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."

Tuesday, November 12, 2013

It Seems More Of Your Money Has Gone Down The Plughole. Still Hard To See Value. When Will It Stop?

This appeared last week:

NEHTA books $74m loss

  • Fran Foo
  • Australian IT
  • November 05, 2013 4:57PM
THE National E-health Transition Authority has registered a $74 million loss for the year ending June 30 compared with a $91m surplus the previous year.
Consultants cost an additional $14m in 2013 or $73m in total, as opposed to $59m last year.
NEHTA paid around $7m less for contractors, from around $20m to $13m this year.
Salaries and on-costs decreased from $43m to $33m over the 12 months to June.
In its 2012-13 annual report released today, NEHTA attributed the loss to two factors:
"During the year, NEHTA received its 2012-13 contributions from its state and territory members ... member contributions of $33.43m were received in the prior year and were therefore brought to account in 2011-12 to be compliant with Australian accounting standards.
"NEHTA also decided to utilise cash reserves to fund activity throughout the financial year.
"These two factors have contributed to the 2012-13 operating deficit result," it said.
Last year NEHTA terminated the contract it awarded IBM to build the National Authentication Services for Health.
Compensation figures were not mentioned in the report but the cost to design and build NASH was around $5m in expenditure not yet incurred.
Key management personnel took home an extra $90k with the addition of Kate Ebrill and Les Schumer.
They joined Peter Fleming (CEO), David Bunker, Ray Grant, Christopher Hale, Andrew Howard, Bettina McMahon, Lisa Smith, Teri Snowdon, Mandy Varley and John Zelcer to book $3.6m compared with $3.5m.
Remuneration to directors David Gonski (also NEHTA chairman) and Lynda O'Grady increased marginally from around $131,000 to $135,000.
In August, it suffered a major blow when top clinical lead Mukesh Haikerwal and many members of his team left the organisation.
See full article here:
Here is the announcement from NEHTA.

NEHTA's Annual Report 2012-13 is now available

Created on Tuesday, 05 November 2013
NEHTA's Annual Report 2012-13 is now available and can be downloaded from NEHTA Annual Report 2012-13 (6.76 MB).
The National E-Health Transition Authority was established in 2005 by the Council of Australian Governments (COAG) to help transform Australia’s health system by building the foundations for a national eHealth infrastructure.  In 2010 the Commonwealth Government appointed NEHTA as the managing agent for the personally controlled electronic health record system (eHealth record system).
NEHTA's Annual and Financial Reports contain detailed information about its operations during the past financial year as well as an overview of its work programme.
ENDS
Link is here:
It was interesting to see that  NEHTA said its focus for 2013-2014 will be on:
  • Infrastructure improvement: achieve improvements in national eHealth infrastructure by responding to lessons learned from early use and new priorities, so that the national eHealth infrastructure is useful, safe, usable, trusted and well integrated.
  • Priority solutions: coordinate the progress of priority eHealth solutions and processes, including electronic medication management, ePathology and continuity of care.
  • ·      NEHTA capability: Evolve and refine NEHTA’s internal capabilities to ensure NEHTA is effective and responsive in the delivery of value to the health sector.
  • Adoption, change and meaningful use: work towards creating a critical mass of eHealth users who are connected and meaningfully embedding NEHTA foundations, solutions and the eHealth records system into healthcare.
  • Support and assurance: provide ongoing support for delivery and assure the clinical safety, usability, benefits, security and privacy of national eHealth infrastructure and solutions.
And that from then on they would be aligning with the refreshed e-Health Strategy which recommended in 2008 that they be fundamentally re-vamped. I wonder will Deloittes have changed their mind?
It’s also good to see NEHTA recognises after all this time - in Point 3 - that they could maybe a bit more responsive to the health sector.
Other points I noticed were:
1. The 2 paid directors are doing pretty well for attending eight meetings and reading the board papers ($135,000) - when can you get on a gravy train like that?
2. The MMR Global story is apparently of no worry. Here are the comments on this and the IBM NASH saga.
- In February 2013, NEHTA was provided with a press release in which MMRGlobal (MMR) asserted on behalf of its subsidiary MyMedicalRecords that NEHTA and the Australian Government appeared to be infringing two of MMR’s Australian patents and other intellectual property. At that time, NEHTA had not received any contact from MMR asserting an infringement and no claim of patent infringement has been pursued by MMR against NEHTA since the press release was issued in February 2013.
As a result of the assertions made in the press release, NEHTA undertook a thorough investigation of MMR’s Australian patents, which investigation revealed that there has been and is no infringement of MMR’s Australian patents by NEHTA. That has been communicated to MMR’s lawyers both in the United States and Australia by NEHTA’s solicitors.
At this time, the directors do not expect there to be any significant impact on the Group’s stated financial position as set out in the financial statements read with the associated explanatory notes, as a result of MMR’s assertions.
- On 4 July, 2012, NEHTA entered into discussions with IBM regarding termination of the Design & Build Contract held between NEHTA and IBM, and the Operate Contract held between IBM and E-Health Authentication Services Pty. Limited, pertaining to the National Authentication Services for Health (NASH) project. The parties engaged in confidential and without prejudice discussions regarding that matter and the matter was resolved in December 2012.
3. The State contributed funding seems to be dropping out dramatically so what happens next seems to be in doubt.
4. Approved funding runs out in less than 8 months’ time. I wonder what the planned review will think about the future - they are not specifically mentioned in the Terms of Reference.
5. The total absence of e-Health expertise and current front line clinical representation on the Board.
All in all, interesting times for NEHTA.
David.

Monday, November 11, 2013

Weekly Australian Health IT Links – 11th November, 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

Well there was really only one story this year. Below is all the comment and so on. Additionally we have a few interesting bits and pieces.
Next question is to see how a submission can be made. I note it is a little over 4 weeks until the report is due!
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Unfixable: time to ditch personally controlled e-health record scheme

Author
Federal health minister Peter Dutton has commissioned a review of Labor’s troubled Personally Controlled Electronic Health Record (PCEHR) project. It’s unclear whether the review committee is to decide whether to scrap the project altogether or to try and fix it. Hopefully it is not the latter because if the past year has taught us anything, it is that this is not a fixable problem. It needs to go.
The PCEHR project, which has cost A$1 billion so far, had earlier this year failed to meet a self-imposed target of 500,000 patients signed up by July 1. Of more concern was the lack of participation by GPs and the lack of any significant progress to meaningful use of the system.
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Calls to continue funding e-health records system

Updated Wed 6 Nov 2013, 11:14am AEDT
The Hunter Medicare Local organisation says most local GPs are part of the e-health records system, and there is an increasing number of patients coming on board.
The Hunter region has had access to e-health for about four years and became a pilot site before the system was adopted nationally.
The Federal government this week announced a review of e-health saying the take-up has been too slow, both for patients and doctors.
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PCEHR review to get e-health back on track

The review of electronic health records announced by the Minister for Health this week is a welcome opportunity to get e-health back on track.
The Personally Controlled Electronic Health Record (PCEHR) adventure started slowly, and then effectively stalled – at great cost to the taxpayer. It drastically needs a review and an overhaul so that it can develop as a truly national, effective system with tangible universal benefits for patients.
The three-member review panel includes AMA president Steve Hambleton. We congratulate Dr Hambleton on this appointment, all the more important as he is the only practicing clinician on the team. He knows the importance of medication history in any comprehensive health record.
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Government launches e-health records review

Date November 4, 2013 - 4:08PM

Lia Timson

The federal government has announced an inquiry into Labor’s under-used $1 billion electronic health records system.
Health Minister Peter Dutton said so far only a few hundred doctors were uploading patients’ records into the Personally Controlled Electronic Health Records (PCEHR) database.
Australians wanting to consolidate their health records including medications, allergies, immunisations, doctor's and hospital notes and prescriptions, could apply online at ehealth.gov.au from July 1, 2012, but the launch was met with a low initial uptake. Its aim was to achieve 500,000 patient records in the first year but it was dogged by glitches, and security concerns, and has reportedly fallen 100,000 short of the target.
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Electronic health records rollout has not met expectations, Australian Medical Association says

October 4, 2013
The Australian Medical Association says the rollout of electronic health records has not met expectations.
Federal Health Minister Peter Dutton has announced an independent review of the project to see how it can be improved.
AMA national president Dr Steve Hambleton, one of the panel members for the review, says e-health records need to be made easier for doctors to use.
"It's certainly timely to actually have a look at the e-health records and just see where it is, where it's going, whether it's actually achieved what it set out to do and what we need to do to actually make it work," he said.
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eHealth review to probe private sector buy-in

By Australian Ageing Agenda on November 5, 2013 in Technology
By Julian Bajkowski 
The private sector and medical providers could soon have a much bigger say in how Australia’s ailing efforts to create a national system of electronic health and medical records unfolds.
The Abbott government has revealed it now wants substantial input on what non-government providers can contribute to make eHealth a reality after federal Health and Sports Minister Peter Dutton outlined the terms of reference for a new probe into what almost a decade of development has achieved – and what it hasn’t.
Announcing a review foreshadowed before the election, Mr Dutton said the Coalition government still “fully supports the concept of electronic health records but it must be fit for purpose and cost effective.”
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Federal review of PCEHR program announced

Federal Health Minister Peter Dutton this week announced a six-week review of the Personally Controlled Electronic Health Records program, to be chaired by Richard Royle who is currently Executive Director of the UnitingCare Health group in Queensland.
The review panel will comprise Royle, AMA President Dr Steve Hambleton and Andrew Walduck, who is Chief Information Officer of Australia Post.
The Panel’s Terms of reference include implementation and uptake, with other areas of investigation cited including usability, the level of consultation with end users, use of the PCEHR in clinical settings and the barriers to its increase, the potential to integrate comparable private sector products and potential future role of private sector solutions.
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E-health scandal costing $200,000 a patient: Dutton

4th Nov 2013
THE federal government is set to launch an inquiry into Labor's underused $1 billion electronic health records system.
Health Minister Peter Dutton said the system cost $1 billion but so far only a few hundred doctors were uploading patients' records into it.
He said this was another Labor problem, although not in the same league as the National Broadband Network (NBN).
Mr Dutton said there were savings to be made in the health budget through the electronics records system.
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Poor GP uptake sparks e-health record review

4 November, 2013 Nick O'Donoghue
GPs’ failure to embrace the Personally Controlled Electronic Health Record (PCEHR) is behind the Federal Government’s decision to launch a review of the project.
A review of the PCEHR was promised by the Coalition during the election campaign, when it criticised Labor’s failure to deliver the program, “despite the $1 billion price tag”.
The Pharmacy Guild of Australia has previously backed a review of the PCEHR, with Kos Sclavos, former national president, saying there were “some significant mistakes and missed opportunities” with current system.
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Labor’s e-health ‘scandal’ cost $1bn

4 November, 2013
Joanna Heath
Health Minister Peter Dutton has launched an inquiry into the former Labor government’s e-health records system, after what he described as a poor take-up by doctors and patients.
“The problem is that the former ­government spent about a billion dollars in this area and the number of people that are actively using the record numbers in the thousands,” Mr Dutton said on Sky News on Sunday.
“There are only a few hundred doctors that are actually uploading details into people’s files and it has been a ­scandal. So on those numbers, it runs out at about $200,000 a patient in terms of the investment the former ­government made.”
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Labor ignored multiple e-health alerts

LABOR pushed ahead with its troubled e-health project despite repeated warnings the billion-dollar scheme was flawed.
As federal Health Minister Peter Dutton yesterday described the Personally Controlled Electronic Health Record as "meaningless", documents obtained by The Australian under Freedom of Information laws give new insight into the failure of this technological revolution.
In June - a month before the PCEHR was expected to reach Labor's target of 500,000 registrations in its first 12 months - the board of the National E-Health Transition Authority was warned the PCEHR could not be used properly in a clinical setting. The admission laid bare the lack of acceptance by GPs and clinics who were expected to input patient information and data.
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Australia's 'struggling' e-health records under review

Summary: The Australian government has announced an inquiry into the rollout of the AU$1 billion e-health record system implemented under the former government.
By Josh Taylor | November 3, 2013 -- 22:13 GMT (09:13 AEST)
Health Minister Peter Dutton has announced a short review into Australia's "struggling" AU$1 billion Personally Controlled E-Health Record project over its failure to attract doctors to participate.
Since 2011, the former Labor 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.
Unlike the current problems affecting the US government's healthcare website, Australia's e-health system faced the opposite problem: Very little interest from the public and doctors in signing up.
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'Avoid blame game in review': doctors' plea on e-health inquiry

HEALTH minister Peter Dutton's inquiry into the troubled $1 billion electronic health records system has been widely welcomed, with doctors urging the government to avoid playing the "blame game" by pointing the finger at Labor.
Mr Dutton announced the review at the weekend that will be headed by UnitingCare Health Queensland chief Richard Royle and supported by Australian Medical Association president Steve Hambleton and Australia Post chief information officer Andrew Walduck.
The panel will examine the level of consultation with end users and stakeholder groups during development, gaps between expectations and what has been delivered, and what needs to be done to fix the Personally Controlled Electronic Health Record.
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Govt to probe e-health record's rollout

Review to examine possible private sector role for PCEHR
The former Labor government's rollout of the Personally Controlled Electronic Health Record "has wasted over a billion dollars," according to federal health minister Peter Dutton.
Dutton yesterday announced a review into the current status and future of the PCEHR program. The review will be led by Richard Royle, executive director of the UnitingCare Health group in Queensland and vice-president of the Australian Private Hospitals Association.
Working with Royle will be AMA chief Dr Steve Hambleton and Australia Post CIO Andrew Walduck.
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Your e-health record – a good idea? (Video)

I am sure many agreed with Health Minister Peter Dutton when he called the Australian e-health record system a scandal. The PCEHR review is under way and the Australian Medical Association is on board. The review committee will take public submissions.
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Budget cuts slow work at NSW information commission

No time left to champion citizen’s information rights.

Employee numbers at the NSW Information and Privacy Commission (IPC) have slipped below the bare minimum that the former information commissioner warned was required to meet the agency’s legislative requirements.
Deirdre O’Donnell, who retired as Information Commissioner in July, wrote to the NSW parliamentary committee overseeing the IPC’s operations earlier this year with the “firm view” that the agency needed a minimum of 28.5 full-time equivalent staff to “fulfil our legislative obligations as an accountability agency that also champions citizen’s privacy and access to government information rights.”
An operational review in 2012 sparked a voluntary redundancy program designed to return the agency's budget operating statement into surplus over the forward estimates.
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Robotic prostate surgery: keyhole to the future

Date November 5, 2013

Lucy Cormack

The uptake of robotic prostate surgery is growing worldwide, but opinion on its efficiency is divided.
When urologist Justin Vass scrubs in for surgery, he and his team are not alone. These days they are joined by surgical robot, the da Vinci.
At first glance, the da Vinci appears like a man-made praying mantis. It comprises a surgeon console, a patient-side cart with four interactive robotic arms and offers 10-times three-dimensional visual magnification.
I think the jury is still out. 
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NEHTA's Annual Report 2012-13 is now available

Created on Tuesday, 05 November 2013
NEHTA's Annual Report 2012-13 is now available and can be downloaded from NEHTA Annual Report 2012-13 (6.76 MB).
The National E-Health Transition Authority was established in 2005 by the Council of Australian Governments (COAG) to help transform Australia’s health system by building the foundations for a national eHealth infrastructure.  In 2010 the Commonwealth Government appointed NEHTA as the managing agent for the personally controlled electronic health record system (eHealth record system).
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NEHTA books $74m loss

  • Fran Foo
  • Australian IT
  • November 05, 2013 4:57PM
THE National E-health Transition Authority has registered a $74 million loss for the year ending June 30 compared with a $91m surplus the previous year.
Consultants cost an additional $14m in 2013 or $73m in total, as opposed to $59m last year.
NEHTA paid around $7m less for contractors, from around $20m to $13m this year.
Salaries and on-costs decreased from $43m to $33m over the 12 months to June.
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Come clean on Medicare Locals Dutton told

5th Nov 2013
FEDERAL Health Minister Peter Dutton has been accused of backing away from Prime Minister Tony Abbott's election commitment not to close down Medicare Local facilities.
During the election campaign, Mr Abbott pledged the coalition would not shut any Medicare Locals, only to later clarify the statement by saying he couldn't guarantee they would "stay exactly the same".
The coalition has promised to review the 61 Medicare Locals, which were set up by the former Labor government to coordinate local primary healthcare services in communities.
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Cambridge device could identify fake meds, goods

  • AAP
  • November 07, 2013 12:00AM
A NEW device to help identify counterfeit goods could help combat the fake drugs trade and save hundreds of thousands of lives each year.
The United Nations says about 700,000 people die every year after being administered fake malaria and tuberculosis drugs.
About 100,000 deaths a year in Africa are linked to the billion dollar trade, which often includes substances like chalk or flour being passed off as live-saving treatments.
It is almost impossible to identify such treatments using the naked eye but researchers say the new laser “watermark” could be used to stop the illegal trade.
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NIB site to rate health experts

Date November 8, 2013 - 12:07AM

Madeleine Heffernan

Health insurer NIB is launching on Friday a controversial and long-mooted website that rates and compares allied health professionals such as dentists, optometrists and chiropractors.
Previous plans for comparison sites have been shouted down by industry bodies, but NIB is confident its site will be popular among its 900,000 policyholders and the public.
The site, flagged by BusinessDay in October, provides information on 30,000 providers in Australia to which it has provided rebates through its "extras" policies.
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Controversial health website launched

  • November 08, 2013
PRIVATE health fund nib has launched a controversial website that allows patients to rate the cost and service levels of health practitioners.
The searchable Whitecoat website is open to all Australians and lists 30,000 "extras" providers such as optometrists, dentists and chiropractors.
"Whitecoat represents a new way of connecting consumers and providers," says the fund's Rhod McKensey.
It is particularly useful for people who have moved to a new area or need a treatment for the first time.
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Website to rate health staff

A WEBSITE rating more than 30,000 allied health professionals will be launched today by insurer NIB, less than a fortnight after it confirmed plans to enter the medical tourism market next year.
The Australian revealed two years ago that NIB wanted to use Medicare data for its Whitecoat ratings website, sparking an outcry that ultimately forced the insurer back to the drawing board.
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Proper guidelines are benefiting Government’s telehealth initiative: LifeSize

Unified communications vendor sees stricter rules around telehealth benefiting the initiative
The Federal Government’s telehealth initiative may not have achieved its intended goal, but LifeSize A/NZ country manager, Gerry Forsythe, said that is finally changing.
“With no real guidelines behind it, the one-off incentive payment of $6000 was not really taken on properly, though it is coming together now,” he said.
In 2011, the Federal Government introduced an initiative to encourage the use of telehealth by offering an incentive payment of $6000 to medical practitioners.
However, the rules were tightened and funding was reduced in 2012 following a less than anticipated uptake of telehealth.
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Superbug tracking app hits top medical spot in Apple's App Store

The superbug tracking app has been accessed more than 300,000 times
An application that uses big data to enable clinicians to track superbug transmission in their region has reached 100,000 downloads in less than a month.
In its first week, the " Bugs + Drugs" app, created by medical software vendor Epocrates, shot to the number one free medical app spot in Apple's App Store when it was released last month.
The app was created to track antibiotic resistant bacteria or "superbugs" such as e.coli and staph.
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Question: When should you adopt FHIR?

Posted on November 5, 2013 by Grahame Grieve
Question: 
Need your opinion on this matter of encouraging people to adopt FHIR for national programs/ national standards for healthcare exchange.
What will be your counter arguments if some cowboys say
  1. FHIR is still new, we will wait and see till it matures.
  2. Standard Development is cumbersome process, and it takes extremely long time for them to incorporate new requirements. It is much faster to cook our own unique xml to suit our requirements.
You talked about XML cowboys on your website in the past – hopefully you can provide much stronger fire power after two years spent developing FHIR.
Answer:
Well, FHIR is still new, and it will change. The “DSTU” that is coming out soon will be a Draft Standard undergoing Trial use, and users should expect breaking change after trail use. Right now, users that are risk adverse should consider long and hard before using FHIR. Implementing bleeding edge standards is a process that involves the shedding of a great deal of blood – and early adopters of FHIR will be have additional costs due to change in FHIR that people who wait the process out won’t.
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COAG 'fails to deliver on reforms'

FEDERAL and state leaders have failed to meet targets to lift economic growth and improve services for taxpayers, in a bleak verdict on the national reform agenda as Tony Abbott prepares for a crucial first council with premiers and chief ministers.
Ringing the alarm on stalled promises, the agency that monitors national reforms will warn today that Australians are not getting the boost to education, health and indigenous welfare pledged by governments five years ago.
The warning will come with a call for Canberra and the states to overhaul national agreements worth billions of dollars to get dozens of major changes back on track.
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Enjoy!
David.

The PCEHR Enquiry Is Planning To Exclude The Public From Comment. Bad Early Signs.

I just found this:

Electronic Health Records Review Panel to Consult with Key Stakeholders

Department of Health
8/11/2013 1:51:00 PM
8 November 2013
Electronic Health Records Review Panel to consult with key stakeholders 
The Review into the operations of the troubled electronic health records scheme, commissioned by the Federal Minister for Health, the Hon Peter Dutton, met this week to determine its operating procedures.
Panel Chair, Richard Royle, said today that, due to the urgency of developing recommendations to improve the Personally Controlled Electronic Health Records (PCEHR) scheme, the Panel had decided to initially invite written submissions from those 210 organisations which have previously submitted to consultation on the PCEHR.
“In addition the Panel will have more detailed meetings with a number of key stakeholders to assist the Panel to gain the views of those people most closely involved with the system,” Mr Royle said. “These stakeholders will include IT, clinical, and consumer representatives.”
Review Terms of Reference
The panel will conduct a Review into the personally controlled electronic health record system dealing with implementation, uptake and including, but not limited to the following:
  •          The gaps between the expectations of users and what has been delivered
  •          The level of consultation with end users during the development phase
  •          The level of use of the PCEHR by health care professions in clinical settings
  •          Barriers to increasing usage in clinical settings
  •          Key clinician and patient usability issues
  •          Work that is still required including new functions that improve the value proposition for clinicians and patients
  •          Drivers and incentives to increase usage for both industry and health care professionals
  •          The applicability and potential integration of comparable private sector products
  •          The future role of the private sector in providing solutions
  •          The policy settings required to generate private sector solutions
Media contact: 02 6289 7400 
The release is here:
Interesting that the Ministerial announcement found here talked of Public Submissions:
See here:
To quote:
“The Review panel will invite submissions from the public along with key stakeholder groups including peak clinical bodies. The Review will report back to Minister Dutton by mid-December 2013 after which the government will consider the recommendations and respond.”
Seems they have already realised they have bitten off a good deal more than can be chewed in a few short weeks.
Again we see politics messing with a major Health IT Project. Will they never learn?
Also apparently the panel are going for the fix it option - so we now know outcome is preset since they are saying this absent submissions.
“Speaking at the HITWA 2013 conference in Perth on Friday, the lead of the PCEHR Inquiry, Richard Royle, made it clear that the desire of the inquiry is not to 'kill off' the PCEHR, but to ensure the system is a useful and workable clinical tool. 
Royle said the PCEHR is a genuine opportunity to set up a system that can help all Australians with their healthcare.  Usability and implementation issues need to be addressed to ensure clinicians have confidence in the information that is held in the system.”
From HISA link on Twitter
Really, really sad.
David.

Privacy Unbound - Fantastic Privacy Conference With Global Input Comes To Sydney In Two Weeks.

I heard about this yesterday. Here is part of the e-mail:
Dear Friends
On 25th November in Sydney Privacy unbound takes place.
It will be a day of the most useful and cutting edge privacy information and workshops. Danny Weitzner who advised the Obama administration in respect of privacy and security  will be there, Nokia’s chief Privacy Officer and CIO Mikko Niva is a Keynote as well as the former UK ICO, Richard Thomas CBE. The NSA, PRISM  & Edward Snowdon will of course be discussed by Danny Weitzner, and Richard Thomas spent days in the witness box at the Leveson Inquiry into the News of the World scandal. Attendees  will be hearing about the hottest privacy issues from the most qualified in the World.
The Hon. Michael Kirby CBE will be presiding and there will be a specific security, health and credit reporting  Workshops as well as  sessions on Privacy breaches, Big Data, Hacking, transfer of data overseas and a Global Panel to discuss the hard issues.
The day will be held in the luxurious heritage wing of the Westin Hotel and the networking opportunities will be amazing. I do hope that you and your colleagues will join us for the most sparkling event in the area of security and privacy in this year’s calendar. The new Privacy legislation starts on 12 March 2014. Can you afford not to be there?
For more please see the attached or click here:
See the link for details.
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This is must not miss for those on who want to understand where all this fits in eHealth etc.
David.

Sunday, November 10, 2013

How Should We Respond To The PCEHR Enquiry Terms Of Reference? Some Interesting Questions Posed. What Have They Missed?

I thought it might be useful to have a look at the Terms of Reference in detail and make a few comments.
Here they are.

Review Terms of Reference

The panel will conduct a Review into the personally controlled electronic health record system dealing with implementation, uptake and including, but not limited to the following:
  • The gaps between the expectations of users and what has been delivered
  • The level of consultation with end users during the development phase
  • The level of use of the PCEHR by health care professions in clinical settings
  • Barriers to increasing usage in clinical settings
  • Key clinician and patient usability issues
  • Work that is still required including new functions that improve the value proposition for clinicians and patients
  • Drivers and incentives to increase usage for both industry and health care professionals
  • The applicability and potential integration of comparable private sector products
  • The future role of the private sector in providing solutions
  • The policy settings required to generate private sector solutions
The Panel will make findings and recommendations to the Minister.
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Now one by one with a few comments:
  • The gaps between the expectations of users and what has been delivered
International experience has made it pretty clear that what consumers want from systems like this are things like access to e-mail the doctor, ability to request repeat prescriptions and appointments and access results. Most of this the PCEHR cannot do and at present it does none. Ease of use is also important - not good on this front as well - as well as slow.
For clinicians the needs are for usability, no workflow issues, integrity and no medico-legal issues or liability as well as sufficient useful information to make access worthwhile.
This would only score 2/10 at best.
  • The level of consultation with end users during the development phase
Essentially there was none until very late and this did not actually create a useable system at the time of launch
This would only score 1/10 at best.
  • The level of use of the PCEHR by health care professions in clinical settings
The PCEHR is not designed to be used in the clinical setting - the present practice management systems are. It is an add-on that seems to add delay and extra work for not much benefit at this point. It is thus not all that much used
This would only score 2/10 at best.
  • Barriers to increasing usage in clinical settings
I can’t see that the PCEHR will ever replace the prime clinical systems and will only be used in those settings when it adds value to a consultation for the clinician or the patient. This will require removing all the medico-legal, privacy, security and usability concerns and then to have a network effect expand the usage base in that order. To me this will need a major re-design based on real consultation. It also won’t happen overnight and probably cost a fair bit. A business case is needed on the proposed new system.
This would only score 3/10 at best.
  • Key clinician and patient usability issues
See the discussions above - especially 1 and 4.
This would only score 2/10 at best.
  • Work that is still required including new functions that improve the value proposition for clinicians and patients
As above.
  • Drivers and incentives to increase usage for both industry and health care professionals
The key for clinicians is to ensure that using the national system is cost and workflow neutral while not exposing them to risk.
For industry there needs to be much improved governance and leadership which is not anti-private sector as NEHTA and DoH are presently felt to be - despite their rhetoric.
This would only score 1/10 at best.
  • The applicability and potential integration of comparable private sector products
This depends on what the final - as opposed to the present design of the PCEHR is.
  • The future role of the private sector in providing solutions
There are already private sector solutions (e.g. Extensia and CDM-Net) and these need to be looked at - with others to see what is possible
  • The policy settings required to generate private sector solutions
The main issue here is to stop NEHTA and DoH engaging in behaviours that are costing the private sector money while not providing reasonable conditions for private sector solutions to develop and flourish.
It is also important to remember General Practice is made up of many small businesses who are very cost sensitive and need reasonable compensation for the time spent doing any e-Health activities that are not clearly useful to them or the patient.
----- End responses.
I am interested in all views - as well as comments as to what also needs to be addressed - from strategy, leadership and governance down.
I am reminded of the following quote which seems to say it all.
“If a man does not know what port he is steering for then no wind will be favourable.”
Seneca (4BC - 65AD
Nothing has changed!
As a final note - this appeared the day before yesterday.

Standing Council on Health Communique - 8 November 2013

8 November 2013

Australian Health Ministers met in Launceston today for a meeting of the Standing Council on Health (SCoH). The meeting was chaired by Michelle O’Byrne, Tasmanian Minister for Health.

Items discussed included:

eHealth: Ministers welcomed the announcement by Federal Health Minister, Peter Dutton, that he had commissioned a review of the troubled Personally Controlled Electronic Health Records scheme. To be chaired by Mr Richard Royle, the Review Panel is expected to report to the Minister by mid December 2013.
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I wonder where the submissions go?
David.

AusHealthIT Poll Number 191 – Results – 10th November, 2013.

The question was:

Do You Think Six Weeks Is Enough Time To Undertake A Credible Review Of The PCEHR Program?

Yes - For Sure 7% (7)

Probably 4% (4)

Probably Not 10% (10)

No - I Will Be A Waste Of Time 40% (40)

No - The Outcome is Pre-determined 34% (34)

I Have No Idea 4% (4)

Total votes: 99

Huge response with over 80% feeling this will not do what is really needed.

Again, many thanks to those that voted!


David.