Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, March 26, 2014

I Have Seen Rent Seeking Before But This Is A Really Great Example!

There was a white paper produced a little while ago.

One in Four Lives

The Future of Telehealth in Australia

March 2014
·         Lisa Altman
·         Shehaan Fernando
·         Samuel Holt
·         Anthony Maeder
·         George Margelis
·         Gary Morgan
·         Suzanne Roche
Here is the direct link.
Here is an article on the release of the white paper.

Calls for national telehealth strategy

By Australian Ageing Agenda on March 6, 2014 in Technology

One In Four Lives group speaker Dr George Margelis presenting the white paper to MP Steve Irons, chair of the House of Representatives Standing Committee on Health
The Federal Government is being urged to develop a national strategy for telehealth as an effective way to help rein in Australia’s ballooning health budget deficit.
A collaboration of health industry stakeholders, One In Four Lives, released a white paper in Canberra on Wednesday to promote the adoption of telehealth nationally.
The group, whose members include the Australian Information Industry Association (AIIC), BT, anywhere healthcare, Philips, and the University of Western Sydney, said telehealth could save $4 billion a year in avoidable hospital presentations related to chronic conditions.
The group said its name reflected the fact that almost six million, or one in four Australians, were affected by chronic health conditions. This accounted for 60 per cent of all hospital bed days and an estimated $17 billion annually in public health costs, it said.
The white paper said that the Australian health system was not sustainable in its current form. It cited Treasury modelling that predicted healthcare costs would consume more than 100 per cent of the entire revenue collected by the states by 2046.
Chair of the body, BT’s director of health Lisa Altman, said the aim was to encourage industry participation in the large-scale adoption of telehealth – providing faster, more efficient healthcare solutions without imposing an additional burden on the health budget.
Ms Altman said the evidence base for telehealth already existed, through large scale deployments such as the Department of Veterans Affairs in the US and the Whole System Demonstrator Program in the UK.

Lots more here:
There is also coverage here:

Telehealth could save "unsustainable" federal health budget, according to a white paper

A national strategy for Telehealth could save the federal government about $4 billion
A national strategy for Telehealth could save the federal government about $4 billion and help rein in an unsustainable health budget.
One In Four Lives, a group of industry stakeholders, has released a white paper in Canberra, to stimulate discussion and is urging the government to start a national scheme to take control of a ballooning health budget.
The One In Four Lives group estimates that Telehealth has the ability to slash Australia’s public hospital costs by about $4 billion a year in avoidable hospital presentations related to chronic conditions and improve access to healthcare for the thousands of Australians who wait months to see a doctor.
The name of the new body reflects the fact that almost six million, or one in four Australians, are affected by chronic health conditions.
This is a major burden on the health budget, accounting for 60 percent of all hospital bed days and an estimated $17 billion annually in public health costs.
The white paper recognises that the Australian health system is not sustainable in its current form.
Treasury modelling predicts that on current trends health care costs will consume more than 100 percent of the entire revenue collected by the states by 2046.
One In Four Lives is a collaboration of organisations representing a broad range of the health industry, including The Australian Information Industry Association, BT, anywhere healthcare, Philips and the University of Western Sydney.
Lots more here:
Disappointingly the white paper is really sad.
It is 8 pages long - rehearses all the information we know about rising health costs and - with very little evidence - suggests all sorts of additional MBS funding for the sector to make money for all the providers of bandwidth, equipment and the clinicians.
All these experts somehow want the Government to develop a National Telehealth Strategy rather than doing to work to propose one themselves!
The white paper has a total of seven references
1. Australian Bureau of Statistics,  Profiles of Health , Australia,  2011-13 [excluding Cancer, Arthritis and Osteoporosis]
2. Towards a National Strategy for Telehealth in Australia 2013- 2018, Australasian Telehealth Society, 2013
3. A National Telehealth Strategy for Australia, Australian National Consultative Committee for Electronic Health, 2012
4. Caring for the last 3%: Telehealth Potential and Broadband Implications for Rural Australia, CSIRO, Nov 2012.
5. National Digital Economy Strategy, Department of Broadband, Communications and the Digital Economy, 2012.
6. Supporting a Telehealth Strategy for Australia, Medical Technology Association of Australia, May 2012
(Also: Developing a comprehensive Telehealth Policy for Australia, Medical Technology Association of Australia, Dec 2012)
7. Telemedicine in the context of the National Broadband Network, National ICT Australia report for Department of Broadband, Communications and the Digital Economy, June 2010.
I list these to point out none appear to be literature / evidence reviews and are all older than 12 months - i.e. created under a different Federal health minister. I can't see the present Government lifting a finger without a really high quality business case at the least!
Interestingly  calling a report One In Four Lives seems to have some rather absurd assumption that every person with a chronic illness needs and will benefit from telehealth!
As they say - Nothing to see or going on here, move on!
David.

Tuesday, March 25, 2014

Weekly Australian Health IT Links – 25th March, 2014.

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

Social Media and the regulation of doctors communication with patients has been causing some consternation. Interesting to see how long it will be before AHPRA decides to properly fix the issue.
Other than that the non e-Health minister announces an e-health app and we have some other interesting positioning of various e-health infrastructure - some of which is very close to rent seeking.
Lastly we have two great articles on the major cosmological discovery which is likely to change our view of the very early universe. Worth reading.
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New mobile app an e-Health world first for people with bleeding disorders

The official launch of a new mobile application makes Australia a world leader in assisting people with bleeding disorders.
21 March 2014
The official launch of a new mobile application makes Australia a world leader in assisting people with bleeding disorders, the Assistant Minister for Health, Senator Fiona Nash, said today.
Launching the National Blood Authority’s new MyABDR app in Canberra, Minister Nash said the “globally-unique” smartphone app changes the way people with bleeding disorders, such as haemophilia, monitor and treat their condition.
“MyABDR enables people with bleeding disorders and their carers to record bleeds and their home treatments in real time,” Senator Nash said.
-----
7 March 2014, 6.35am AEST

Digital tools for a better, more sustainable health system

IIt seems that almost every politician, health economist, policy expert and health-care worker has a different take on the state of the nation’s health system and ways to make it more sustainable. But notably…
Sarah Dods
Research Theme Leader, Health Services at CSIRO
It seems that almost every politician, health economist, policy expert and health-care worker has a different take on the state of the nation’s health system and ways to make it more sustainable. But notably absent from the debate so far is the role of technology.
So, how can digital innovation improve the health system’s bottom line?
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Discharge letters fixed with 30 mins training

14 March, 2014 David Brill
GPs rejoice: hospital doctors have finally come up with a way to improve the quality of interns' discharge summaries.
The new scheme, being implemented in one of SA's biggest public hospitals, takes aim at the sloppy wording, irrelevant information and poor structure so often found in discharge summaries.
With just half an hour of extra training, interns dramatically raised their game — particularly on the clarity and presentation of their summaries, a pilot study has shown.
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Australian Electronic Health Records market set for growth

Australia’s Electronic Health Record (EHR) industry is tipped for growth next year as more organisations look to streamline their patient processes.
New Accenture research revealed the global market will be worth US$22.3 billion (AU$24.8 billion) by the end of 2015, with Australia set to contribute $700 million.
Australia’s national eHealth program, which received AU$447 million in investment, is thought to be a primary driver of the country’s 2.2 per cent EHR compound annual growth rate over the next two years.
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Compact breath sniffer could warn of diabetes

Toshiba's medical breath analyzer can check your fat metabolism
If you're worried about being out of shape, or suspect you might have a disease like diabetes, just breathe into this Toshiba tube.
It's part of a prototype medical breath analyzer that's small enough to be used in small clinics or gyms.
By detecting trace gases that are exhaled, it could be used to monitor health indicators such as fat metabolism and help diagnose disease, Toshiba said.
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IBM Watson has another go at helping solve brain cancer riddles

IBM has teamed with the New York Genome Center to find specific treatments for specific genetic mutations
IBM is using the powers of its Watson supercomputer service to help solve the mysteries of brain cancer by examining individual genetic mutations.
"When you do whole gene sequencing, you get a very complete picture of the mutations in a specific patient. It is critical to be able to translate that information into something an oncologist can understand and take actions around," said Raminderpal Singh, IBM Research business development executive for genomic medicine.
In a research study, IBM Watson will help New York Genome Center doctors by searching for their patients' mutations that may be referenced in genomic databases and in medical literature. It then can present any findings of interest to the patient's physician.
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Bad quality data costing Australia’s healthcare industry millions

Greater adoption of the global GS1 System of supply chain standards and the National Product Catalogue (NPC) has the potential to significantly improve data quality and bring about savings of anywhere between $30 million and $100 million a year for Australia’s healthcare industry, according to a newly published report.
The Australian Healthcare Industry Data Crunch Report reveals the impact of inaccurate and inconsistent data across the Australian healthcare industry and the effect on patient safety.
And, the report highlights what it says is unnecessary supply chain spending in the healthcare sector, including procurement, where it estimated $8.8million had been spent on resources to manually check unit of measure data in purchase orders, and an estimated $4.37 million was expended to ship emergency deliveries due to under supply.
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Creating nationally-consistent health information: engaging with the national health information committees

14 March 2014
This document provides guidance on engaging with the national processes responsible for health information and data standards. It has been developed to ensure data collected are consistent, accurate and useful for policy, planning and program management.
Summary
In a health system dispersed across the states and territories by the Australian Government, strong governance arrangements are needed to ensure that health information, collected under different health administrations, are consistent and therefore accurate and useful for policy, planning and program management.
The National Health Information Agreement, signed in 2011 by all jurisdictions and the national health agencies associated with health information, provides the overarching framework for the governance of national data collections.
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Getting e-health infrastructure right

RECENT advances in technology have seen a significant take-up and usage of telehealth in Australia.
From video conferencing applications for remote consultations, to the proliferation of e-health records and mobile devices that allow healthcare workers to access relevant patient data, technology is playing an important role in enhancing medical care for Australians.
As more healthcare providers rely on technology to deliver quality services to the community, a greater strain will be placed on the network infrastructure that connects hospitals to specialists, and doctors to their patients.
Now as the government, healthcare industries and service providers set about improving the network infrastructure and associated broadband services in these areas, we should ask: does Australia have the right infrastructure in place to allow healthcare providers to realise the true potential of telehealth solutions?
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One in Four Lives

The Future of Telehealth in Australia

March 2014
Lisa Altman
Shehaan Fernando
Samuel Holt
Anthony Maeder
George Margelis
Gary Morgan
Suzanne Roche
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Nurses’ tablets tame the tyranny of distance

TABLET computers with high-speed wireless broadband connectivity and video capabilities have been credited with saving time and money for healthcare provider Silver Chain.
The technology means specialist nurses don’t have to trek hundreds of kilometres to provide basic consultation or training programs to colleagues in far-flung locations. Nurses can view injuries, provide remote diagnosis, treatment and monitor medication adherence via video conferencing sessions with patients.
The technology, comprising Samsung tablets on Telstra 4G/3G links with Polycom video conferencing software, has been provided by Silver Chain, one of the largest not-for-profit health and community care providers.
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AMT v3 Pre-Production release is now available for download

Created on Tuesday, 18 March 2014
The AMT v3 Pre-Production release is now available for download from the NEHTA website.
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AHPRA UPDATES THE RULES: TESTIMONIALS AND SOCIAL MEDIA ARE IN THE REGULATOR’S SIGHTS

Newsflash - 13 March 2014
On Monday 17 March 2014, a series of updated guidelines drafted by the Australian Health Practitioner Regulation Agency (AHPRA) and the National Boards will come into effect. This includes a major overhaul of the guidelines for advertising health services and the introduction of a social media policy for registered health practitioners [1]. The guidelines for mandatory notifications and the Code of Conduct for Doctors in Australia have also been updated. This article examines the most significant changes in the updated guidelines and explores the potential focus areas for AHPRA and the National Boards.
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Doctors fight AHPRA's social media rules

17 March, 2014 Antonio Bradley
Doctors are petitioning AHPRA to clarify its confusing stance on whether doctors are responsible for patients' online comments about clinical care.
The petition, which has so far been backed by former AMA president Dr Mukesh Haikerwal among other social-media-savvy doctors, is also receiving growing support from medicolegal experts.
Revised advertising guidelines sparked outrage among the profession last month when it emerged comments about a doctor's clinical care on social media sites such as Facebook, and review sites such as RateMDs, were deemed to be testimonials, and as such would break advertising laws.
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AHPRA tries to clarify social media rules

18 March, 2014 Antonio Bradley
AHPRA has moved to explain its confusing guidelines on what doctors are expected to do if patients comment online about their clinical care.
The guidelines, which came into effect on Monday, have sparked outrage among the profession, as they appear to place a professional obligation on doctors to try and delete their patients' online comments about clinical care.
Previous attempts by the Medical Board of Australia to calm doctors' concerns have been unsuccessful, and have led doctors to circulate a petition that calls on AHPRA to change its guidelines.
Here, AHPRA has come up with the questions it believes doctors want answered, and explained how the controversial guidelines apply.
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Doctors still liable for online reviews

17th Mar 2014
PRESSURE is mounting on the Medical Board of Australia (MBA) to clarify guidelines about unsolicited online reviews of doctors’ services, with GPs and medical insurers worried that the door remains open for doctors to be unfairly fined.
Under the new rules, practitioners face a $5000 fine for not requesting the removal of patients’ online reviews of their clinical services.
Following an outcry that the rules placed an unreasonable burden on doctors, MBA chair Dr Joanna Flynn released a statement saying the guidelines were only intended to apply to testimonials intentionally used to advertise.
Medical defence organisations argue the clarification proves there is a need to modify the guidelines to ensure they reflect the board’s intentions.
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Doctors pressure AHPRA to axe social media guidelines

21st Mar 2014
THE doctor-led AHPRA Action campaign targeting controversial new advertising and social media guidelines is gaining momentum, with doctors and medical organisations supporting a petition calling for the rules to be axed.
A petition launched earlier this week by campaign organiser and Melbourne surgeon Dr Jill Tomlinson had attracted more than 100 signatures in just a few days.
Last night the petition and campaign was moved by Dr Tomlinson to the activist website change.org and is continuing to attract support.
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New AHPRA Action campaign kicked off on Change.org

The AHPRA Action campaign has stepped up a notch. Medical Observer is now media partner, the protest action has a new logo (see image) and a new public petition kicked off yesterday.
A Parliamentary Inquiry found that the National Registration and Accreditation Scheme, managed by AHPRA “remains a large and complex bureaucracy with potential confusion over lines of responsibility and accountability.”
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Doomsday approaches for Windows XP users

Date March 19, 2014

Ben Grubb, Tom Pullar-Strecker

Decision day is rapidly approaching for the owners of millions of computers, automated teller machines (ATMs) and cash registers still running the Windows XP operating system.
With less than 20 days to go before Microsoft ends support for the 13-year-old platform on April 8, millions of machines including 95 per cent of the world's ATMs are still running on it.
Microsoft first said it was planning to end support for Windows XP in 2007. It has since been warning consumers and businesses an upgrade is necessary to keep their computers from being run over by a train of malicious software, or malware. 
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Rolling out a new NBN strategy

Date March 19, 2014

Malcolm Maiden

Bill Morrow attended an NBN Co strategy meeting with key suppliers including Alcatel-Lucent on Monday, and sat in on an NBN board meeting on Tuesday. He flew out after it for some R&R in his home town of San Francisco, but will hit the ground running when he takes over as NBN Co chief executive in two weeks' time.
Job No. 1 is to accelerate the broadband rollout, and that part of the brief is in his DNA. Morrow is a corporate turnaround specialist, but he is also an engineer who started out down manholes in California, splicing cable for Pacific Bell.
As his rescue of Vodafone's mobile franchise in Australia showed, he reconstructs networks as part of his rehabilitation of troubled companies.
He will accelerate the NBN project by rapidly ramping up the fibre-to-the-node (FTTN) part of the Coalition's hybrid broadband network.
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NBN: Concern over medical alarms as copper switch-off approaches

NBN Co launches register to track personal medical alarms that may be affected
NBN Co this morning launched a register to track personal medical alarms that may be affected by the switch-off of the copper network in areas where the National Broadband Network has been rolled out.
In late May the initial wave of switch off will take place, affecting some of the first areas to receive NBN fibre, including Armidale and Kiama ion NSW, Brunswick and South Morang in Victoria, Townsville in Queensland, Willunga/Aldinga in South Australia, and George Town, Kingston Beach, Deloraine, Sorrell, St Helens and Triabunna in Tasmania.
NBN Co's medical alarm register will be used to identify households that might need help to transition to the NBN.
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Court approves first-of-its-kind data breach settlement

AvMed agrees to set aside $3 million for breach victims, whether they suffered direct harm or not

March 17, 2014 03:58 PM ET
Computerworld - Courts have generally tended to dismiss consumer class-action lawsuits filed against companies that suffer data breaches if victims can't show that the the breach directly caused a financial hit.
A federal court in Florida broke the mold by approving a $3 million settlement for victims of a data breach in which personal health information was exposed when multiple laptops containing the unencrypted data were stolen.
The Dec. 2009 theft of laptops belonging to AvMed, a Florida-based health insurer, exposed the patient records of tens of thousands of its customers. Several victimes later filed a putative class action lawsuit against AvMed.
The plaintiffs suffered no direct losses or identity theft from the breach but nevertheless accused AvMed of negligence, breach of contract, breach of fiduciary duty and unjust enrichment
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Discovery Bolsters Big-Bang Theory

Signals Reach Back to the Birth of the Universe

By Robert Lee Hotz and Gautam Naik
Updated March 17, 2014 8:43 p.m. ET
Scientists said Monday they have detected the earliest signals reaching back to the birth of the universe almost 14 billion years ago, buttressing the big-bang theory of how the cosmos was formed.
Using a radio telescope at the South Pole, a team of astronomers and astrophysicists said they found telltale patterns of gravity waves in the primordial microwave radiation that lingers in space today. Scientists consider this the faint afterglow of the big bang.
The discovery offers what scientists say is the first direct data on the creation of the universe. Until now, cosmologists had theories but few facts.
If the work proves correct, it demonstrates that gravitational waves, which squeeze and stretch the fabric of space, were created in abundance during the early expansion, or "inflation," of the universe, the instant when space grew from a pinpoint smaller than an atom to the entire observable universe seen today, several experts said. This theory is the keystone of modern cosmology.
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'Fingerprint of God': discovery cements Big Bang theory

Date March 19, 2014 - 2:49PM
A stunning discovery made at a research station in Antarctica indicates that Einstein was right about the nature of the universe. Michael Hanlon explains
The most epoch-making discoveries can be made in the unlikeliest of places. The smoking out of the elusive Higgs boson, perhaps the greatest recent milestone in fundamental physics, took place in 2012 under the serene and agreeable pastures of the Franco-Swiss border, home to Cern's muscular atom-smasher, the £8 billion ($14.6 billion) Large Hadron Collider.
Now another team of scientists, this time American and operating a £12 million telescope in the considerably less clement surroundings of the South Pole, has announced the discovery of what may figuratively be described as the fingerprint of God.
The importance of this finding, announced on Monday afternoon at an excited press conference at Harvard University, cannot be overestimated; one leading physicist has gone so far as to describe it as "one of the most important scientific discoveries of all time". The phrase "Holy Grail" is being bandied about, and there is talk of the most certain shoo-in for a Nobel Prize for decades. The researchers, headed by Professor John Kovac of the Harvard-Smithsonian Centre for Astrophysics, appear to have found the very echoes of creation.
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Enjoy!
David.

Monday, March 24, 2014

It Is A Truth, Universally Acknowledged, That A Wrong Strategy Leads To Bad Outcomes.

I was reflecting on the blog from yesterday. See here:

http://aushealthit.blogspot.com.au/2014/03/jamia-publishes-review-of-pcehr-program.html

In doing that, with apologies to Jane Austen’s great opening line in Pride and Prejudice, it seems we are all pretty clear that if you attempt to implement a flawed strategy you doom yourself to fail.

It seems to me that this is the core of the problem with the PCEHR. The strategy for the PCEHR was developed by bureaucrats and NEHTA and only after they had decided what the strategy would be did they seek serious clinical involvement. Sadly the strategy lacked any clarity as to what the PCEHR was for and who it was for and what the expectations were for both patients and clinicians as to how it would be used and add value.

Nowhere in the world has there been a health computer system that has successfully provided a computing solution that has served both the full needs of clinicians and their patients for the simple reason that each of these groups have very divergent requirements. The strategic assumption that such a system was either possible or appropriate is the key error.

No amount of clinician input was ever going to remedy such a basic strategic flaw. It is just like putting ‘lipstick on a pig’ as they say!

As I said to someone recently regarding flawed strategies ‘adding a better engine to a car with square wheels does not work’!

If the strategy is wrong then no good will flow over the long term and no amount of money, without strategic change, can succeed.

See if I am not right!

David.

Sunday, March 23, 2014

JAMIA Publishes A Review Of The PCEHR Program - Rather Misses The Key Issue For Me.

This paper was released a few days ago - published on-line.
J Am Med Inform Assoc doi:10.1136/amiajnl-2013-002068

A personally controlled electronic health record for Australia

  1. Christopher Pearce1,2,
  2. Michael Bainbridge3,4,5
  1. Correspondence to Dr Christopher Pearce, Inner East Melbourne Medicare Local, 6 Lakeside Drive, Burwood East, VIC 3151, Australia; cpearce@iemml.org.au
  • Received 2 June 2013
  • Revised 6 November 2013
  • Accepted 24 November 2013
  • Published Online First 20 March 2014

Abstract

Objective On July 1, 2012 Australia launched a personally controlled electronic health record (PCEHR) designed around the needs of consumers. Using a distributed model and leveraging key component national eHealth infrastructure, the PCEHR is designed to enable sharing of any health information about a patient with them and any other health practitioner involved in their care to whom the patient allows access. This paper discusses the consumer-facing part of the program.
Method Design of the system was through stakeholder consultation and the development of detailed requirements, followed by clinical design assurance.
Results Patients are able to access any posted information through a web-accessible ‘consumer portal.’ Within the portal they are able to assert access controls on all or part of their record. The portal includes areas for consumers to record their own personal information.
Discussion The PCEHR has the potential to transform the ability of patients to actively engage in their own healthcare, and to enable the emerging partnership model of health and healthcare in medicine. The ability to access health information traditionally kept within the closed walls of institutions also raises challenges for the profession, both in the language clinicians choose and the ethical issues raised by the changed roles and responsibilities.
Conclusions The PCEHR is aimed at connecting all participants and their interventions, and is intended to become a system-wide activity.
Here is the link.
It is important, to understand the paper, to access to full paper which sadly is behind a firewall which greatly reduces its accessibility.
Having carefully read the paper carefully what I took away was the reflection of the core problem of the PCEHR - namely that it is neither ‘fish nor fowl’ in being really not optimal for use by either clinicians or their patients.
This quote - from the issues discussion make it clear the authors see the difficulty.

“Information access

One of the significant proposed benefits is that consumers will have access to their information. As any health problem concerns the consumer, involving patients in their own care by sharing information promotes safety22 and benefits the shared decision model.23 However, despite this, clinical information is usually written with a clinical audience in mind and health literacy levels vary in the population.24 ,25 Test results are confusing and often opaque to consumers, and can be worrying when viewed out of context. Abnormal results can be clinically insignificant, and vice versa. Current plans are that pathology and radiology results will not be released to the PCEHR until reviewed by the ordering clinician. This process is problematic as it does not apply to existing clinical documents that may contain radiology or pathology information. Nor is it reasonable in the long term to treat these two categories of information separately. The ideal solution is to develop mechanisms whereby test results can be presented so that consumers can interpret and understand them, perhaps with access to supporting information and/or in conjunction with their healthcare provider. Access to information must be provided so as to empower patients, not confuse them.”
To me, to wind up with unresolved dilemmas of this sort reflects the lack of clarity in the design phase as to just what and who the  PCHER was address.
The same issue emerges here:

“Workflow/benefit conundrum

One of the challenges for the program is that consumers derive most benefit, yet most of the workflow costs and change is borne by clinicians. This is exemplified by the SHS. While GPs keep information about allergies, etc in their own systems, ensuring that the data are complete, regularly collated, curated, and rendered fit for sharing is not part of their current remit. The program represents a change in workflow and leverages pre-existing effort and (under Australian law) the clinician's intellectual property. Patients may be seeing many specialists or other GPs for specific problems. GPs will have to ensure that data not currently included in their system are placed in an SHS. GP requests for specific funding for PCEHR activities have not been met, and instead GPs must use existing reimbursement items.
Part of the solution to this is to change the whole system, so that GPs have access to information (such as discharge summaries or specialist letters) they could not previously obtain. This indirect benefit of participating in the system is meant to counteract the direct ‘dysbenefit’ of workflow changes.”
Clearly at present the clinicians are not convinced the balance is fair!
There is also a sentence in the conclusion that causes me much concern.
“Central to the original build has been direct clinical leadership in the design to ensure clinical utility, assurance, safety, and ‘meaningful use’ so that the providers deployed by the consumer can and want to use the documents.”
I have to say I believe this to be incorrect - all I have heard indicates clinicians were only involved as an afterthought and it seems clear this has been a factor in the confused shape of the system that was finally delivered.
Indeed is seems likely that the mass resignations of last year of the clinical leads appear to be due to their frustration at their lack of influence in the direction of the PCEHR Program.
See here:
In summary, to me this paper is a useful effort, which recognises clearly the utility and value of the PCEHR is far from established and that it may be that very fundamental change might be needed from here. I can find no real evidence that what consultation has been undertaken with clinicians has been taken as seriously as it might have been. To me that is one of reasons we find ourselves in the rather uncomfortable position we are now in.
This is not news to many of us however!
It needs, in passing, to be noted, that both authors have had significant paid associations with NEHTA - which they clearly acknowledge.
David.

AusHealthIT Poll Number 210 – Results – 23rd March, 2014.

Here are the results of the poll.

Is A Fibre To The Home National Broadband Network (NBN) (Not Alternative Less Costly Technologies) Essential For Successful E-Health and TeleHealth?

Yes 13% (9)

No 70% (50)

I Have No Idea 17% (12)

Total votes: 71

It seems there is a good majority (70%) recognise that most of the time only reasonable quality broadband is needed and not full FTP!

Again, many thanks to the very many who voted!

David.