A Useful Report On How Big Data Can Help Make A Difference In Health Care.

This appeared a little while ago.

9 tips for getting started with big data

By Mike Miliard, Managing Editor

Created 03/20/2013

With big data promising enormous clinical and financial rewards for healthcare, but posing just as many technical and strategic challenges, the Institute for Health Technology Transformation (iHT2) has published a study mapping the way forward for providers at the starting line.

"Health care providers face significant obstacles in implementing analytics, business intelligence tools and data warehousing," writes iHT2 CEO Waco Hoover in the report. "Health data is diverse, comprising structured and unstructured information in a range of formats and distributed in hard-to-penetrate silos owned by a multitude of stakeholders.

Moreover, he writes, "each stakeholder has different interests and business incentives while still being closely intertwined."

The white paper, "Transforming Health Care Through Big Data," is meant to offer providers some models for "innovative uses of data assets that can enable them to reduce costs, improve quality, and provide more accessible care."

Drawing on the expertise of leaders from Kaiser Permanente, IBM, Sharp Community Medical Group, Newton Medical Center and University of Manitoba, the report seeks to help hospitals and health networks overcome the headaches and hurdles on the way to the big goal of big data, says Hoover: "to make better, evidence-based decisions."

And there are plenty of challenges. The industry is still in its infancy when it comes to data collection, for instance, 43 percent of providers say they're unable to collect sufficient data to improve care.

The data that is collected is often untrusted – or at least unstructured, which makes it all but useless to even the best analytics technology. Moreover, data fragmentation – scattered as it is among EHRs, lab systems and financial software, makes it hard to draw meaningful conclusions about organizations' holistic health.


Infrastructure is another big issue, of course. iHT2 shows how legacy systems and new technologies have trouble interfacing, and that lack of interoperability remains "a significant obstacle to many organizations’ efforts to leverage big data." Providers' options for upgrading, even if they could afford it, are limited.

…..

Access iHT2's "Transforming Health Care Through Big Data" here.

Lots more here:

http://www.healthcareitnews.com/news/9-tips-getting-started-big-data

Another useful report that warrants a careful read.

David.

Perspectives on Interoperability and How we Should Approach the Problems from Three Experts.

1.      Dr March Overhage CMIO, Seimens.

2.      Dr William Goossen, directeur Results 4 Care B.V. De Stinse 15
3823 VM Amersfoort the Netherlands

3.      Andrew M. Wiesenthal, Director Deloitte Consulting, San Francisco

Marc Overhage:

*quit chasing butterflies – don’t worry about developing new standards and focus on making existing standards work

* recognize and accept that this is trench warfare – given that healthcare providers have implemented whatever HIT they have in idiosyncratic and unique ways  in terms of terminologies used, which fields are used to record various data, how they define various concepts, degree of rigor applied to data completeness and quality etc., the work to establish interoperability requires effort for each provider implementation.  This is work that requires some expertise in clinical concepts etc.  the actual message based interfaces are usually almost trivial to create – hours in most cases once you have the right person’s attention.

* use the benefits of a network – we have good enough terminology and messaging concepts available (not perfect but good enough) for much of the data we need to share to serve as the “target”.  Google Translate, for example, takes advantage of the many language x to English mappings they have been able to use English as a Rosetta stone for translating language x to language y (using English to mediate the translation), individual provider terminologies need to be mapped to national standard terminologies.

* accept mediocrity (in order to get started) – We will not achieve full semantic interoperability ever if we don’t start.  Begin with the stuff that is “simple” and subject to less interpretation like laboratory results, imaging reports, medication records, simple clinical observations like vital signs, diagnoses/problems assigned, etc.  Recognize that higher level structures will take time to sort out but let’s not hold interoperability hostage pending that happening. In fact moving simple data will greatly facilitate later agreement on higher level constructs.

William Goosen:

I did a study towards coverage of Snomed CT for more granular data for stroke assessment and rehab and care. The moment you have non diagnostic concepts eg to define functions of hands and fingers and toes and nursing care (determined by clinicians as essential data for continuity of care across organisational borders) we found a coverage of 50% approximately.

Following Cimino's desiderata I advised  the Dutch ministry of health that give other studies like yours cover 90% and our granular use case we could solve half of our coding problems. So go ahead with what was in 2007 and invest as priority activity in a procedure to add new codes when required.

Of course it is 2013 we have Snomec ct now and are still waiting for that procedure. So now I moved to CiMI and one target is to set up the Snomed CT extension for missing codes that are required for the detailed clinical models.

Key is none standard will ever be perfect, yet we need them. Most important of any standard is to handle any issue through a transparent governance .

Andrew M. Wiesenthal

Marc--

Hear, hear!  And I would add that the core list of 2500 problems that the NLM has is a great place to start as the "seed crystal" for that Rosetta stone.  It was developed based on contributions like the SNOMED CT terms accounting for more than 90% of all of the diagnoses and procedures attached to the first 25 million encounters (ambulatory and inpatient) recorded in Kaiser Permanente's electronic health record (I know, because I had that report produced and provided the NLM with the information).  About 650 diagnoses accounted for 90% of encounters, varying only slightly by region of the country.

Reported by Dr. Terry Hannan.

This Is An Important Discussion Of Problems We Have Still Not Solved. EHR Usability and Interoperability.

Thursday, May 30, 2013

The Slow Crawl Toward Improved EHR Usability and Interoperability

by Steven J. Stack, M.D.

Well-developed electronic health records hold the promise of helping health care professionals improve patient care and deliver it more efficiently, and the American Medical Association recognizes that enhancing EHR usability and interoperability will further ensure our nation's goal of a high-performing health care system. Physicians are generally prolific users of technology: new patient monitoring devices, diagnostic imaging, equipment and advanced surgical tools, to name a few. In each case, physicians have adopted these tools quickly and became proficient users -- and they have done so without the need for a national incentive program. Why is it, then, that so many physicians are still trying to incorporate EHRs into their practices?

While the Medicare/Medicaid EHR incentive program can be credited with sparking a rapid adoption of health IT, it has also created negative consequences. Swift implementation of certified EHRs, needed to obtain incentives under the meaningful use program, has compelled physicians to purchase tools not yet optimized to the individual user's needs. These tools often impede, rather than enable, efficient clinical care. EHRs can also pose challenges as a physician attempts to meet documentation, coding and billing requirements. AMA has been an outspoken advocate for health IT improvements and continues to work with the federal government and other stakeholders to advance usability and interoperability.

EHR Usability

According to the Healthcare Information and Management Systems Society, "usability is one of the major factors -- possibly the most important factor -- hindering widespread adoption of [EHRs]." Surprisingly, the Office of the National Coordinator for Health IT does not provide physicians any information about the usability of EHRs that it certifies. Usability standards should be included in ONC's certification criteria to ensure that physicians are able to invest in the EHR system that fits the needs of their practice.

Many physicians report they are unhappy with the EHR products available to them, likely due to the fact that EHRs are still in an immature stage of development. They find them clunky, confusing and complex, and they are struggling to successfully incorporate EHRs into their workflow. According to a recent survey of physicians by American EHR Partners, approximately one-third of all surveyed physicians said that they were very dissatisfied with their EHR and that it is becoming more difficult to return to pre-EHR productivity levels.

Given this decrease in productivity, it is no surprise that since the start of the meaningful use program, we've seen continued escalation in physician dissatisfaction with their EHRs. According to the same American EHR Partners survey, the percentage of physicians who would not recommend their EHRs to a colleague increased from 24% to 39% between 2010 and 2012.

AMA also is concerned about the viability of the thousands of certified EHR products. We've heard from many physicians who have invested in EHRs that have gone out of business. These physicians, who were doing their best to adopt EHRs, are now faced with the financial hardship of purchasing an entirely new system. The uncertain future of an EHR extends beyond the product's business model to the security of the product's certification status. In fact, ONC recently revoked the certification of two EHR systems so providers cannot use those EHRs to satisfy meaningful use requirements. Physicians who have already invested in these now-uncertified systems will need to spend even more money on a new, certified EHR to replace their non-certified EHR or face a penalty.

Lots more here:

http://www.ihealthbeat.org/perspectives/2013/the-slow-crawl-toward-improved-ehr-usability-and-interoperability.aspx

This is a very worthwhile discussion of what remain two of the major barriers to real clinical use of EHR systems.

David.

A Little Blast From The Past That Reminds Us How Slowly Things Have Moved in E-Health.

This was published three and a half years ago.

This is the year of delivery: NEHTA

Summary: The standards and foundations for nation-wide e-health solutions in Australia have now mainly been completed, according to National E-Health Transition Authority (NEHTA) CEO Peter Fleming, leaving implementation on the agenda for 2009.

By Suzanne Tindal | January 27, 2009 -- 04:34 GMT (15:34 AEST)

The standards and foundations for nation-wide e-health solutions in Australia have now mainly been completed, according to National E-Health Transition Authority (NEHTA) CEO Peter Fleming, leaving implementation on the agenda for 2009.

"I've actually been pleasantly surprised at a lot of the work that's been done in the background around foundation standards. We're actually starting from a very good position," Fleming told ZDNet.com.au. in an interview last week.

"The reality is, though, that we have to move very quickly into a delivery mode and that means implementing. In my expectation, well, this is the year of delivery for NEHTA."

NEHTA had an "absolute mandate" from the Council of Australian Governments (COAG) to deliver in individual healthcare identifiers (which link electronic medical records together), Fleming said, which the authority has been working together with Medicare on. "Medicare is extraordinarily well positioned to do this because of its history and very keen to make this work," he said.

Although creating the individual healthcare identifier for Australians meant a "fairly substantial database", Fleming said the difficulties were created by non-technical issues. There were privacy issues, work flow issues and overarching consumer and government requirements, he said. Legislative changes would also have to be made.

This year would also see a number of pilots, according to Fleming. "I am expecting that as the year progresses we will move very quickly around some fairly reasonable scale pilots around medication management and discharge referrals, and we are talking to a number of groups about that at the moment," he said.

Those waiting for an all-at-once implementation would go home disappointed, however. NEHTA would move ahead incrementally, Fleming said, with the authority consulting states, peak bodies and vendors along the way.

Lots more here:

http://www.zdnet.com/this-is-the-year-of-delivery-nehta-1339294585/

There is really some great reading in the rest of the article.

Heavens this has taken a long time!

Feel free to rate NEHTA’s performance via the comments.

David.

AusHealthIT Poll Number 172 – Results – 19th June, 2013.

The question was:

How Long (From Now) Do You Think It Will Be Before We See Measurable and Demonstrable Positive Clinical Outcomes For The Australian Population At Large From The NEHRS / PCEHR?

It Has Already Happened 2% (1)

Six Months 0% (0)

One Year 8% (5)

Two Years 2% (1)

Three Years 3% (2)

Five Years 7% (4)

More Than Five Years 23% (14)

Never 50% (30)

I Have No Idea 5% (3)

Total votes: 60

This is a pretty clear outcome. We have 73% saying never or more than 5 years to see real clinical outcomes.

Again, many thanks to those that voted!

David.

Do You Think Standards Australia Is Behaving In Conformance With Its Memorandum of Understanding With HL7 and IT-14?

Here is the HL7 Australia Mission Statement and The MOU.

HL7 Australia Mission HL7 Australia is an open, not-for-profit, democratic organisation that supports the HL7 user community by:
Co-ordinating and championing the development and implementation of the Australian and global family of HL7 standards	Developing skills and knowledge exchange amongst members and the wider informatics community	Promoting HL7 as the most effective standard for systems interoperability, EDI message interfaces and information management in healthcare

HL7 Australia strives to collaborate with Standards Australia and the IT14 Health Informatics Committee to best achieve this Mission.

Statement of Collaboration

 Principles of Collaboration

HL7 Australia recognises that the development and implementation of health informatics standards in Australia must involve the active collaboration with Standards Australia, and that there is value in clarifying the broad roles and responsibilities of each organisation.

HL7 Australia will:
•  Maintain open lines of communication
•  Collaborate in a spirit of mutual appreciation, respect and openness
•  Seek pragmatic solutions to create a series of HL7 standards for health care communications

HL7 Australia re-affirms that:
•  we support SA and IT14 in their role as the national standards developer.
•  we coordinate Australia’s activity in the international HL7 Working Group and related meetings.
•  in areas not covered by IT14, we will facilitate Australia’s input to HL7 standards development.
•  we provide education and events relating to HL7.
•  we encourage complete openness in the sharing of technical documents.

 Approved by the HL7 Australia Board, May 2003 (confirmed by SA and IT14 June 2003)

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Here is the link:

http://www.hl7.org.au/docs/Statement%20of%20Collaboration%20-%20SA.htm

It would seem to me on the basis of the last two blogs in the area found here:

http://aushealthit.blogspot.com.au/2013/05/the-australian-e-health-standards.html

And here:

http://aushealthit.blogspot.com.au/2013/06/if-you-thought-issues-with-e-health.html

That we are just not seeing any mutual appreciation, respect and openness from SA to either HL7 and IT14 Health Informatics Committee.

A quick look at the current list of e-Health Standards found here:

http://www.e-health.standards.org.au/Home/Publications.aspx

Will show just how much of  Standards Australia’s work flows from and is based on HL7 work.

One really must wonder just what Australian HL7 Members and their Board are thing about all these shenanigans. I suspect there must be a lot behind the scenes discussion regarding who needs to do what to get things back on the rails.

I continue to hear of a lot of unhappiness from all over on this.

All this reminds me a little of the MOU on Compliance, Conformance and Assessment (CCA) which kicked off with a lot of noise and now seems to be pretty quiet.

See here:

http://ehealthcca.com.au/about-cca/what-is-cca

It is odd that there has been no news update on the site in over a year - rather like the NEHTA Publications Listings. See here:

http://www.nehta.gov.au/media-centre/nehta-publications

Last entry in August last year.

One has to wonder are things just falling to bits.

David.

Weekly Australian Health IT Links – 17th June, 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

The publicity blitz for the PCEHR seems to be reaching fever pitch since there seems to be a deadline for spending promotional money seems to be June 30, 2013. Amazing to see the bus running all over, handing out little goodies and so on!

Other than that it has seemed to be a quiet week. Behind the scenes however there are still a lot of ructions going on regards standards setting. There may be much more news on this in the next week or two.

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http://www.afr.com/p/national/government_rushes_to_spend_on_health_IGKfJgHgHIybONaGQwqtcL

Government rushes to spend $7m on health ads

PUBLISHED: 05 Jun 2013 08:12:00 | UPDATED: 07 Jun 2013 00:46:38

Joanna Heath

The federal government is rushing to spend nearly $7 million on a ­Medicare advertising campaign before caretaker period restrictions begin in about nine weeks time, it has emerged.

Department of Health officials appearing at a senate estimates ­hearing in Canberra on Wednesday said they were awaiting final ­government approval for a national campaign announced in the budget.

The campaign aims “to inform Australians about the benefits of Medicare and health related ­services”.

It will cost $10 million over the next two years. Some $6.5 million is ­allocated for the current 2012-13 financial year, ending on June 30.

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http://www.nehta.gov.au/media-centre/news/412-federal-government-launches-advertising-campaign-medicare-for-all

Federal Government launches advertising campaign 'Medicare For All'

Created on Tuesday, 11 June 2013

The federal government has launched an advertising campaign for the PCEHR, airing new television commercials as part of a “Medicare For All” promotion that also includes information on Medicare Locals and the after-hours GP helpline.

• View the advertisement on the Medicare For All website.

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http://www.zdnet.com/au/australian-e-health-sign-up-target-in-sight-7000016644/

Australian e-health sign-up target 'in sight'

Summary: Despite needing to double the number of users signed up for e-health records, the Australian Department of Health and Ageing is confident that it'll get close to 500,000 users signed up by the end of this month.

By Josh Taylor | June 11, 2013 -- 04:18 GMT (14:18 AEST)

The Department of Health and Ageing is expecting to get close to 500,000 users signed up for Personally Controlled E-Health Records (PCEHR) by the end of June, despite only having approximately half that number signed up so far.

The Australian government, in conjunction with the states, has invested over AU$1 billion in the e-health program aimed at improving patient care through making it easier for healthcare providers to access and share information about a patient throughout the medical system. The project has been slow for uptake, with the government rolling out a number of the features of the system over time as GPs and other healthcare providers implement key system upgrades in order to accommodate the new e-health record system.

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http://ehealthspace.org/news/year-ahead-ehealth-state-budgets-analysis

The year ahead in eHealth – State budgets analysis

Posted Wed, 12/06/2013 - 14:07 by Fran Molloy

With six of the eight state and territory budgets now published, we look at the state of health, eHealth and IT budgets in Victoria, Tasmania, the ACT, NT, Queensland and South Australia in the coming year.

VICTORIA

Budget:  Delivered 7 May 13 by Treasurer Michael O’Brien (Liberal) 

Surplus budget - by $225 million

Total health budget: $14 billion

Key announcements in health, eHealth and IT:

• High investment in health infrastructure – particularly hospitals ($1.2 billion over four years, $629 million for new capital projects)
• $238 million for additional clinical training
• $19 million over four years to technology portfolio for Victorian Government ICT Strategy – using ICT to deliver better government services  

NORTHERN TERRITORY

Budget:  Delivered 14 May 13 by Treasurer David Tollner (Country Liberals) 

Deficit budget – by $1.185 billion

Total health budget: $1.36 billion (increased by $136 million)

Key announcements in health, eHealth and IT:

• $173 million for health infrastructure upgrades
• New Service Framework decentralises hospital and health services from Department of Health to new authorities in Top End and Central Australia, managed through service delivery agreements
• $575 million operational funding to Top End Health and Hospital Service - Royal Darwin, Katherine and Gove District hospitals
• $229 million operational funding to Central Australian Health and Hospital Service - Alice Springs and Tennant Creek hospitals
• $10 million capital and $35 million operational per year for alcohol mandatory treatment tribunal and rehabilitation facilities

http://www.afr.com/p/technology/trialling_digital_health_startups_Y0ANdRxnUNf3bJTQtnv1pO

Trialling digital health startups v online snake oil salesmen

11 June, 2013

Jessica Gardner

To stand out among Facebook bikini body challenges and questionable claims from wearable device makers, Nick Crocker realised he would have to speak the language of the medicos.

”In the medical realm, the answer to ‘does something work’ is never yes until you’ve done a randomised controlled trial,” Crocker, the co-founder of exercise start-up Sessions says. “This is the currency of doctors to share information about new products.”

Crocker has been linked to numerous technology start-ups – from music discovery app We Are Hunted to TV streaming device company Boxee – but his latest venture has brought home the challenges unique to digital health.

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http://www.nehta.gov.au/media-centre/assisted-registration

Get your personal eHealth record now!

The Australian Government has brought in the eHealth record system to make healthcare in Australia even better, safer and more effective.

The NEHTA truck will be touring Queensland in May and June this year to help consumers to register for your own online record. It’s free and it only takes a few minutes. Your Medicare Local team will be there to help.

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http://www.noosanews.com.au/news/sign-up-for-ehealth/1901271/

Sign up for eHealth at toy libraries

• Natasha Christian
• 10th Jun 2013 12:08 PM

PARENTS who take advantage of toy libraries can now register their families for eHealth records in the same place.

Metro North Brisbane Medicare Local has teamed up with Playgroup Queensland to raise awareness about the personally controlled electronic health record.

On Wednesday Moreton Bay Regional Council Mayor Allan Sutherland visited the Burpengary community hall toy library to find out more.

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http://www.news-mail.com.au/news/hundreds-sign-ehealth/1905285/

Hundreds sign up for eHealth

• 13th Jun 2013 6:00 AM

HUNDREDS of Bundaberg people turned out to visit an eHealth roadshow and along the way signed up for a more efficient health record.

Wide Bay Medicare Local eHealth advisor Tina Connell-Clark was on hand earlier in the week to help out in the purpose built eHealth semi-trailer, in the Sugarland Shoppingtown carpark. She said the initiative could save lives of those who were most vulnerable.

"The reason we are bringing the truck here is to encourage the community to get an electronic health record," she said.

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http://blogs.abc.net.au/queensland/2013/06/ehealth-rolled-out-in-mount-isa.html

eHealth roll out in Mount Isa

13 June 2013 , 11:37 AM by Emma Cillekens

In a national first eHealth records will be rolled out en masse in North West Queensland.

The technology, which was released last year, allows all Australians to control an online summary of their medical records which can be shared with and added to by a number of health professionals.

Mount Isa Centre for Rural and Remote Health director Professor Sabina Knight says Mount Isa and the North West is the first area that all health professionals are working together to understand the new technology and get more community members to sign-up.

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http://www.frasercoastchronicle.com.au/news/crowds-queue-up-to-sign-on-for-ehealth-program/1905486/

Crowds queue up to sign on for eHealth program

• Hayden Johnson
• 13th Jun 2013 5:00 AM

HUNDREDS of Fraser Coast residents have signed up for an online eHealth record after the Wide Bay Medicare Local truck arrived in Hervey Bay on Wednesday.

The eHealth truck was busy at Pialba Place with locals queuing to sign up for a better way to manage personal health records.

An eHealth record is a secure online summary of your health information.

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http://www.penrithstar.com.au/story/1569998/e-health-talk/?cs=1247

E-health talk

June 13, 2013, 9:36 a.m.

U3A Curriculum Convener e-Health A one hour Presentation about e-Health will be given at the U3A, Penrith School of Arts, 3 Castlereagh St., Penrith at 1.30pm on Tuesday 18th June.

The Australian Government has developed a national, personally controlled electronic (e-Health) health record system.

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http://www.theaustralian.com.au/national-affairs/health/online-health-deadline-looming/story-fn59nokw-1226661478243

Online health deadline looming

• by: Fran Foo
• From: The Australian
• June 11, 2013 12:00AM

THE Gillard government must sign up more than 9600 people a day to meet its target of 500,000 registrations by the end of the month for the $467 million eHealth record system.

It took 11 months to hit the first 250,000 as of June 5. This time the government will have about three weeks to repeat the feat.

The government had aimed for half a million Australians with a personally controlled eHealth record by next month.

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http://www.thereporter.com.au/news/check-your-ehealth-sunshine-coast-show/1907598/

Check your eHealth at the Sunshine Coast Show

• 14th Jun 2013 11:02 AM

FOLLOWING a successful attendance at the Maleny Agricultural Show, the eHealth team at Sunshine Coast Medicare Local are ready for a flood of eHealth sign-ups at the Sunshine Coast Agricultural Show this weekend.

"A Personally Controlled Electronic Hallows you, and medical professionals authorised by you, to access health details, such as any current medications, allergies, immunisation status and health conditions," Sunshine Coast Medicare Local CEO, Ian Landreth said.

"In an emergency, all this information is accessible, and stored securely in a single place.

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http://www.nehta.gov.au/our-work/supply-chain/updates-news-and-events/healthcare-recallnet-solution

Healthcare Recallnet Solution

3 June 2013

In a world first, NEHTA Supply Chain, in partnership with GS1 Australia, is poised to launch the first Healthcare Recallnet Solution. This solution provides real time notification and recall of therapeutic products listed on the National Product Catalogue. Based on the successful completion of the Recallnet pilots in April, the planning and preparation continues for the production release of the solution which is set for September 1st.

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http://www.zdnet.com/ge-healthcare-to-spend-2-billion-on-software-development-7000016669/

GE Healthcare to spend $2 billion on software development

Summary: The company said that the $2 billion spread over five years will focus on asset management, hospital operations, clinical effectiveness and patient care.

By Larry Dignan for Between the Lines | June 11, 2013 -- 13:27 GMT (23:27 AEST)

GE Healthcare said Tuesday that it will invest $2 billion to develop software for hospital information technology, patient monitoring and other technologies.

The company said that the $2 billion spread over five years will focus on asset management, hospital operations, clinical effectiveness and patient care.

New applications by GE Healthcare will be created in collaboration with GE's software development arm and research hubs.

GE is increasingly competing with established software giants such as IBM. The Internet of things, or industrial Internet as GE calls it, means that every company has the potential to be a software player.

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http://www.smh.com.au/world/human-genes-cant-be-patented-supreme-court-20130614-2o7st.html

Human genes can't be patented: Supreme Court

Date June 14, 2013 - 7:17AM

Adam Liptak

Washington: Isolated human genes may not be patented, the Supreme Court ruled unanimously on Thursday. The case concerned patents held by Myriad Genetics, a Utah company, on genes that correlate with increased risk of hereditary breast and ovarian cancer.

The patents were challenged by scientists and doctors who said their research and ability to help patients had been frustrated. The particular genes at issue received attention after actress Angelina Jolie revealed in May that she had had a preventive double mastectomy after learning that she had inherited a faulty copy of a gene that put her at high risk for breast cancer.

The price of the test, often more than $3000, was partly a product of Myriad's patent, putting it out of reach for some women. The company filed patent infringement suits against others who conducted testing based on the gene. The price of the test "should come down significantly," said Dr. Harry Ostrer, one of the plaintiffs in the case decided on Thursday. The ruling, he said, "will have an immediate impact on people's health."

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Enjoy!

David.

Isn’t It Interesting Just How Widely Different Medical Commentary Is On The NEHRS / PCEHR.

I found it amusing to see just how different the commentary on the PCEHR in the social media is. Here are two examples that appeared in the last week or so.

First we have a tale of frustration and time wasting:

Tillyard Drive Medical Practice

Friday June 15, 2013

A few months ago I thought that our system was finally ready to use the #PCEHR. This was after at least 18 months' worth of countless forms, calls, faxes and e-mails. We were the eight out of 88 Canberra GP clinics to get to this stage. Lo and behold it would appear that we were not there yet. We were now told we had to fill out a form to link us with a Contracted Service Provider which in our case turned out to be Healthlink. A month later this was done and we had the nice Tech from Healthlink log into our system (yet another stranger allowed in behind our security barriers) and after nearly an hour he managed to set up the secure certificates - AFAIK we are the first GP clinic in Canberra to get this far. Everything should work now? Not. It would appear that our business HPI-O is supposed to be linked to each individual doctor's HP-I but off course it is not. We are now required to fill in a form for each doctor to get this done (a form that looks nearly identical to the multiple previous ones we filled out). In addition we are told we have to log into Medicare' secure HPOS website to link and publish our details in the Health Provider Directory. Now to do this the RO or the OMO for the organisation needs to use his PKI certificate/Dongle to log in. All the doctors and the practice manager has one of these but we have never felt the need to use them so they have been in a drawer. So today our Practice manager tries to log into HPOS - it turns out that none of our PKIs can be used as they are more than a year old and incompatible with Windows seven or eight machines. So guess what - we have to fill out a multi-page application out for each user again - last time it took nearly two months to get a response.
More of the saga here:

https://www.facebook.com/TillyardDriveMedicalPractice/posts/519437091452040

Secondly we have a post of enthusiasm and optimism with great faith that after 8 years NEHTA is about to deliver and a slight recognition it has taken way too long.

Shared publicly  -  Jun 12, 2013

David Guest

Trust me I'm a ... data manager

‘Grete long cures note in folio/ shorter common cures that come or send in half side or quarto/ note visiting cuers in a manuell" Thus wrote Dr Barker in early 17 century England advising his colleagues on the way to record medical treatments. It was early days in Western medical data management and the routine recording of a patient's clinical details was a long way off.

Things changed little for centuries. The doctor's diary was, like Samuel Pepys', a personal record of his life. While it contained some clinical details, it was for private thoughts and memoirs and was not written with the patient in mind. The physician's day book was more financial than clinical record and Dr Finlay's Case Book was produced primarily for the edification of the audience. Dr Joseph Bell, Conan Doyle's inspiration for Sherlock Holmes, would have had little need for documentation. A brilliant mind and shrewd observation seemed to make both history taking and medical records superfluous.

By the early twentieth century science and medicine had changed. Early diagnostic testing added to the volume and complexity of the data that needed to be managed. More people were involved in an individual's care. In 1906 Dr Henry Plummer of the Mayo Clinic sparked a revolution in medical data management. The "unit record" contained all the patient's data in one folder that accompanied the patient around the Clinic.

Despite computerisation changing both the world and medicine in the last 40 years, medical records have been surprisingly resistant to its advances. The vast majority of Australian hospitals still use paper records for patient management. The business case for computerisation in general practice has been much stronger. Over the course of ten years from the early nineties, electronic health records progressed from printing scripts, producing health summaries and generating letters to note taking, pathology and radiology processing and finally document handling. By the early 2000s many practices were completely "digital".

Form follows function, but function does not follow form. Cheap, near instantaneous communication has been a reality since the late nineties. Education, banking and the business supply chain have readily embraced it. It continues to make significant inroads into retail. Ten years ago it seemed inevitable that the medical IT marketplace would develop solutions for rapid seamless secure communication.

It didn't happen. Clusters of proprietary medical data transport systems developed in pockets around the country but the coverage was patchy at best. There was no incentive for competing companies to interoperate and many medical practitioners after dabbling in electronic communication returned to the lingua franca that paper provides.

In 2005 the government established he National Electronic Health Transition Authority to break the impasse. To the outsider the pace of change has been glacial. This is probably inevitable given the foundation work needed for developing the legal framework, medical IT standards and specifications, and for developing the authentication infrastructure for the Australian populace. These were major undertakings but made no change to a GP's day to day medical practice.

Lots more here:

https://plus.google.com/u/0/103595642866347393604/posts/X6LAgD1gN8H

I will leave it to others to comment on how they see all this (glass half full or empty etc.)  but I would point out that there is still a long way to go, no matter how you look at it, before we will see the hoped for benefits and improved clinical outcomes.

Is this the triumph of experience over hope or hope over experience? You be the judge..

David.