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, July 18, 2013

An Interesting Paper In the New England Journal Of Medicine on eReferral.

This paper appeared a week or so ago.

eReferral — A New Model for Integrated Care

Alice Hm Chen, M.D., M.P.H., Elizabeth J. Murphy, M.D., D.Phil., and Hal F. Yee, Jr., M.D., Ph.D.
N Engl J Med 2013; 368:2450-2453June 27, 2013DOI: 10.1056/NEJMp1215594
Health care reform has generated new pressures for the U.S. health care system to take better care of more patients at lower cost. Whereas these challenges are relatively new in the fee-for-service private sector, safety-net systems have perennially had to “do more with less”; innovations in this arena have generally been prompted by clinical exigencies rather than the need to gain market share or maximize revenues.1 We believe that one such innovation — eReferral — can serve as a new model for integrating primary and specialty care.
In 2005, San Francisco General Hospital (SFGH) was grappling with a challenge familiar to safety-net organizations: providing access to specialty care.2 Because of a tremendous mismatch between supply and demand for specialty services, patients were waiting 11 months for a routine clinic appointment for gastroenterology, 10 months for nephrology, and 7 months for endocrinology. If a patient needed to be seen sooner, the referring clinician had to plead with a specialist to overschedule into already overflowing clinics. Patients would sometimes wait for months only to discover that they were in the wrong subspecialty clinic or needed further diagnostic testing, which added to delays in care.
The dual imperatives of timely access and rational triage drove the creation, implementation, and spread of our homegrown, Web-based, integrated specialty referral and consultation system, called eReferral. It uses health information technology to link primary care providers (PCPs) and specialists, with the goals of increasing access to care, improving dialogue, optimizing the efficient use of specialty resources, and enhancing primary care capacity.
Originally piloted for gastroenterology services, eReferral is now used for more than 40 services at SFGH. PCPs initiate new specialty referral requests through eReferral. The electronic form is automatically populated with relevant information about the patient and the PCP, and the reason for consultation is entered as free text, along with relevant history and exam findings.
Every service has a designated specialist provider who reviews and responds to each referral. The specialist reviewer uses the system to schedule a routine or expedited clinic visit, ask for clarification or additional information, recommend additional evaluation before scheduling a clinic visit, or provide education and management strategies without a visit (see diagram Workflow and Volume of eReferral, July 1, 2011, through June 30, 2012.). eReferral allows for iterative communication between the PCP and the specialist reviewer, with all exchanges captured in real time in the patient's electronic health record. If the patient is scheduled for an appointment, the electronic referral form — including the dialogue between PCP and specialist reviewer — is available to specialists seeing the patient in clinic.
Our PCPs and specialist reviewers quickly recognized that the system provided expeditious access to specialist expertise, with or without a visit. PCPs now use eReferral to request advice and guidance for patients who may not need a specialty clinic visit, and the system is used for virtual comanagement of certain conditions (e.g., management of subclinical hypothyroidism and evaluation of anemia). When needed, the system allows for a seamless transition to formal consultation.
The full paper (with references) is freely available here:
This interactive referral model with an expert gatekeeper to ensure referrals are handled as they should be makes a great deal of sense to me and the paper certainly suggests it can be made to work well.
David.

Wednesday, July 17, 2013

Minister For Health Speaks On E-Health At HISA Conference. Spin In Full Flight!

This was delivered today.

Speech to the Health Informatics Conference 2013

17 July 2013
Check Against Delivery
I’m delighted to be with you here this morning.
I would like to acknowledge the traditional owners of the land, and pay my respects to elders past and present.
I would also like to recognise:
  • Dr Brendan Lovelock, Chair of the Health Informatics Conference 2013
  • Dr Louise Schaper, CEO of the Health Informatics Society of Australia (HISA)

Introduction

I understand congratulations are in order.
The Health Informatics Conference has come of age.
Happy 21st birthday!
Just think back to 1992. And I know some of us would rather not.
Technology wise, there was CD-ROM.
Super Nintendo.
Microsoft’s Windows 3.1.
And according to Tony Abbott, Malcolm Turnbull was still about two years away from ‘virtually inventing the Internet’.
How far things have come.
In my time with you this morning I would like to touch on three things:
  • Firstly, the compelling case for eHealth
  • Secondly, how the Government’s built Australia’s eHealth superhighway, and
  • Thirdly, how we can unleash the full potential of eHealth for patients

The Compelling Case for eHealth

I know that this audience requires little convincing of the case for eHealth.
But when we talk so often about the minutiae of the system it’s sometimes easy to lose sight of the big picture.
We can forget the difference eHealth is making, and will make, for patients, and for our health system.
For patients eHealth means their medical history travels with them.
It means fewer medication errors, and duplication of tests.
It means better, more accurate treatment in an emergency. Put simply, eHealth could save your life.
By way of example, the story I often use is one of an elderly man who collapsed in a shopping centre. He collapsed from a perfectly preventable interaction between medicines. The incident occurred after the man’s GP, and his specialist, changed his medication independently of each other — without knowing what the other had done.
eHealth is making stories like that a thing of the past.
eHealth is also a revolution in patient access to their own medical information. Information that empowers patients to make more informed decisions about their own healthcare.
And the benefits of eHealth for our health system are just as clear.
Every year, eHealth will help to stop around 15,000 unnecessary hospital admissions, by reducing avoidable medication related problems.
That will make even more room for extra doctors, nurses, beds, the latest medicines, and more life changing medical research.

Building Australia’s eHealth Superhighway

In the proud tradition of true nation building, this Government has been busy constructing the eHealth infrastructure Australia needs to secure a bright future.
No good building, no good system can exist without a strong foundation.
And that’s where we started with eHealth.
This Government has built Australia’s eHealth superhighway.
We’ve invested more than $160 million in general practices to upgrade their computer systems for eHealth.
We’ve built the Healthcare Identifier service that has created more than 22 million digital eHealth passports - identifying every Australian for healthcare purposes.
And we’ve built the $467 million national eHealth records system, which has the potential to connect every single Australian to every single doctor in the nation.
A patient’s eHealth record on our national system can now hold:
  • A summary of the patient’s important medical history
  • A list of medications prescribed and dispensed
  • Allergy information
  • Childhood immunisation records
  • Child health and development information
  • Hospital discharge reports
  • Organ donor status
  • Advanced care planning details
  • Summaries of individual patient health events
  • Medicare and PBS claims data, and
  • Private notes patients make about their own health
And in June, we launched the first smartphone app to link to the national eHealth records system – the child eHealth app.
The app allows parents to keep their children’s important health, growth and development information at their fingertips ,and there’s been more than 5000 downloads already.
Hospitals have also started uploading discharge summaries to patient eHealth records, with nearly every state and territory to be on board by the end of the year.
Importantly, the Government has also paid for upgrades to the medical software doctors already use in their clinics.
The software upgrades have been designed to make it as easy as possible for doctors to use the national eHealth system; In many cases being able to add information to a patient’s eHealth record at the click of a button.
We’ve built the eHealth superhighway, and I’m proud to say we’ve had a lot of drivers join it already.
The Government set a goal to have about half a million patients on the national eHealth records system by the middle of this year. Not only did we meet this goal, we’ve exceeded it.
There are now around 520,000 patients on board.
There are nearly 5,000 GP practices, hospitals, and other healthcare organisations signed up too, covering all the nurses, doctors and other health professionals in those organisations.
And more than 16 million healthcare documents have been uploaded to patient eHealth records.
We’ve put strong foundations in place, but there is more to do to unleash the full potential of eHealth for patients.

Unleashing the Full Potential of eHealth for Patients

The future of eHealth is incredibly exciting.
I recently announced $10 million to allow advance care plans to be put on the national eHealth records system; another important feature to help patients with end of life planning.
Now the Government’s established the eHealth infrastructure, we’re starting to see some impressive innovations grow forth from the private sector, developed by experts like you.
I was very pleased to hear that the 2013 HISA app competition has received entries that connect and interact with the national eHealth records system.
This Government sees eHealth as a natural extension of our universal health system, Medicare.
Creating better access.
Helping every Australian get great healthcare, no matter where they live or how much they earn.
Which is why today I am delighted to announced a landmark next step for our national eHealth records system.
I can reveal the Government is investing $8 million to enable pathology results and diagnostic imaging reports to be stored on a patient’s eHealth record.
This will mean things like a patient’s blood tests and x-ray results will be stored securely online, in one place, and can travel with them wherever they go.
It will mean patients and doctors will have even more health information available to them at the click of a button.
And it paves the way for the diagnostic images themselves, including x-rays and MRI scans to be stored on a patient’s eHealth record. Thanks to work of this Government, that’s now on the horizon.
An exciting piece of progress for eHealth in Australia.

Conclusion

In some ways, I believe continued progress on eHealth over the long term is inevitable.
And that’s because I think good reform eventually gets its day.
But, unfortunately, in other ways, I see some very real risks to the progress of eHealth in the foreseeable future.
I believe Australians expect a bipartisan commitment to eHealth. And so they should.
What they don’t expect is for eHealth funding to be threatened – like we saw from those across the political divide three years ago.
Stopping investment in eHealth means no eHealth records.
It means patients having to repeat their medical history every time they see another doctor.
It means unnecessary medication errors and hospital admissions – putting lives at risk.
I am confident that what Australians want is for Australia to be a leader in eHealth, to explore the possibilities of eHealth in conjunction with other modern national infrastructure like the National Broadband Network.
Australians want the convenience of electronic access to their medical history wherever they.
They want control of their health information so they can make better, more informed decisions about their own care.
I ask for our Government to be judged on our record.
A Government that didn’t just talk, but acted on eHealth.
And a Government that has a vision for the possibilities eHealth can unlock for patients into the future.
-----
There are massive fibs, distortions and threats in all this. Feel free to pick them up in comments.
Talk about an e-Health spruiker!
Truth out the windows again.
“The Government set a goal to have about half a million patients on the national eHealth records system by the middle of this year. Not only did we meet this goal, we’ve exceeded it.”
Spin to die for.
David.

Analytics Seems To Be Making a Big Difference In This Situation.

This report appeared a little while ago.

Analytics help hospital cut readmissions by 25%

June 28, 2013 | By Susan D. Hall
El Camino Hospital in California reduced readmissions by 25 percent through the use of predictive analytics and videoconferencing with nursing home staff who care for the most high-risk patients, according to a newly published case study by the College of Healthcare Information Management Executives.
The 443-bed hospital based in Mountain View, Calif., identified 25 characteristics that could help predict whether readmission would be likely and grouped patients by low, medium or high risk. Those factors included the patient's age; where the patient was to be placed after discharge; five diagnoses (congestive heart failure, pneumonia, stroke, sepsis and renal failure); and whether the patient's primary care physician (PCP) was identified in the record.
Based on that information, a banner appeared across the top of the screen on records of high-risk patients to alert everyone involved in their care, allowing them to intervene early and plan accordingly.
What's more, according to the case study, when patients were discharged to nursing homes, weekly telepresense sessions allowed staff to exchange patient information.
More with reference etc. here:
There is another useful report here:

El Camino slashes hospital readmissions

Posted on Jun 28, 2013
By Erin McCann, Associate Editor
New telehealth and data analytics initiatives at a Silicon Valley-based hospital aimed at significantly curbing readmissions rates have already helped effect a 25 percent decrease in hospital readmissions.
Officials at the 433-bed El Camino Hospital in Mountain View, Calif. — the subject of a recent CHIME case study — decided to tap into hospital data and create a readmissions rate formula identifying which patients were considered high-risk for the metric. By utilizing both care transition teams and its year-old telehealth program connecting the hospital with long-term facilities, providers are able to follow up with high risk patients who normally would be readmitted to the hospital. 
The Centers for Medicare and Medicaid Services estimate that 30-day readmissions rates for Medicare beneficiaries are nearly 20 percent, with a price tag of some $17.5 billion. For many hospital and health systems, these numbers are also significant. 
Lots more here:
El Camino is a very technologically advanced hospital and one of the places where one would expect technology to be able to demonstrated to make a difference - and so it seems.
Silicon Valley strikes again.
Good stuff.
David.

AusHealthIT Poll Number 175 – Results – 17th July, 2013.

The question was:

Is It Important That A Public Cost Benefit Study Be Undertaken (as is planned) on e-Health Before More Funds Are Allocated In The Area?

No - We Know It Works 11% (5)
Probably Not 2% (1)
Neutral 5% (2)
Probably 2% (1)
Yes - Vital To Justify Spending 75% (33)
I Have No Idea 5% (2)
Total votes: 44
This is a pretty clear outcome. 75% are convinced that we need proper cost benefit analysis of any more spending.
Again, many thanks to those that voted!
David.

Tuesday, July 16, 2013

This Is A Pretty Big Hurdle For The NEHRS / PCEHR To Jump Over. Docs Don’t Like It and Don’t Want To Use It.

I visited the Australian Doctor Web Site a few days ago to see how their poll on the plans for usage of the system was going.
The site is found here:
Here is what I found.

Are you taking part in the national e-health scheme and writing health summaries for PCEHRs? (Poll Closed)

Yes, I am taking part in the scheme and have already written health summaries for PCEHRs.  6.03%  (31 votes)  
Yes, I will be taking part in the scheme, but have yet to write a PCEHR health summary.  28.99%  (149 votes)  
No, I am not personally taking part, but colleagues in my practice are who I can refer patients to.  7%  (36 votes)  
No, I will never take part in the scheme and will not be promoting its use to patients.  57.98%  (298 votes)  
Total Votes: 514
You can view the results here:
This result - coming from a significant sample of the profession - tells me that the one of two things has happened. Either the PCHER has not been designed to address the clinicians needs and wants for a shared electronic system or the way the system has been implemented has not made clinicians comfortable to become involved - with concerns regarding risk, liability, insurance, security and information currency and so on.
This blog from Dr Edwin Kruys recently provides a useful list of the concerns many have.

eHealth: The good, bad and ugly



We’ve come a long way with technology in general practice. Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us. Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.

Read all the details here:
If the situation is to be recovered what needs to happen is that all these issues are formally address and resolved to the satisfaction of those clinicians who are involved.
Without this being done the PCEHR is a dead duck!
David.

Very Heavy News Day For E-Health. A Lot For One Day!

A few quick links and titles to enjoy.

E-health flaws adding to GP stress

Most doctors reject e-health record system as 'white elephant'

'Scrap it before it bleeds more money' - Edwin Kruys damns e-health

Some fun reading to start the day!
David.

Monday, July 15, 2013

Weekly Australian Health IT Links – 15th July, 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 week but enough happening to keep us interested.
The loss of the NBN CEO was hardly a surprise and whoever takes over will have a huge job - no matter who wins the election - remember in part it is a huge IT project which we don’t have a wonderful track record with.
Had a look at my NEHRS only to discover the PBS data is out of chronological order for some odd reason - and the whole thing is as slow as a wet week which I still don’t understand
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GP input to PCEHRs remains miniscule

9 July, 2013 Paul Smith
The number of shared health summaries created by GPs for the personally controlled electronic health records  system is little more than 1100 — about 0.3% of nearly 400,000 patients who have been recruited to the billion-dollar scheme.
Health summaries are meant to be the backbone of the PCEHR and will list patients' current diagnoses, medications, allergies and immunisation histories.
However, there have been ongoing concerns about the workload the scheme will generate for GPs.
Doubts have also been raised over whether the profession will agree to take on the task of managing the summaries, which are designed to help streamline care with other health providers, such as hospitals and specialists.
The number of shared health summaries was obtained by Australian Doctor in May.
-----

Low sign-up for Australian eHealth records

  • Jordanna Schriever Health Reporter
  • The Advertiser
  • July 07, 2013 9:45PM
LESS than 2 per cent of Australians have signed up for an eHealth record in the year since its launch, and the Australian Medical Association says most of those records would be unused and blank.
The AMA supports the idea of the personally controlled electronic health record (PCEHR) system, but president Steve Hambleton said the current system was flawed because GPs and hospitals could not easily access and enter information in the system.
Nationally, the Health Department says 407,000 Australians - about 1.7 per cent of 23 million people - had registered for an eHealth record since its launch in July 2012.
-----

E-health records result in reduced medical errors for Australian doctors

July 8, 2013
The majority of Australian doctors (77 per cent) say sharing health records electronically had a positive impact on reducing medical errors in 2012, according to a survey by Accenture. The survey of 3,700 doctors in eight countries – Australia, Canada, England, France, Germany, Singapore, Spain and the United States – also found that 83 per cent of Australian doctors are actively using electronic medical records (EMR) and roughly 70 per cent reported improved quality of diagnostic and treatment decisions as a result of their use of shared electronic health records.
Patient access to records
Accenture’s survey revealed most Australian doctors (83 per cent) want patients to actively participate in their own healthcare by updating their electronic health records (EHR). However, the majority believe that patients should only have limited access to this record – a view shared across the surveyed countries. There was broad agreement among Australian doctors that patients should be able to update standard information in their health records, including demographics (87 per cent) and family medical history (78 per cent). However, a significant proportion of doctors were opposed to patients providing updates in areas such as medications (29 per cent), medication side effects (28 per cent), allergic episodes (26 per cent) and lab test results (59 per cent). The level of opposition to such patient input was notably higher than most other countries.
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Toongabbie doctor signed up for eHealth Records system

July 11, 2013, 5:24 p.m.
A Toongabbie doctor will be one of the first in western Sydney to use the new eHealth Records system.
Western Sydney Medical Local is rolling out the new system to general practitioners across western Sydney.
Toby Nasr, principal of Metella Road Family Practice at Toongabbie has started uploading the shared health summaries to the National e-Health records system for patients who have registered for Personally Controlled electronic health records.
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Call for Nominations for the IHTSDO Standing Committees

Created on Wednesday, 10 July 2013
NEHTA is now inviting expressions of interest from Australian clinical informaticians to be nominated as independent experts on the International Health Terminology Standing Development Organisation (IHTSDO) Standing Committees.
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Question: FHIR Versioning

Posted on July 10, 2013 by Grahame Grieve
Question:
Can you tell me roughly when FHIR 1.0 is scheduled for? Is that the DSTU version? or is that the post-DSTU version?
Answer:
We’ve never formally discussed versioning for FHIR. At present, I’ve upped the minor version whenever we reach some kind of publishing milestone – typically, I up the version when we enter a connectathon freeze, and again afterwards when changes recommence. We’ve not had any policy discussion about it. I’m inclined to target 1.0 as the first full normative release. So the DSTU would be 0.5 maybe.
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New eMedical service launched in Australia

Monday, 08 July 2013 09:21
A collaboration between Australia and Canada has resulted in more than 100 countries now having access to eMedical, Australia’s Department of Immigration and Citizenship’s (DIAC) new electronic health processing system that enables more efficient and cost-effective visa processing.
eMedical is an updated and improved version of the former ‘eHealth’ online system used to record the health examination results of visa applicants who complete their examinations for both DIAC and Citizenship and Immigration Canada (CIC).
“Increased use of eMedical will result in substantial benefits to DIAC and our clients, including improved client service, enhanced integrity and significant financial savings,” a DIAC spokesman said.
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Health-related web searches could be tracked, researchers warn

Date July 9, 2013 - 9:58AM
New research has raised the alarm about threats to privacy posed by patients searching for health-related information on the Internet.
Marco Huesch, a researcher at the University of Southern California, Los Angeles, searched for "depression," "herpes" and "cancer" on various health-related websites and observed that the data was being tracked.
"Confidentiality is threatened by the leakage of information to third parties" through trackers on the websites themselves or on consumers' computers, he wrote in the Journal of the American Medical Association.
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Privacy fears in visiting Google doctor

  • From: AFP
  • July 09, 2013 11:59AM
PATIENTS searching for health-related information on the Internet may find their privacy threatened, said a research letter published in a major US medical journal.
Marco Huesch, a researcher at the University of Southern California, Los Angeles, searched for "depression," "herpes" and "cancer" on various health-related websites and observed that the data was being tracked.
"Confidentiality is threatened by the leakage of information to third parties" through trackers on the websites themselves or on consumers' computers, he wrote in the Journal of the American Medical Association.
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Canadian partnership feature of research funding boost

Date July 10, 2013 - 11:20AM

Dan Harrison

Health and Indigenous Affairs Correspondent

The Federal Government has announced an extra 13.5 million for research projects to improve primary care, including $2.5 million for a research partnership with Canada.
The Canadian initiative will focus on chronic disease prevention and management, rural health, and better care for people in low socio-economic communities.
Health Minister Tanya Plibersek said on Wednesday that the project would bring together more than 20 researchers, clinicians and decision makers from both countries.
-----

Plibersek’s $13.5m boost for primary care research

10th Jul 2013
PRIMARY care research is set to receive a $13.5 million shot in the arm after Health Minister Tanya Plibersek announced additional funding for the sector via the National Health and Medical Research Council (NHMRC).
The announcement today at the Primary Health Care Research Conference in Sydney includes $2.5 million towards a new research organisation that will see local researchers partnering with colleagues in Canada.
Ms Plibersek said it would be Australia's first international primary healthcare research organisation to focus on studying ways to improve health outcomes for vulnerable populations.
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Help is on its way with life-saving apps

Date July 1, 2013

Jenneth Orantia

You can transform your smartphone into a panic button in your pocket, writes Jenneth Orantia.
Knowing to dial triple-0 in an emergency is something everyone learns from an early age. But what do you do if you can't get through to the switchboard, or you aren't sure whether the situation warrants intervention?
There are a handful of apps you can turn to that transform your smartphone into a personal safety device.
After the tragic death of his wife and son in the Queensland floods of 2011, John Tyson came up with the idea for the Ultimate Civilian app (available for iPhones and iPads, $4.49) and approached Maxmoment Interactive to help him develop it.
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Mercy mission delivers users a one-stop data shop

HEALTHCARE provider Mercy Health's systems were not coping with the surge of data spooling off half a million clients every year.
Reports were not available and production was manual and time consuming, with low trust levels of the data.
"There was a lot of ad-hoc extraction of information as well as a number of different reporting tools across different systems," Mercy Health strategy, planning and business general manager Jenny Smith says.
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Health provider broadband connectivity: a review of technical requirements

3 July, 2013
PDF
03 July 2013 | Over the next 5 to 10 years high-speed broadband will enable a number of new services in the health sector including telemedicine consultations, electronic health records, eLearning for clinicians, and personalised medicine and participatory healthcare. Currently there are a variety of piecemeal data connectivity arrangements with multiple connections and service providers in the health sector. For the healthcare sector to take advantage of high-speed broadband, delivering an efficient and effective transformation of service delivery and supply chain reform, integrated planning and better coordination of data connectivity are essential.
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Rudd adds $10m muscle to 2020 Summit pet bionic-eye projects

  • by: SEAN PARNELL, HEALTH EDITOR
  • From: The Australian
  • July 10, 2013 12:00AM
KEVIN Rudd's favoured project from the 2020 Summit -- an Australian-made bionic eye -- has received a $10 million boost to allow researchers to keep working on their concepts for another year.
The Prime Minister was so determined to replicate the Australian innovation shown in the development of a cochlear implant that he insisted health experts make the bionic eye a priority.
Two Australian research groups have already received $50m in taxpayer funding and were yesterday granted an extension, with Bionic Vision Australia, led by the University of Melbourne, to receive $8m and Monash Vision Group, led by Monash University, to receive $1.9m.
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Health apps you should avoid

Date July 11, 2013

Gloria Dawson

Your health is a complicated puzzle best solved by professionals, but that doesn't mean you shouldn't use technology to make things simpler. Never has it been easier to track your health, monitor your fitness goals or research treatment options.
"It turns out that your interaction with your doctor has two parts. There's a technical component: your doctor is gathering information about you to make a diagnosis and recommend a care plan. And then there's the emotional overlay," says Dr Joe Kvedar, the founder and director of the Centre for Connected Health, which focuses on providing healthcare outside of the traditional hospital or doctor's office setting. 
"We're not taking your doctors visit away," Dr Kvedar explains. "So much of what we do with patients is the algorithmic information; it's not that emotionally laden piece." Following up with a doctor about when to take a medication is a good example of something that can be done over email. Who wants to spend an afternoon in your physician's waiting room for that?
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'No crisis' as Mike Quigley quits

  • by: Mitchell Bingemann and Damon Kitney
  • From: The Australian
  • July 13, 2013 12:00AM
MIKE Quigley, the outgoing chief executive of the NBN Co, has denied he is leaving the company building Australia's largest infrastructure project in a state of crisis as he deflected speculation that he was pushed from the high-profile role.
Mr Quigley announced yesterday that he would step down and retire from corporate life after four years leading the company building Labor's $37.4 billion broadband project.
His departure comes after a frenetic year in which the company was forced to revise its rollout targets as it was beset by problems with its construction contractors, an exodus of experienced staff and the exposure of workers and residents to asbestos risks during the build.
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The future of Google goggles is here

9th Jul 2013
IT’LL be several months before the average gadget-lover will get their hands on Google Glass, but among software developers there’s already a gold-rush mood about the potential of the new wearable technology device made by the search giant.
So far only a few hundred developers and tech experts have worn the futuristic glasses, but at last month’s Google I/O annual developers’ conference in San Francisco, everyone wearing the US$1500 ($1600) prototype had a permanent smile on their face.
A short time wearing the glasses explains the fascination: the wearer has access to all the information available on the internet without having to use a smartphone or computer to get it.
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Pre-Google-era search engine AltaVista goes to web graveyard

  • From: AFP
  • July 09, 2013 12:04PM
ONCE upon a time, there was a popular search engine called AltaVista. It lives no more.
On Monday, its owner Yahoo Inc sent AltaVista.com to the internet graveyard to rest alongside order-almost-anything venture Kozmo.com and the butler from Ask Jeeves.
Palo Alto, California-based AltaVista was introduced in 1995, three years before Google Inc was founded.
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Enjoy!
David.

Sunday, July 14, 2013

What Is The Biggest Issue With E-Health At Present? I Don’t Think It Is What You Think.

This week we have the most recent Health Information Society of Australia (HISA) annual conference in Adelaide. (15-18th July, 2013)
You can download the program here:
I thought I would have a browse to see what was being featured.
Reading through there was lots of emphasis in Digital Health and following patient journeys in areas such as oncology and mental health.
What seemed to be missing  was some sense of how the overall e-Health initiative was going and any serious retrospective review of what has gone on to date and what real outcomes have been achieved that make measurable differences to cost, quality and actual clinical outcomes for the health system.
I guess my point is that what is going on is not being strategically co-ordinated and more importantly we do not seem to be measuring the things that matter - i.e. the impact technology is having on the overall health system and what benefits are flowing overall - and not just at a particular institution with a particular narrow expertise.
Astonishingly it seems everyone speaking at the conference is so convinced everything is just fine and dandy that titles suggesting we have all the basics in place with e-Health and now need to elaborate, complexify and move forward. A search of the program reveals one hit for PCEHR and one for ‘record system’ do clearly that is seen and being done and dusted.
I would suggest that what we are seeing is a evidence based fantasy at the macro and outcome level. We have not measured and reported anything meaningful regarding the NEHRS / PCEHR for example other than the numbers enrolled - rather than the levels of actual use and actual clinical impact and even simple usage stats are unavailable.
This says it all:

GP input to PCEHRs remains miniscule

9 July, 2013 Paul Smith
The number of shared health summaries created by GPs for the personally controlled electronic health records  system is little more than 1100 — about 0.3% of nearly 400,000 patients who have been recruited to the billion-dollar scheme.
Health summaries are meant to be the backbone of the PCEHR and will list patients' current diagnoses, medications, allergies and immunisation histories.
However, there have been ongoing concerns about the workload the scheme will generate for GPs.
Doubts have also been raised over whether the profession will agree to take on the task of managing the summaries, which are designed to help streamline care with other health providers, such as hospitals and specialists.
The number of shared health summaries was obtained by Australian Doctor in May.
The Department of Health and Ageing did not respond when asked to provide an updated figure.
More here:
All this just goes back to a theme I have mentioned a few times on this blog - being that what we need is to do the absolute basics well, show those basics are actually working to deliver the benefits expected and then - in an incremental evidence based way - move forward measuring what we do for the population as a whole.
Reading as I do about what is going on overseas I am getting a distinct sense that the e-Health world is dividing into the excited spruikers who a technology focussed and sure all is well and the much more realistic and pragmatic who are realising that benefits delivery will be very hard and that issues of useability, complexity and safety in actual use in the hands of ordinary clinicians.
What is happening in the universities, research labs and the facilities lucky enough to have great leadership and motivation is fine - but diffusion into the real world is a much more challenging issue. We are a long way from that I believe.
I hope people have a great time in Adelaide and give a moment or twos thought to the bigger and much less clear picture.
David.