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."

Monday, April 14, 2014

Weekly Australian Health IT Links – 14th April, 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

Really quite an interesting week. We have NEHTA coming out and agreeing there are some security problems with EHRs and the PCEHR, Dubbo being recruited to using the PCEHR and some really interesting and successful private sector e-Health initiatives.
Still no news from the PCEHR Review and it is now less than a month till Budget night.
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IT spend on healthcare continues apace in Asia Pacific

Australia is up there with other Asia Pacific countries in continuing a steady increase in IT investment in the healthcare sector. China is the fastest growing IT spender, with a new market report showing an expected APAC region annual growth rate in IT spending on healthcare of 8%.
China is predicted to outstrip other APAC countries over the next five years, with a compound annual growth rate of 11.7% on IT spending in its healthcare sector.
In its latest Health Insights report, IDC says that Australia, China, India, Singapore and South Korea represented close to 90% of Asia Pacific IT healthcare IT spending last year.
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Privacy minefield

8th Apr 2014
SHARING or secrecy? E-health is forcing GPs to wrestle with competing demands while trying to protect patient privacy.
It's good to share, right? 
Think again.
As kids we might have faced a slap on the wrist for not sharing properly. Now, under the new Australian Privacy Principles, we face a $1.7 million slap in the face.
But that’s just not fair, I hear you cry. How am I supposed to play with the 900,000 medical apps available on iTunes without making a bit of a mess? And how do I know all my stuff is safe when I lock it up at night in the great national information cupboard?
There was a day when patient confidentiality was almost child’s play. Now, with enticing opportunities for improved sharing of information through telehealth advances but draconian penalties facing those who break the sharing rules, GPs are caught between a rock and a hard place, otherwise known as the personally controlled electronic health record (PCEHR).
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New e-recall program kicks off

8 April, 2014 Chris Brooker
The recall process for therapeutic goods is set to be streamlined for pharmacists with the launch of GS1 Recallnet Healthcare – an electronic product recall notification management system.
Developed over four years by GS1 Australia, in association with the National E-Health Transition Authority (NEHTA), the TGA, state and territory health departments and medical device and pharmaceutical suppliers, GS1 Recallnet Healthcare went live on 1 April.
It is an online portal that will allow users to create recall and non-recall notifications that follow the uniform recall procedure for therapeutic goods guidelines, as well as submit recall notifications directly to the TGA for review and approval.
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Update On Clinical Document Architecture And E-Health Records

Created on Wednesday, 09 April 2014
The National E-Health Transition Authority (NEHTA) and our partners are aware of potential issues citing security vulnerabilities which could affect eHealth systems worldwide. NEHTA, the Department of Health, and the PCEHR System Operator identified and considered these issues some time ago and as a result put in place actions to either negate or mitigate them.
The issues are around the use of the Clinical Document Architecture (CDA) standard, via style sheets, and in particular the Health Level Seven International (HL7) supplied style sheets, and all deal with the potential for malicious content to be exposed through the clinical documents.
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No more missed test results: Hospital tracking system a success

11th Apr 2014
A QUEENSLAND hospital system that raises the alarm if test results and x-rays are not viewed by a specific deadline has delivered perfect follow-ups of 27,354 records for 6855 patients over a 13-month period.
The system at Mater Mothers' Hospital in Brisbane scored a life-saving 100% in a University of New South Wales (UNSW) assessment.
"It is an unprecedented result," said Associate Professor Andrew Georgiou from the Australian Institute of Health Innovation, which is based at the university.
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eHealth records up and running across district

By KIM BARTLEY

April 12, 2014, 4 a.m.
GEOFFREY and Judith Smith feel more confident about travelling away now they have registered for a free eHealth Record.
They were among the patients of Boundary Road's Dubbo Family Doctors who took advantage of a visit by staff off the Western NSW Medicare Local (WML) yesterday.
The practice and WML joined forces to promote the secure and electronic record that brings together key patient information from sources such as general practices, hospitals, imaging centres, specialists and allied health practices.
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A digitally-enabled health system

What will our healthcare system look like, once the full potential of the digital era is harnessed?
  • 26 March 2014
Australia's health system faces significant challenges including rising costs, an aging population, a rise in chronic diseases and fewer rural health workers. Treasury estimates even suggest that at current rates of growth, and without significant change, health expenditure will exceed the entire state and local government tax base by 2043. We need to look at new ways to make the health system work smarter. Digital technologies and health service innovation promise that.
This report A Digitally-enabled Health System looks at how the Australian health system can reduce costs and deliver quality care.
Some of the technology identified in the report includes telepresence robots taking rural health workers on city rounds, wireless ID wristbands monitoring patients in real time, mobile health apps assisting with at-home rehab and smart software that knows what patients will be turning up to emergency departments, 6-12 months in advance.
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Data Role

Technology will be a key factor controlling the exponential rise of healthcare costs in Australia’s future, according to the newly-released CSIRO paper, A Digitally Enabled Health System. 
The paper was released during the Health-e-Nation 2014 Summit, and Dr David Hansen, who is CEO of the Australian e-Health Research Centre (AEHRC), a CSIRO and QLD government joint-venture, says that it will be a talking point that spurs future research collaborations.
“There’s been a lot of downloads of the document,” he says. “We have had serious numbers of hits on it.”
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Security cases for EHR systems

Posted on April 8, 2014 by Grahame Grieve
Well, security is the flavor of the week. And one thing we can say for sure is that many application authors and many healthcare users do not care about security on the grounds that malicious behaviour is not expected behaviour. One example that sticks in my mind is one of the major teaching hospitals in Australia that constantly had a few keys on the keyboard wear out early: the doctors had discovered that the password “963.” was valid, and could be entered by running your finger down the numeric keypad, so they all used this password.
So here’s some examples of real malicious behaviour:
Retrospectively Altering Patient Notes
A Queensland-based GP retrospectively changed his notes to falsely claim that a patient refused to go to hospital – then submitted those notes as evidence in an inquest, has been found to have committed professional misconduct and been suspended from practising medicine for 12 months including six months plus another six if he breached conditions within three years – and banned him from conducting most surgical procedures except under supervision for at least a year.
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3D printing a new face, or liver, isn't that far off

Surgeons see a day when skin, organs and bones will all be printed
Sixty years from now, we'll look back on today's 3D-printed tissue and organ technology and think it's as primitive as the iron lung seems to us now.
Six decades out, replacing a liver or a kidney will likely be a routine procedure that involves harvesting some patients cells, growing them and then printing them across artificial scaffolding.
Dr. Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine, spoke at the Inside 3D Printing Conference in New York about where the technology is today, and what hurdles it still must overcome.
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Bionic revolution to ‘keep us active well into old age’

  • Hannah Devlin
  • The Times
  • April 07, 2014 9:30AM
BIONIC limbs and 3-D printed organs will keep people in good enough shape to play tennis beyond the age of 100, one of Britain's leading materials scientists has predicted.
Professor Mark Miodownik, of University College London, believes that rapid progress in biomedical engineering will transform old age by allowing people to "upgrade" failing body parts such as kidneys, livers and bones.
"The difference between animate and inanimate materials is getting more blurred and the body is going to become much more bionic," he said. He envisages the transformations to be as subtle as today's dental fillings rather than a case of people morphing into Robocop-style cyborgs.
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Doctors' robot reduces spine surgery risk

  • April 09, 2014 10:15AM
  Clifford Fram, AAP National Medical Writer
  AAP
SURGEONS have been using GPS-based devices for some time, but a Sydney operating theatre has been fitted with the medical equivalent of park-assist.
It's a leap forward, says neurosurgeon Dr Jonathon Ball, who is using the new robotic system to make his already exacting spine operations more precise.
Apart from reducing risk and improving accuracy, the Israeli-designed Renaissance guidance system improves recovery time and reduces pain.
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Jawbone’s UP24 bracelet raises the bar on health goals

IT’S a year since I reviewed Jawbone’s UP health bracelet. It measures your steps and sleeping patterns, and vibrates to wake you when it detects you in light sleep around alarm time.
Now Jawbone has released the UP24. It remains a rubber bracelet that fits snugly on your wrist, it’s water resistant and it still lacks a display. That has not been a big issue with the UP, which seeks to help you manage your activity habits rather than offer instant performance data.
There is one major change: the UP24 syncs to your smartphone wirelessly via Bluetooth 4. The old UP required you plug the end into a smartphone to upload its data. The UP24 syncs data about every 20 minutes to the UP app.
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Push for GP software to default to generics

9th Apr 2014
AN INFLUENTIAL political think tank wants to reduce the influence of brands on GP prescribing and referrals for diagnostic testing as part of a drive to cut costs for patients.
In a submission to the Senate enquiry into out-of-pocket expenditure on healthcare, the Australian Institute (AI) proposed two measures to reduce the estimated $1.3-$1.7 billion patients spent on GP visits plus brand premiums on medications and diagnostic testing in 2012–13.
It also recommended an update of the 2008 Australian Bureau of Statistics survey on the negative impact of costs on access to health services before any decision was made to charge a standard co-payment for GP visits.
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Case study: security vulnerabilities in C-CDA display

Apr07
For background, see my previous blog post describing the details of three security vulnerabilities in C-CDA Display using HL7′s CDA.xsl.
Last month I discovered a set of security vulnerabilities in a well-known commercial EHR product that I’ll pseudonymously call “Friendly Web EHR”. Here’s the story…

The story: discovery and reporting

I was poking around my account in Friendly Web EHR, examining MU2 features like C-CDA display and Direct messaging. I used the “document upload” feature to upload some C-CDAs from SMART’s Sample C-CDA Repository. At the time, I was curious about the user experience. (Specifically, I was bemoaning how clunky the standard XSLT-based C-CDA rendering looks.) I wondered how the C-CDA viewer was embedded into the EHR. Was it by direct DOM insertion? Inline frames? I opened up Chrome Developer Tools to take a look.
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Tech-Savvy Australian seniors want digital tools to manage health, according to Accenture survey

SYDNEY, Australia; 08 April 2014 – Driven by increasing healthcare demand from Australia’s aging population, a recent survey from Accenture (NYSE:ACN) found a growing number of tech-savvy seniors (63 per cent) are seeking digital options for managing their health.
The latest figures from the Australian Bureau of Statistics reveal that Internet participation has nearly doubled among Australia’s growing population of seniors since 2003, showing 41 per cent of older citizens are active online users.  Although roughly three-quarters (77 per cent) of seniors surveyed by Accenture say that online access to their health information is important, only 17 per cent say they can currently access their records. 
“While prior generations were commonly more resistant to technology, the explosive growth of digital tools are enabling more options for seniors to remain connected and manage many areas of their lives from home,” said Leigh Donoghue, managing director of Accenture’s health business in Australia.  “Older Australian’s are increasingly online, and just as they turn to the Internet for banking, shopping and entertainment, they also expect to be able to manage certain aspects of their healthcare services virtually.”
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Suspension of GP Super Clinics program the right move for general practice

9 April 2014
The Royal Australian College of General Practitioners (RACGP) welcomes the Federal Government’s plans to suspend any further expansion of the GP Super Clinics program, detailed in media reports yesterday.
The $650 million GP Super Clinic program was implemented by the previous Government as a strategy to build a stronger primary healthcare system, with the announcement yesterday set to re-coup some of the costs of the controversial program.
The revoked funding, allocated for the development of Super Clinics in Darwin, Rockingham and Brisbane is set to save the Government around $25 million.
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Do robots have a role in dementia care?

10 April, 2014 Kate Aubusson
From Alien to Terminator, Blade Runner to The Matrix — science fiction has long taught us never to trust robots, androids or cyborgs.
But surely even Sigourney Weaver would be won over by Paro, a cuddly robotic baby seal designed to improve quality of life in dementia.
Researchers hope the $9000 mechanised harp seal will ease agitation among elderly patients and reduce the need for restraints in aged care facilities.
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Coalition orders ‘technology mix’ to officially replace Labor’s NBN plan

THE Abbott government has officially repealed the blueprints issued under the Labor government to build the National Broadband Network using fibre-to-the premise technology.
It has issued new instructions to the NBN Co to use a variety of new and existing broadband technologies to save money and time on the $41 billion project.
Communications Minister Malcolm Turnbull and Finance Minister Mathias Cormann last night handed down a new statement of expectations to the board of NBN Co to lock in the government’s “optimised multi-technology mix”.
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GOLDMAN: These 7 Tech Trends Are Changing The World

Mamta Badkar Apr 9, 2014, 7:07 AM
Goldman Sachs has a cool feature on its website titled “25 Ways We Saw The World Change,” which comes from the bank’s 2013 annual report.
The list includes seven “concurrent revolutions within the technology space.” Disruptive technology is having a huge impact on global businesses and the economy that we can’t ignore.
We’ve highlighted the seven key tech trends they think are about to impact the global economy.
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Australian internet speeding up

Date April 8, 2014 - 3:34PM

Paddy Wood

Australian internet is speeding up and people are downloading more than ever before, new figures show.
The number of Australians accessing download speeds of 24 megabits-per-second (Mbps) passed 2 million for the first time in the three months to December, according to the Bureau of Statistics.
That's an increase of about 27 per cent on the number of people accessing the fastest category of internet service since the same period in 2012.
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How to protect yourself from the 'Heartbleed' bug

A new security bug means that people all across the Web are vulnerable to having their passwords and other sensitive data stolen. Here's what consumers can do to protect themselves.
A major new security vulnerability dubbed Heartbleed was disclosed Monday night with severe implications for the entire Web. The bug can scrape a server's memory, where sensitive user data is stored, including private data such as usernames, passwords, and credit card numbers.
It's an extremely serious issue, affecting some 500,000 servers, according to Netcraft, an Internet research firm. Here's what you can do to make sure your information is protected, according to security experts contacted by CNET
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Enjoy!
David.

It Seems Minister Dutton Is Committed To An Electronic Health Record. But Not The PCEHR Explicitly.

This appeared a day or so ago. See the section on e-Health Implementation below.

Standing Council on Health (SCoH) Communique - 11 April 2014

Australian Health Ministers met in Brisbane today for a meeting of the Standing Council on Health (SCoH). The meeting was chaired by Jillian Skinner, NSW Minister for Health and Minister for Medical Research. 
Items discussed included:
Australian Health Management Plan for Pandemic Influenza
Health Ministers endorsed an enhanced national plan for health sector management of an influenza pandemic. The national pandemic plan of 2008 was used to guide the response to the H1N1 2009 Influenza Pandemic. Following this response, a major review was conducted. Health sector stakeholders worked closely together and a new plan was developed based on existing seasonal influenza and emergency management systems. This has made the new plan stronger, better integrated and more sustainable. The Australian Health Management Plan for Pandemic Influenza (AHMPPI 2014) also uses a more flexible approach, which allows decision makers to implement measures that are in proportion to the severity of the pandemic and tailored to the needs of Australia’s diverse communities.
20th International AIDS Conference
Ministers noted an update from Victoria and NSW on the 20th International AIDS Conference being held in Melbourne from 20 to 25 July 2014.  The conference provides an opportunity to highlight the unique responses to the diverse nature of the Asia Pacific region's HIV epidemic, and to strengthen efforts across all regions and around the world. It also provides a chance to assess the current status, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward.
Privately Practicing Midwives
The Standing Council on Health considered the current exemption from holding professional indemnity insurance for home births available to privately practicing midwives, which is scheduled to end in June 2015. The Council acknowledged the importance of resolving this issue from a patient and professional practice perspective, and agreed to ask AHMAC to progress measures which will improve the governance and safety of home birthing services provided by privately practicing midwives.
Organ Donation targets
Ministers reviewed the 2013 organ and tissue donation and transplantation outcomes from the DonateLife Network which showed a further increase in the organ donation rate over previous years. In 2013, there were 391 donors who made a life changing difference to 1,122 transplant recipients. This represents a 58% increase in the number of organ donors since 2009, the year the DonateLife Network was established.
Ministers discussed and agreed the national and jurisdictional indicative donation targets for 2014 and the projected donation and transplantation growth trajectories to achieve 25 donor per million population (dpmp) by 2018, noting that there has been an increase from 11.4 dpmp in 2009 to 16.9 dpmp in 2013.
Integrated care
Ministers noted the recent announcement by NSW of significant new investment in integrated care and discussed opportunities for collaboration on integration of care within the health system.  Ministers agreed that collaboration across jurisdictions, including joint initiatives and shared learning, would help all parties achieve a sustainable, integrated health system that better meets the needs of Australians.  Areas identified for collaboration included increased sharing of information and data.
Multi-jurisdiction clinical trials
Ministers endorsed work to identify ways to enhance clinical trial activity in Australia by implementing a national approach to clinical trials.  They agreed to ask the Australian Health Ministers’ Advisory Council to conduct a scoping exercise, in consultation with the National Health and Medical Research Council, to report back on practical approaches to enhancing clinical trials activity.
Medical Intern Training
Ministers agreed to commission a Review of Medical Intern Training to examine the current medical internship model and consider potential reforms to support medical graduate transition into practice and further training.  Phase one of the review will be undertaken by an Independent Reviewer appointed by Australian Health Ministers’ Advisory Council who will be supported by an Expert Advisory Panel.  It is envisaged that phase one of the review will commence early in the 2014–15 Financial Year. 
Childhood Immunisation and Family Assistance Payments
Ministers noted that the Commonwealth will consider issues associated with incentives to reduce vaccine refusal.  Under the Commonwealth’s current payment scheme, parents who refused immunise their children on non-medical grounds are eligible to receive the same financial benefits as parents who do immunise.
Hospital Capacity Recording in Contemporary Healthcare
Health Ministers have agreed to work together to improve the consistency of reporting of public health service capacity by developing more accurate measures that are aligned with contemporary healthcare. This includes the ability to capture nationally for the first time hospital in the home services, same-day dialysis and chemotherapy chairs, capacity contracted from the private sector, as well as ambulatory care services.
A National Framework for Communicable Disease Control
Ministers endorsed the National Framework for Communicable Disease Control - a framework that, for the first time, brings together government, agencies and committees under the shared goal of strengthening our defences against communicable diseases.  The Framework’s objectives are to improve national prevention, detection and response to communicable diseases and to improve the organisation and delivery of communicable disease control. The Australian Government and state and territory governments, through the Australian Health Protection Principal Committee are developing implementation options for the Framework.
eHealth Implementation
Ministers heard from the Commonwealth Minister for Health, Peter Dutton that the government had ordered a review of the Personally Controlled Electronic Health Records and had received the review report and recommendations.
The Minister said there were a number of concerns identified in the report, including clinician engagement and the government is working through the issues.
All Health Ministers supported the concept of the PCEHR but agreed that there was work to be done on making this a much better system that is properly coordinated and really works.
Minister Dutton said the Commonwealth is committed to an electronic eHealth record and will be working with the states and territories to implement it properly.
National Blood Supply
Ministers approved the 2014–15 National Supply Plan and Budget (NSP&B) of $1,156 million.  The NSP&B is cost shared by all jurisdictions with Australian government contributing 63 per cent and states and territories 37 per cent.
Review of the National Registration and Accreditation Scheme (NRAS) for Health Practitioners
Ministers determined that the NRAS Review will be undertaken by an independent reviewer; an eminent person with expertise in health and practitioner regulation.
Health Ministers are pleased to announce the appointment of Mr Kim Snowball as the independent reviewer for the NRAS Review.  Mr Snowball has held a variety of senior leadership roles in both the public and private health sectors. Mr Snowball was previously the Director General of WA Health and has also served as the Chair of the Australian Health Ministers’ Advisory Council (AHMAC).
National Health Practitioner Ombudsman and Privacy Commissioner
Ministers agreed to seek funding from National Boards for the ongoing costs of the National Health Practitioner Ombudsman and Privacy Commissioner without the need for fee increases.
Media contact:  Kay McNiece, 0412 132 585
Here is the link:
The relevant bit it this:
“eHealth Implementation
Ministers heard from the Commonwealth Minister for Health, Peter Dutton that the government had ordered a review of the Personally Controlled Electronic Health Records and had received the review report and recommendations.
The Minister said there were a number of concerns identified in the report, including clinician engagement and the government is working through the issues.
All Health Ministers supported the concept of the PCEHR but agreed that there was work to be done on making this a much better system that is properly coordinated and really works.
Minister Dutton said the Commonwealth is committed to an electronic eHealth record and will be working with the states and territories to implement it properly.”
I read this to say that the PCEHR is not ‘really working’, has a range of problems that are not yet solved - so they are tricky or they would have been quickly fixed - and that the program is not well co-ordinated and has not been implemented properly.
I also read this to say the Government is committed to an electronic eHealth record, and not necessarily the PCEHR or they would have said so!
Hardly a great endorsement.
David.

Sunday, April 13, 2014

I Wonder Will We See Similar Accountability For A Health IT Disaster As Has Happened In The USA.

The resignation of the US Secretary for Health was announced a few days ago.
Reporting is found here:

Sebelius quits after HealthCare.gov mess

Posted on Apr 11, 2014
By Bernie Monegain, Editor
HHS Secretary Kathleen Sebelius seemed to have weathered the maelstrom surrounding the botched rollout of the government's health insurance exchanges back in October and come through the other side where more than 7 million people signed up for health insurance through the exchanges.
But on Thursday, after five years at the HHS helm, Sebelius resigned.
President Barack Obama is set to nominate Sylvia Mathews Burwell, director of the White House Office of Management and Budget, to take over at HHS. She faces congressional confirmation -- where, according to pundits, she is likely to face resistance from Republican senators who continue to oppose the Affordable Care Act.
Back in October the launch of the HealthCare.gov website left people who wanted to sign up unable to do so, with the website apparently unable to handle the rush of applicants. Several Republicans called for Sebelius' resignation and took the opportunity to criticize Obamacare, their name for the ACA.
Lots more here:
There is even another Australia report here showing how this is reasonably important news:

Obama's health secretary Sebelius to resign

  • AFP
  • AFP
  • April 11, 2014 9:12AM
BARACK Obama's Health and Human Services Secretary Kathleen Sebelius is to resign, paying the price for the chaotic initial rollout of the US President's signature healthcare law, officials said.
Sebelius will officially step down on Friday, US time, and Obama will nominate Sylvia Mathews Burwell, his current budget director, to replace her, the officials said.
The administration will hope that the departure of Sebelius will draw a symbolic line under the early implementation period of the law, which had a botched debut due to a malfunctioning sign-up website.
The administration was forced into an emergency effort to fix the site and other implementation problems — and 7.5 million people have now signed up for health insurance under the new law.
More here:
The back story here is that implementation of the web-site Healthcare.gov, which was to assist in obtaining healthcare insurance for millions of uninsured, and which was  associated with some large scale health reform, went badly technically and was associated  with the implementation being rushed, not properly tested and failing badly on a number of occasions.
There has been a lot of political blame attached to the Secretary (She is at the the same as our Health Minister and a member of the US Cabinet) and after 5 years she has finally resigned - interestingly after fixing things pretty well and having had 7.5 million enrolled using the system.
It was also pretty impressive just how quickly the system has been fixed and now appears to be working and that only after it is fixed has the Secretary left.
If only  we could see the same responsibility from our Departmental Health Secretary! Decide, with proper consultation, on the correct fix for the PCEHR Program, implement it and then accept responsibility for the overspend and delays and leave - given the responsible Minister has already left!
We can dream I guess!
David.

AusHealthIT Poll Number 213 – Results – 13th April, 2014.



Here are the results of the poll.

The Department Of Health Has Refused FOI Requests Regarding Release Of The PCEHR Review. Are They Justified In Doing This?

Of Course Not 88% (136)

Possibly 7% (11)

Neutral 1% (1)

Probably 1% (2)

Yes Indeed 3% (4)

I Have No Idea 1% (1)

Total votes: 155

A very clear outcome with 88% + taking the view that we are entitled to see the PCEHR Review.

Good to see so many votes!

Again, many thanks to all those that voted!

David.