fervent hopes of healthcare executives.

Today, 40% of the 250 respondents say the operating IT budget takes up 2-3% of their organizations' overall operating revenue. But the respondents—who represent a range of C-suite leaders and VPs, including CEOs, CFOs, COOs, and CIOs—expect an upward shift in the near future. More than half (56%) say the operating IT budget will account for 4% or more of overall operating revenue, and a fifth expect IT spending to take 6% or more.
Those percentages are historically high for healthcare, but not necessarily for other industries. You could argue that healthcare is simply catching up.
But what is that extra spending going toward? The top driver, ticked off by 52% of respondents, was regulatory reporting requirements, most notably ICD-10. The American Health Information Management Association (AHIM) has long argued that ICD-10 codes will lead to better patient care, and it's certainly true that better coding can lead improve reimbursements, but in the end that's a lot of money to pay for more coders.

Still, a majority of survey respondents (58%) say their organizations invest in IT, meaning they expect a financial return, rather than simply spend on IT (indicated by 42%).

But while the survey indicates overall trends and expectations, the comments by individual executives reveal how they view healthcare IT. "IT will always disappoint if you expect a return," says the president of a large physician organization. "Most CFOs will say they haven't seen a ROI on the investments made in IT as an industry compared to industries like banking," says Donna Abney, executive vice president of Methodist Le Bonheur Healthcare, whose organization helped shaped the Intelligence Report.
…..

(Editor's note: Many of the figures cited here draw from the
paid Premium version of our February Intelligence Report. A free version, containing HealthLeaders analysis but less data, is also available for download.)
Full article here:
Well it is interesting to see just how hard people are finding it to obtain a Return On Investment (ROI) for their Health IT investment.
Support for this view is found here:

The unfulfilled promises of health information technology

February 27, 2013 6:00 AM EST
A 2005 RAND report predicted that widespread use of electronic health records technology would save the US healthcare system at least $81 billion per year. At the time, the vendor-funded report helped drive substantial growth in the electronic health records industry and probably contributed to the federal government making billions of dollars of incentive payments available to physicians and hospitals to adopt and meaningfully use electronic health record (EHR) systems via the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Realizing that the cost savings and improvements in healthcare delivery are nowhere near what was optimistically predicted in 2005, RAND recently commissioned a new study to take a fresh new look at the state of health information technology.  The new study paints a very different picture and received broad coverage by mainstream news outlets, including “In Second Look, Few Savings From Digital Health Records” by the New York Times in January.
To put it bluntly, the authors of the new report essentially admit that the original RAND study was dead wrong. Healthcare spending has risen by $800 billion since the first report was published, and while much of that is due to an aging population and the increase in overall medical services, there is scant evidence of cost savings due to electronic health records. In addition, there is increasing concern that electronic records have actually made it easier for providers to over-bill for certain services.
Lots more here:
This story is one that has a long way to go in my view!
David.

Tuesday, March 05, 2013

It Seems Others Are Starting To Notice The NEHRS May Not Be A Well Structured System.

This appeared a few days ago.

Opinion: Should e-health be more about relationships?

Placing the consumer at the centre of a consolidated health data repository may not be the right approach
The concept of a Personally Controlled Electronic Health Record (PCEHR) might be the correct political tactic to address ethical concerns around the confidentiality, consent and involvement of healthcare providers in accessing electronic health records.
But the decision to place the consumer at the centre of this national health information repository may not prove to be the right approach.
Last month, it was reported that the Federal government’s PCEHR initiative, developed by Australia’s National E-Health Transition Authority (NEHTA) had failed to reach the expected uptake of 500,000 consumers in the first year.
NEHTA’s consumer-driven model is also facing another potential hurdle with US company MMRGlobal’s claim that NEHTA may be infringing on patents issued to its subsidiary MyMedicalRecords.com. See here:
The firm is investigating whether federal and state governments, through NEHTA, have infringed on two patents that cover a method that enables consumers to access health records through their personal account using the PCEHR system.
This begs the question: Has too much emphasis been placed on an individual electronic health record (EHR) rather than a “shared EHR”, which recognises the importance of the relationship between consumers and their healthcare providers in sharing information?
Should a national electronic health record service place the relationship between consumers and healthcare providers at the heart of the data repository – allowing this relationship to govern the consolidation, contribution and protection of health data?
Relationships with our healthcare service providers govern our interactions with healthcare professionals and the level of care they provide us. Establishing meaningful and beneficial relationships between consumers and their healthcare providers is fundamental to the success of healthcare services.
Service providers recognise the health and financial benefits of providing and maintaining long-term and continued care to their clients and consumers want to receive care from providers they trust.
The long-term value of the relationship between healthcare providers and consumers is what encourages information sharing and the quest for better access to better health information.
Information shared between a consumer and healthcare provider belongs to both parties in joint custody – they don’t need to argue about who owns the information when it is disclosed by a consumer or given by the healthcare provider. The information is contributed jointly to benefit of both the consumer and the healthcare provider.
Lots more here:
What an interesting take. As I have been saying for the last few years the NEHRS is a ‘barnacle on a battleship’ in terms of lacking centrality in both a technical and more importantly a patient - provider sense.
Maybe some sanity is emerging?
David.

AusHealthIT Poll Number 157 – Results – 5th March, 2013.

The question was:

Is MMRGlobal A Simple 'Patent Troll' Or Are They A Legitimate Company Just Protecting Their Rights?

A Patent Troll 52% (33)
Just Protecting Their Rights 38% (24)
I Have No Idea 11% (7)
Total votes: 64
Very interesting. It seems a tiny majority see them as a patent troll!
Again, many thanks to those that voted!
David.

Monday, March 04, 2013

Weekly Australian Health IT Links – 04th March, 2013.

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 very quiet news week indeed. Just the continuing theme of the build-up to the election in September with input from all sorts of stakeholders.
It was very interesting that Kos Sclavos mentioned in his article that  Deloittes is undertaking a review of the National E-Health Strategy.  Wonder what that actually means? Given how much attention was paid to the last effort one does wonder.
My weekly review of my NEHRS showed it running like a dead duck. Just awfully slow and still way to hard to access.
-----

Future of e-health hinges on election result

E-health is one key health policy area that is likely to take a significantly different path depending on who wins the federal election.
We know the Labor vision because they are in government and the Department of Health and Ageing is implementing their vision.
However, Dr Andrew Southcott, the opposition e-health spokesperson, has made it very clear that if the coalition wins the election a very different path will be taken.
The Guild has used e-health to accentuate the value add that community pharmacy can provide the health sector and our patients. E-Health will embed the role of the pharmacist in the health system.
-----

Dutton hits out at 'waste' in health bureaucracies

25th Feb 2013
AAP
MEDICARE Locals have been highlighted by Opposition health spokesman Peter Dutton as a key area of wasteful spending in the health sector that could face cuts under a coalition government.
Mr Dutton said the Labor government has established 12 new bureaucracies without improving health services.
"There is a lot of waste in the new bureaucracies that have been created," Mr Dutton told Sky television on Sunday.
"I will put money back into frontline health services, particularly around mental health."
The new bureaucracies included Medicare Locals, which duplicated the federal health bureaucracy across Australia, and new health funding authorities, Mr Dutton said.
-----

IT glitch hits Canberra Hospital

Date February 27, 2013

Fleta Page

Reporter at The Canberra Times

A glitch in Canberra Hospital's IT system has forced their emergency department to direct patients with "non-urgent" issues elsewhere.
"Patients who present to the Canberra Hospital Emergency Department who do not require urgent treatment should expect delays," Canberra Hospital and Health Services Deputy DirectorGeneral Ian Thompson said.
"Work is currently under way to resolve these issues, but it is not clear when the work will be complete.
-----

Request for Tender (RFT) for the provision of Solution Delivery Services to deliver an Aged Care Gateway system

ATM ID                      DoHA/220/1213
Agency                      Department of Health and Ageing
Category                   80101507 - Information technology consultation services
Close Date & Time          3-Apr-2013 2:00 pm (ACT Local time)
-----

Facing up to depression over the phone

Date February 27, 2013

Larissa Nicholson

DEPRESSION sufferers may soon be monitoring the severity of their condition via smartphones and tablets using Australian-developed voice and facial recognition technology.
Researchers say the computer program, created in partnership with the mood disorder treatment and prevention organisation the Black Dog Institute, has brought them closer to an objective indicator of melancholic, or biologically determined, depression.
The University of Canberra's Dr Roland Goecke, an expert in human-computer interaction, worked with the institute to develop the program, which measures the indicators of melancholic depression including a lack of facial movement, slow speech and avoiding eye contact.
-----

Online mood tool a time-saver for GPs

1st Mar 2013
AN AUSTRALIAN-developed online mood disorders diagnostic tool can elicit vital information from patients and encourage disclosure of symptoms, according to analysis of data from 16,000 users.
An audit of reports generated by the Mood Assessment Program (MAP), introduced by the Black Dog Institute in 2007, shows 85% of patients who completed the online questionnaire have significantly depressed mood.
The tool includes questions about life stressors, previous treatments and personality.
-----

eProcurement Now Live in Five Health Jurisdictions

NEHTA this week released their latest Healthcare Product Purchaser’s intention statement, a report giving a snapshot of the adoption of electronic procurement processes by health authorities and private healthcare providers around the country.
The report shows that from the June 2013, most health tenders will now include the requirement that suppliers have all of their products loaded into the National Product Catalogue (NPC) and can operate with that system, so that eProcurement can go ahead.
Mark Brommeyer is NEHTA’s Manager Supply Chain and says that the intention statement was developed following a survey conducted in 2011.
-----

Victorian public hospitals digital trial is in for the long haul

It’s been a monumental few years for Libby Owen-Jones, who is the Clinical Systems Project Director at Austin Health, one of two public hospitals selected by Victoria’s Department of Health to trial a phased roll-out of eHealth services.
“It’s been a huge challenge, implementing such a massive, transformative change into a health system when hospitals have traditionally been run on paper,” Ms Owen-Jones says.
Since the project went live in June 2011, all radiology orders are fully electronic (end to end), and 95 per cent of pathology orders and discharge medication orders were completed electronically. 
-----

Opinion: Should e-health be more about relationships?

Placing the consumer at the centre of a consolidated health data repository may not be the right approach
The concept of a Personally Controlled Electronic Health Record (PCEHR) might be the correct political tactic to address ethical concerns around the confidentiality, consent and involvement of healthcare providers in accessing electronic health records.
But the decision to place the consumer at the centre of this national health information repository may not prove to be the right approach.
Last month, it was reported that the Federal government’s PCEHR initiative, developed by Australia’s National E-Health Transition Authority (NEHTA), had failed to reach the expected uptake of 500,000 consumers in the first year.
-----

Unified communications may give nurses two hours back each day for patient care

Summary: IBM claims its unified communications offerings can save time looking for others and responding to calls in a clinical environment. If its claims are true, that might mean two more hours per day for patient care.
By Denise Amrich for ZDNet Health | February 28, 2013 -- 03:55 GMT (14:55 AEST)
One of the challenges of being a floor nurse is the running around, trying to find people. A hospital is a big facility, and even though the reporting and management structure is defined in such a way to operate in smaller floors or wards, there's still a tremendous amount of time spent by all of us, chasing down all the rest of us.
For example, if a tech needs to find me when I'm in a patient's room, he might have a rough idea of where I am, but he also might have to pop from room to room to find me. Pagers have had their uses, smartphones have been tried, and some of us even have to wear Star Trek-type commbadges around our necks all day. But there are few centralized systems that really deal with the problem systematically.
-----

Medibank aims to reduce delays for online, mobile customers with HP software

Private health insurance company to deploy HP BSM software.
Medibank plans to deploy software to better measure performance of its online member services platform and smartphone app, HP announced today.
Medibank will deploy HP business service management software to monitor IT infrastructure and identify areas that may be causing delays for online and mobile customers, HP said.
HP didn’t disclose the terms of the contract.
-----

Australia’s bizarre fibre diet

Published 8:03 AM, 27 Feb 2013
We’re going to have to wait seven months for a sensible discussion about technical options for the NBN – it’s pointless trying before the election – but there are other options, and they need to be discussed.
Last Friday NBN chief Mike Quigley had a go at encouraging an “open and transparent debate on the future options for Australia’s NBN”, which Opposition spokesman Malcolm Turnbull promptly labelled “bizarre” and the Minister Stephen Conroy carefully ignored.
The industry body, the Communications Alliance, which Quigley was trying to get to lead the debate, kind of shrugged its shoulders and mumbled something about it being an election year.
-----

Facebook can revolutionise health, education: Eduardo Saverin

THE billionaire co-founder of Facebook, Eduardo Saverin, believes the data storage potential of the social networking site can be used to revolutionise the global education and healthcare industries, putting people at the centre of innovation.
In a rare wide-ranging interview at The Wall Street Journal's inaugural Unleashing Innovation conference in Singapore, Mr Saverin also said he was now focused on backing internet start-ups that "reduced consumer friction" in what he termed "the transactional economy", making it easier for people to make purchases on mobile devices.
Mr Saverin, whose net worth is said to be about $US2.2 billion ($2.13bn) and who has lived in Singapore since 2009, has invested in a start-up company called Jumio.
-----

Parents lack faith in confidential teen consults

27th Feb 2013
CONFIDENTIAL consults with adolescents are viewed with concern by many parents, particularly those with a poor opinion of the medical profession, an Australian study suggests.
In-depth interviews with parents show their attitude to confidential consults stemmed from the level of trust they held in the GP, or in health professionals generally, and from how they saw their own responsibility as a parent.
“It wasn’t the doctor that gave birth to those kids and should have the responsibility for those decisions,” was how one mother put it.
-----

The hackers are coming, the hackers are coming

Published 7:04 AM, 25 Feb 2013
It seems that China’s 'Unit 61398' hasn’t yet got round to hacking any Australian companies’ computer systems, but chief executives and company directors in this country shouldn’t get too cocky: it may only be a matter of time, if it hasn’t happened already.
The United States is now engaged in virtually all-out cyber warfare against Iran, Russia and China, with much of the effort focusing on Iran’s nuclear weapons program. But revelations in the past week have highlighted the big investment China has been making in industrial cyber espionage since 2006.
Internet security firm Mandiant published a 76-page report last week detailing the work of what it calls Advanced Persistent Threat No.1 (APT1) or Unit 61398, based in the Pudong New Area of Shanghai.
-----

Public servants baulk at FOI changes

Date February 25, 2013

Stephanie Peatling

Senior writer

The public service is revolting against reforms brought in by the federal government to make it easier and cheaper for people to use freedom-of-information laws.
Nearly all public service departments have made a submission to a review of the laws saying the changes have created more work than they can handle and question whether the changes are delivering ''value for money'' for the government.
''The first word that comes to mind is blowback,'' lawyer and FOI expert Peter Timmins said.
''The general thrust of most of them is to bring into question the reforms of 2010.''
-----

In Pictures: 5 tricks to restore the Windows 8 Start menu

As everybody knows, the Start button is not included in Windows 8, and Microsoft has vowed not to put it back. If you’d rather not be forced to use the full-screen, tile-based UI, called Modern, here are five alternative programs that install on Windows 8.
As everybody knows, the Start button is not included in Windows 8, and Microsoft has vowed not to put it back. If you’d rather not be forced to use the full-screen, tile-based UI, called Modern, here are five alternative programs that install on Windows 8.
-----

Married couple to travel to Mars

Date February 28, 2013 - 9:47AM

Seth Borenstein

In less than five years, a married couple could be on their way to Mars in an audacious but bare-bones private mission that would slingshot them around the red planet.
The voyage to Mars and back would be a cosmic no-frills flight that would take the husband-and-wife astronauts as close as 161 kilometres to the planet, but it would also mean being cooped up for 16 months in a cramped space capsule half the size of a caravan.
The private, non-profit project, called Inspiration Mars, will get initial money from multimillionaire investment consultant Dennis Tito, the first space tourist. The team would not say how much the overall flight would cost, but outsiders put it at more than $US1 billion.
-----
Enjoy!
David.

Professor Enrico Coiera Explores Why Health IT Is So Hard. A Very Good Read.

This appeared in the Medical Journal of Australia today.

Why e-health is so hard

Enrico Coiera
Med J Aust 2013; 198 (4): 178-179.
doi: 10.5694/mja13.10101
We need to respect the basic rules of informatics and invest in e-health expertise
Medicine holds dominion in the microcosm of molecules and genes. It is in the macrocosm of people and organisations where things seem to fall apart. Modern health care appears unsustainable in its current form,1 and information technology is increasingly seen as a major intervention that can drive “reform”.
Evidence for e-health’s potential to improve the safety and quality of care grows,2 but remains patchy.3 The long list of disappointments and failures,4,5 locally and internationally, is also hard to ignore. There is a real dissonance in the discourse between what research evidence tells us is possible and what often happens with large-scale e-health projects in practice.6
The literature repeatedly describes basic “rules of informatics” for implementation success: the need for stakeholder engagement, culture change, user training, slow and considered implementation, and user-friendly systems that fit into clinical workflow.7 The very first rule of informatics tells us to start with the clinical problem we want solved rather than the technology we want to build.8 Yet, too often, large-scale e-health projects break this most basic rule, focusing on technology rather than compelling clinical problems.5 We are often told that national e-health projects must first lay down basic technical infrastructure and that high-value clinical systems will naturally follow, in the same way that laying railway lines is a precursor to delivering transport services.9 But railways can be too expensive, over-engineered, or not take us anywhere particularly useful — unless there is a destination on which we can all agree.
Why so many projects repeatedly fail to observe these basic rules of informatics remains a mystery, but it probably reflects that there are still very few people with deep expertise in e-health.10 Despite the crucial role of the informatics workforce in e-health success, and the billions spent on e-health over the past decade by government, barely a dollar has been in direct support of informatics workforce training.
E-health is hard because it is a complex intervention in a complex system.11 Indeed, e-health projects are probably among the most complex interventions we can undertake, especially at a national scale. The rules for designing e-health at the level of clinical practice are not the same as those at large scale, and the gap is as wide as that between in-vitro and in-vivo clinical studies. This explains why success at individual sites is no guarantee of success elsewhere.
…..
Just because e-health is hard does not mean we can ignore it and do something else instead. The goal is worthy, and alternatives are thin on the ground. We do, however, need to urgently invest in the informatics workforce, as this is no game for amateurs. We must also respect the basic rules of informatics. Like the laws of physics, they exist, whether you like them or not.
---- end article.
If you have access to the MJA go here:
If not, for the full article, references and so on you can e-mail Professor Coiera. He has kindly agreed to send a .pdf of the full article to all who ask. (Be gentle).
You can e-mail him at e.coiera@unsw.edu.au
Many thanks for making this article freely available to those who don’t have access to the MJA directly.

Also, an interesting paper of a NSW Emergency Department System is found here in the same issue here:

Effect of an electronic medical record information system on emergency department performance

Murugabalaji K Mohan, Rod O Bishop and James L Mallows
and there is commentary here:

Good HIT and bad HIT

Jon D Patrick and Susan Ieraci
Both these are freely available to read at the site! Thanks MJA!

Good to see so much e-Health in the MJA!
David.

It Seems MMRGlobal Patent Claims Are Spreading. Missed This Release A Few Days Ago.

This has been out for a few days.

MMRGlobal Investigates Possible Patent Infringement in Singapore

LOS ANGELES, CA -- (MARKETWIRE) -- 02/19/13 -- MMRGlobal, Inc. (OTCQB: MMRF) today announced that as a result of recent publicity, it has been brought to the Company's attention that vendors providing services to the Ministry of Health in Singapore appear to be infringing on patents (including Singapore patent number 200801954) and other Intellectual Property (collectively, the "MMR-IP") issued to MyMedicalRecords, Inc., a wholly owned subsidiary of MMRGlobal. The Company has been advised that personally-controlled health records, or Personal Health Records (PHRs), are included in programs for the Ministry of Health, the Health Promotion Board, the Health Sciences Authority and numerous other organizations in Singapore, which the Company believes is clearly part of MMR's inventions that led to its MyMedicalRecords patents. The discovery came as a result of the Company's investigations in Australia, which were reported in recent announcements that the Australian Government, both state and federal, through the National E-Health Transition Authority (NEHTA), appears to be infringing on two MyMedicalRecords patents.
NEHTA has reportedly spent an estimated one billion Australian dollars on a Personal Health Records program which is the subject of the potential infringement and which it appears broadly incorporates numerous portions of the MMR-IP. The Company has spoken with an attorney for NEHTA. MMR suggested entering into an agreement to exchange documents to facilitate an informal resolution to this matter for the benefit of all parties. MMR also suggested that all relevant parties schedule a meeting at the 2013 HIMSS Conference starting March 3rd in New Orleans in a good faith effort to get this resolved.
As part of the Company's continued efforts to protect its patents, MyMedicalRecords, Inc. announced on February 12, 2013 the filing of a complaint in the United States for patent infringement against WebMD Health Corp. and its wholly owned subsidiary, WebMD Health Services Group, Inc. ("WebMD"). The complaint alleges that WebMD is infringing on MMR's Personal Health Records patent, specifically U.S. Patent No. 8,301,466, and as a result, MMR is seeking monetary damages as well as a permanent injunction. The complaint was filed in the United States District Court for the Central District of California, case number CV 13-00979, on February 11th, and is available on the court's website http://www.pacer.gov/.
The full release is here.
I feel sorry for Singapore being sucked into all this. It does rather seem to be spreading! Interesting to read of actual suits being underway.
David.