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, June 24, 2014

Opt in or Opt Out - A Discussion From A Privacy Expert.

This article is reprinted from the iappANZ Journal with permission of the Author - Ms Emma Hossack.
You can see the whole May 2014 Issue of Privacy Unbound here:
http://pams.com.au/iapp/StaticContent/Images/iappANZ_Journal_May_2014.pdf

To Opt in or to Opt Out, THAT is one of the questions for the Personally Controlled Electronic Health Record [1]in Australia

Forgive me if it feels like Groundhog Day.
“EHealth is a complex infrastructure project that requires a fundamental change in consumer and business practice as well as a cultural shift in both professional and consumer behavior…..In such a project, implementation is key. I want to make sure we bring consumers with us in the eHealth journey by adopting an “opt in” model – allowing them to choose when to sign on. I believe that the benefits of giving the Australian public the choice as to whether they participate will be key to the successful implementation. I think moving to an “opt out” position would be a serious mistake.”
The Hon Nicola Roxon MP
Minister for Health and Ageing
Address to the Consumer Health Forum, Canberra. 14 September, 2011.
The above quote was the introduction to a piece published in this Journal in September 2011.  That article is useful background to the current and is reprinted in the current Journal. In essence, this is what happened in the interim:
·         The PCEHR Act 2012 (Cth) became law on 26 June 2012
·          The assurance that “…the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks” (Ministers own bold type)[2] appears to have been forgotten.  A massive data repository has been built.   
·         The Opt In model was adopted and $50 Million AUD was spent on Medicare Locals to assist them with engaging consumers.[3]
·         The Medicare Local Review was released which impacts on the PCEHR implementation.[4]
·         The cost of the PCEHR Project blew out from $467 Million AUD to $1 Billion AUD.[5]
·         The lack of consumer and clinician engagement resulted in the current Health Minister stating in Parliament in 2013 that the cost was equivalent to over $100,000.00 for each person enrolled in the system.[6]
·         Minister Dutton called for a review of the PCEHR in November 2013.
·         The PCEHR Review[7] contained 38 recommendations, including one to convert the opt in system to an opt out system.
·         The Clinical Document Architecture, known as CDA which is used by the PCEHR has been found to be flawed with security risks[8]
·         The security flaw in the myGov website potentially opened health information held in the PCEHR to malicious attacks.[9]
·         The clinicians and consumers have not been given a business case for using the PCEHR and remain confused[10]
·         Clinicians having to renew PCEHR security tokens by fax has been criticised as it is not very efficient or modern[11]
·         It is suggested in the PCEHR Review that the name of the system be changed from the PCEHR to” My Health Record”. This would not normally rate a mention, but the fact that the concept has been given 5 names to date, suggest confusion not only about what it is, but what to call it. [12] “What’s in a name?  That which we call a rose
By any other name would smell as sweet.”[13] It is unlikely the name change will be the answer to a better system.
When a system works well, and people who benefit from using it would know about it and any risks, then opt out is clearly a good option to maximise the benefits for the community. When a system is not understood and is flawed, converting it into an opt out system is risky and inappropriate. We all know that “The most effective way of controlling information about oneself is not to share it in the first place.”[14]  We also all know that most people are naturally lazy, and the statistics for organ donation demonstrate that clearly.[15]However in health, where sharing of information and co-ordination of that information is critically important for the best outcomes, trust is the foundation. Earning the trust of patients is the difference between empowering individuals with knowledge, and saving or improving lives or not. Sharing clinical information in a privacy compliant way is worth getting right, and informing consumers and respecting their trust are the first steps.
Health information is amongst the most sensitive information, and the complexity and beauty of being able to share that information privately through technology is what changed my career.[16]The benefits when it is done well are compelling[17]it is also one of the hardest areas to get right. It involves politics (funding issues between states and commonwealth, enabling individuals and doing as much as necessary), technology (a world of architecture and acronyms), ethics, clinical support [18]and patience.[19] Underlying everything that we do in eHealth is the concept of “…abstain from doing harm”[20].  A system which is accessible by a consumer who is not aware of what kind of information the PCEHR holds, or what it means could result in harm.  The sharing of certain sensitive information has resulted in depression, embarrassment and suicide.
Having worked in this area for almost a decade I am committed to seeing ehealth reform work. This does not simply mean the economic benefits of $AUD7Billion savings annually which have been suggested[21].More importantly there will be better health outcomes and individuals will have more autonomy over their lives and health. The PCEHR Review supports returning to the decentralised architecture for ehealth which has been supported by the National Health and Hospital Reform Commission[22] which means it supports an ecosystem of different technologies with dedicated purposes which are interconnected.
Once the eHealth ecosystems s are working and Australians are fully educated about the pros and cons of the system, Opt Out would be justifiable. Getting more “numbers” in the system will not change the fact that the current PCEHR is not achieving its goals. Merely counting registrants is not a meaningful measure. We need meaningful use that provides clinicians, patients and all Australians with benefits. Adding empty numbers to a system to make it better is like changing its name – lipstick on a pig.  It’s too soon for Opt out.
Emma Hossack
President iappANZ
CEO Extensia
Vice president of the Medical Software Industry Association
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Many thanks to Emma for a useful article!
David.

[1] The Personally controlled electronic health record is an initiative of what was known as the Department of Health & Ageing in 2010 and was a part of the then Government’s eHealth reform and was allocated a spend of $467 Million

[2] The Hon. Nicola Roxon, MP, Minister for Health and Ageing – November 30 2010, opening address to the e-health Conference, “Revolutionising Australia’s Health Care”, Melbourne.
[12] Originally in 2009 the National Electronic Health Transition Authority called it the Shared Electronic Health Record “SEHR”, then the Individual Electronic Health record “IEHR”, then the PCEHR”, then the previous Government suggested the National Electronic Health record System “NEHRS” and now we see the fifth suggestion.
[13] Romeo & Juliet, Shakespeare Act 2, Scene 2.
[14] A Michael Froomkin, “The Death of Privacy” Vol 52: 1461 may 2001] 1462. 1463
[15] Cass Sunstein, Nudge
[16] The inherent conflict led me to post graduate work in privacy and ownership of shared electronic health records. I subsequently retired from legal practice and became CEO of Extensia a shared electronic health record company.
[17] 26% reduction of avoidable admissions to hospital in just one trial:
Part 2, Pg. 103, Tables 32 & 33: The National Evaluation of the Second Round of Coordinated Care Trials – Final Report, Commonwealth of
Australia 2007

[19] A ten year journey according to The Deloitte eHealth Strategy 2008 http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy
Endorsed by the National Health and Hospital Reform Commission 2009 http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report

[20] Hippocratic oath
[21] PCEHR Review at p.9 Booz & Co
[22] See recommendation 123 http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report and PCEHR Review recommendation #31.
Posted by Dr David G More MB PhD at Tuesday, June 24, 2014 4 comments

Monday, June 23, 2014

Weekly Australian Health IT Links – 23rd June, 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

Another quiet week.
Fascinating and pretty accurate commentary on e-Health from the AFR this week. The commentary was pretty spot on in my view and is worth a read. Figuring out just what to do with the diagnosis is the hard bit. Not sure we have the answers to that as yet!
I wonder if we will ever see a response to the PCEHR Review of will the whole thing just roll on in perpetuity? Its feeling like the latter at present.
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http://www.afr.com/p/business/healthcare2-0/leadership_vacuum_cripples_health_VrDsiSCDYOWXyuvg54QfJN

Leadership vacuum cripples e-health

June 19, 2014
Mark Eggleton
Australia continues to struggle with the concept of e-health, with numerous health sector stakeholders equally to blame. This was one of the key messages to come out of the recent Big Data in Healthcare roundtable held by The Australian Financial Review in partnership with GE in Sydney.
Capital Markets CRC principal adviser Dr Paul Nicolarakis suggested part of the problem was Australia lacks a vision for healthcare. He suggested we don’t have someone or a collection of individuals working towards one goal. There are numerous stakeholders across the sector all vying to be the loudest voice, yet not pursuing a common goal.
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http://www.lexology.com/library/detail.aspx?g=95ecdb2d-057e-48f8-92ee-5872316a679f

Personally Controlled Electronic Health Record review

On 20 May 2014, the Federal Government released its review of the Personally Controlled Electronic Health Record, published in December 2013.
The review makes 38 recommendations to improve clinical confidence and usability of the electronic health records system.  These include, among other things, a change of name to "My Health Records" and the establishment of privacy, security and advisory committees.
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http://www.health.nsw.gov.au/statehealthplan/Pages/NSW-State-Health-Plan-Towards-2021.aspx

NSW State Health Plan: Towards 2021

The NSW State Health Plan: Towards 2021 provides a strategic framework which brings together NSW Health’s existing plans, programs and policies and sets priorities across the system for the delivery of ‘the right care, in the right place, at the right time’.
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http://www.zdnet.com/it-comes-up-trumps-in-nsw-budget-7000030606/

IT comes up trumps in NSW budget

Summary: An outlay of several hundreds of millions of dollars this financial year will see IT projects across the NSW government kick on.
By Chris Duckett | June 17, 2014 -- 06:19 GMT (16:19 AEST)
The Departments of Health, Education, Police and Justice, took home a sizable chunk of the information technology funds on offer in the NSW budget for 2014-15.
The Health department picked up AU$83 million for e-Health and IT programs from the department's AU$18.7 billion budget for 2014-15, and will see AU$20 million spent to upgrade IT systems and enable wireless and mobile connectivity for clinical systems as part of the AU$23 million kicking off of the third phase of the department's critical ICT infrastructure enhancements program, that is projected to cost AU$51.1 million by 2018.
NSW's electronic health project, HealtheNet, will receive AU$10 milllion to fund the design and start of developing a "collaborative two way integrated care" portal for doctors, patients, and health care providers. On the remainder of the Health department's technology funding, the Ambulance service was allocated AU$5.3m, the community health and outpatients information system received AU$11.14m, the AU$170.3 million electronic medications management system got AU$26.68 million for this year, the intensive care unit clinical information system nabbed AU$13.42 million for 2014-15.
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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton041.htm

Better Mental Health Care in Australia

The Australian Government is bolstering mental health services in Australia, with a $6.5 million initiative to train primary health practitioners in the use of e-mental health therapies and associated technologies.
Page last updated: 17 June 2014
17 June 2014
The Abbott Government is bolstering mental health services in Australia, with a $6.5 million initiative to train primary health practitioners in the use of e-mental health therapies and associated technologies.
Minister for Health, Peter Dutton, said Queensland’s University of Technology would lead the e-Mental Health in Practice (eMHPrac) initiative, in partnership with the Menzies School of Health Research, The University for Rural Health at the University of Sydney, the Australian National University and the Black Dog Institute.
“One in five Australians suffers from mental illness every year, while around 45 per cent of Australians will be affected by mental illness at some stage in their lives,” Mr Dutton said.
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http://phys.org/wire-news/164539855/qut-to-lead-roll-out-of-65-million-e-mental-health-initiative.html

QUT to lead roll-out of $6.5 million e-mental health initiative

June 18th, 2014
QUT will take a lead role in delivering a $6.5 million e-mental health initiative to train primary health practitioners in the use of e-mental health services, announced by the Federal Government in Canberra today.
The e-Mental Health in Practice (eMHPrac) initiative will be led by QUT in collaboration with the Menzies School of Health Research, The University Centre for Rural Health at the University of Sydney, the Australian National University and the Black Dog Institute.
Professors David Kavanagh and Robert King, from QUT's Institute of Health and Biomedical Innovation, said the project would promote e-mental health to GPs, psychologists and allied health workers across Australia, and would train and support more than 15,000 practitioners in the use of e-mental health services.
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http://ehealthspace.org/news/doubling-delivers-dividends-austin-and-peninsula-health

Doubling up Delivers Dividends for Austin and Peninsula Health

Posted Wed, 18/06/2014 - 04:40 by Fran Molloy
Two Victorian Health Services – Austin Health and Peninsula Health – have moved to the second phase of the rollout of an ambitious electronic medical record project which has already transformed clinical care at both organisations.
The joint project was awarded the Australian Council on Healthcare Standards 2013 Quality Improvement Award for Clinical Excellence and Patient Safety in recognition of the efficiencies and safety generated by electronic drug ordering and administration, electronic radiology and pathology test ordering and the reduction of errors and test duplication.
Austin Health – comprising Austin Hospital, Heidelberg Repatriation Hospital and the Royal Talbot Rehabilitation Centre in north-east Melbourne – deals with around 100,000 inpatient admissions, 180,000 outpatient attendances and over 70,000 emergency attendances each year.
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http://www.smh.com.au/digital-life/digital-life-news/is-the-fitnesstracking-device-trend-over-20140616-zs90b.html

Is the fitness-tracking device trend over?

Date June 16, 2014

Tim Biggs

With Apple and Google each preparing software applications to track our health activities, various hardware-makers releasing all-in-one wearable smart devices and big names like Nike scrambling to get out of the way, the writing appears to be on the wall: the dedicated fitness-tracking device is over.
Last month Nike laid off the majority of its FuelBand hardware team and announced it would no longer produce the fitness-tracking band, to the surprise of many given its recent popularity and that of other smartphone-connected bands like FitBit Flex and the Polar Loop.
Yet the move may turn out to be prescient, as it's since become clear health-tracking systems integrated more directly into your tech ecosystem — specifically into the devices you already use every day — are the future. 
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http://www.medicalobserver.com.au/news/us-heart-risk-app-not-first-choice

US heart risk app not first choice

10th Jun 2014
Dr Rosemary Atkinson
The ASCVD Risk Estimator is published jointly by the American College of Cardiology and the American Heart Association to help healthcare providers estimate 10-year and lifetime risk for atherosclerotic cardiovascular disease (CVD).
Key Features
It’s similar to the Australian absolute CVD risk calculator (www.cvdcheck.org.au – also available on the Heart Foundation website and through some general practice software) but the ASCVD estimator provides risk estimates in an app format.
It varies in that it includes ethnicity and whether the patient is using anti-hypertensives, and leaves out the presence of left ventricular hypertrophy on ECG. A trap is that cholesterol needs to be converted in to mg/dL from mmol/L.
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http://www.smh.com.au/technology/sci-tech/iphone-pancreas-shows-promise-in-diabetes-test-20140616-zs9bf.html

iPhone pancreas shows promise in diabetes test

Date June 16, 2014

Nicholas Bakalar

The system consists of a smartphone hard-wired to a glucose monitor and pumps that deliver insulin or glucagon. Photo: Boston University Department of Biomedical Engineering
A portable artificial pancreas built with a modified iPhone successfully regulated blood sugar levels in a trial with people who have Type 1 diabetes, researchers have reported.
Type 1 diabetes, which usually starts in childhood or young adulthood, is a chronic condition in which the pancreas produces little or no insulin, the hormone that lowers blood sugar levels. Insulin works in conjunction with glucagon, a hormone that raises blood sugar. Together, they keep blood sugar in a healthy range.
Currently about one-third of people with Type 1 diabetes rely on insulin pumps to regulate blood sugar. They eliminate the need for injections and can be programmed to mimic the natural release of insulin by dispensing small doses regularly.
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http://www.nehta.gov.au/media-centre/nehta-publications/webinars/656-the-australian-association-of-practice-managers-aapm-and-nehta-introduction-to-ehealth-for-practice-managers-webinar-1-presentation

The Australian Association of Practice Managers (AAPM) and NEHTA: 'Introduction to eHealth for Practice Managers' - Webinar 1 Presentation

The Australian Primary Health Care Nurses Association (APNA) and NEHTA recently started hosting a new series of webinars. Webinar 1 in this series - 'Introduction to eHealth for Practice Managers' was held Wednesday 18 June 2014. Download the presentation.
Overview
  • Benefits of eHealth in your Practice
  • The foundations of the National eHealth Record System including healthcare identifiers and clinical documents such as eDischarge Summary, Shared Health Summary and Event Summary
  • The key role Practice Managers play
  • Assisting Patients to register for the eHealth Record
  • How to get your Practice eHealth ready
  • Resources available
(see NEHTA web site for multiple links)
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http://www.deloitte.com/view/en_au/au/news-research/media-releases/eeb219ef81796410VgnVCM3000003456f70aRCRD.htm

Better Health Channel app meets consumer expectations

16 June 2014:  Deloitte Digital, and the Victorian Department of Health Digital Strategy and Services team, have released the third major version of the Better Health Channel mobile app.  The app aims to help all Victorians remain as healthy as they can be, through a range of features including healthy recipes and customisable environmental health alerts and notifications. 
As consumer expectations grow and the global design aesthetic shifts, the Department of Health have kept on building upon their successes, making Victorians the envy of the rest of Australia.
Jason Hutchinson, Deloitte Digital partner said: “We have found that consumers now want more information from this app to improve their understanding of health issues and to actually manage their health and wellbeing. It is all about helping them gain easy access to health information and health services wherever and whenever the need arises.”
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www.hcn.com.au
For Immediate Release on the 16th June 2014

Mapping Australia’s Healthcare

Health Communication Network (HCN) is pleased to announce a partnership with clinical pathway solution company, Map of Medicine. This new partnership aims to provide Australian health practitioners with access to international evidence-based healthcare pathways.
Established 13 years ago in collaboration with the NHS the in UK, Map of Medicine provides healthcare professionals with the ability to produce local clinical pathways to create continuity of care and improve patient outcomes. By involving GP’s, acute clinicians and allied health professionals in the development of agreed Care Pathways, positive patient outcomes already evident; including reduced waiting times, more appropriate referrals and integrated care.
Since 2013, the program has been successfully rolled out in Australia by the Metro North Brisbane Medicare Local, with additional sites set to apply Map of Medicine shortly.  “We have had strong interest from Australia and are excited to be able to provide Australian healthcare professionals with the access to international clinical care pathways that Map of Medicine provides,” said Darren Nichols, Map of Medicine Managing Director of Commercial Operations.
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http://www.health.gov.au/internet/main/publishing.nsf/Content/foi-246-1314

FOI Request 246-1314

Documents relating to the Commission of Audit and the Department of Health
Page last updated: 11 June 2014
Documents 3, 5 and 6 are exempt from release.

In this section

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http://www.computerworld.com.au/article/547509/no_byoa_terry_white_chemists/

No BYOA for Terry White Chemists

White Retail Group manages software installation, updates with Kaseya
Adam Bender (Computerworld) on 13 June, 2014 14:49
White Retail Group is fighting against the trend known as 'bring-your-own applications' – or BYOA – due to security concerns, according to its IT manager.
The managed service provider for Terry White Chemists and medical centres across the east coast of Australia has also avoided the cloud due to regulations around storing sensitive patient data, White Chemist Group IT manager Darryl Roberts told Computerworld Australia.
White Retail Group has resisted BYOA, under which users can install personal applications for work purposes. Roberts described this as a battle of “trying to convince our users not to install Google Chrome.”
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http://www.computerworld.com.au/article/547485/series_errors_led_department_immigration_data_breach_kpmg_/

Series of errors led to Department of Immigration data breach: KPMG

Unfamiliarity with Microsoft Word, limited awareness of IT security risks may have led to asylum seekers data breach, says report
Hamish Barwick (Computerworld) on 13 June, 2014 09:50
Unfamiliarity with some Microsoft Word functions and limited awareness of IT security risks may have led to the accidental publishing of almost 10,000 asylum seekers details on the Department of Immigration and Border Protection (DIBP) website in February 2014, says a new KPMG report.
The file contained information about every asylum seeker held in Australian detention centres and on Christmas Island, as well as those in community detention, The Guardian reported at the time.
DIBP commissioned KPMG to conduct an investigation into the data breach.
In its findings (PDF), the firm found a number of factors that may have led to the incident including “time pressures, unfamiliarity with certain functions of Microsoft Word and limited awareness of IT security risks associated with online publishing".
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Enjoy!
David.
Posted by Dr David G More MB PhD at Monday, June 23, 2014 0 comments

Sunday, June 22, 2014

Guess What? Major Experts Also See The Lack Of National E-Health Leadership As A Major Problem.

This appeared a few days ago:

Leadership vacuum cripples e-health

June 19, 2014
Mark Eggleton
Australia continues to struggle with the concept of e-health, with numerous health sector stakeholders equally to blame. This was one of the key messages to come out of the recent Big Data in Healthcare roundtable held by The Australian Financial Review in partnership with GE in Sydney.
Capital Markets CRC principal adviser Dr Paul Nicolarakis suggested part of the problem was Australia lacks a vision for healthcare. He suggested we don’t have someone or a collection of individuals working towards one goal. There are numerous stakeholders across the sector all vying to be the loudest voice, yet not pursuing a common goal.
Chief scientist at The George Institute for Global Health, Professor Anushka Patel said there was no one out there explaining and selling the potential value of big data and e-health or really engaging the government in a productive manner.
“There’s potential to reduce waste and reduce healthcare expenditure without sacrificing quality of care and health outcomes,” Professor Patel said.
“I also think big data could improve our ability to ensure equity, better health outcomes and health access. Those are the two of the big policy messages that need to be conveyed.”
Professor Enrico Coiera, who is the director of the Centre for Health Informatics, said data is already on the move – it just needs to be better linked. He said there is already plenty of data that’s slowly improving quality out there.
“The job is to get that moving around the system. Cheap fees and hospitals sharing information is what we want. Importantly, let’s drop the e from e-health and just improve health services,” Professor Coiera said.
Paul Nicolarakis reiterated that part of the problem was we lack strong, informed, insightful leaders of our health system.
“With all respect to the Australian Medical Association, they are not appointed to be the leaders of the health system. Our health ministers are not health people, they aren’t clinicians or experts in health, and I think, because of these sort of structural limitations, it’s very hard to develop the idea of e-health.
More here:
http://www.afr.com/p/business/healthcare2-0/leadership_vacuum_cripples_health_VrDsiSCDYOWXyuvg54QfJN
It is hard to disagree with anything that these experts are saying. I would only add to the need for dramatically improved leadership a desperate need for a fundamental re-design of the Governance structures for e-Health.
It seems to me we are gradually moving towards improved, local and responsive management of the health sector while at the same time there has been absolutely none of that change at the national e-Health level and it really shows.
The PCEHR Review offers a good set of suggestions as to what is needed and if anything is to come from this review I believe these recommendations are fundamental and desperately required.
To quote:
“ -  Restructure the approach to governance, dissolve NEHTA and replace with the Australian Commission for Electronic Health (ACeH) reporting directly to the Standing Council on Health (SCoH).
-  Establish a Clinical and Technical Advisory Committee to ACeH.
-  Establish a Jurisdictional Advisory Committee to ACeH.
-  Establish a Consumer Advisory Committee to ACeH.
-  Establish a Privacy and Security Committee to ACeH.
-  Establish a taskforce to transition arrangements between the current governance structure and the one recommended in this report.
-  Maintain the Independent Advisory Council (IAC) with an altered reporting line, direct to the Federal Minister for Health. “
If these recommendations are not largely implemented there will be just no hope for Australian e-health in the foreseeable future.
David.
Posted by Dr David G More MB PhD at Sunday, June 22, 2014 0 comments

AusHealthIT Poll Number 223 – Results – 22nd June, 2014.

Here are the results of the poll.

Do You Have Confidence In Australian The E-Health Standards Setting Processes As They Are Being Managed By DoH / NEHTA / Standards Australia?

For Sure 3% (2)

Mostly 4% (3)

Neutral 4% (3)

Mostly Not 42% (29)

No Way 42% (29)

I Have No Idea 4% (3)

Total votes: 69

Very interesting to see most lack confidence in the present standard setting processes.

Again lots of votes and very few fence sitters this time as well.

Again, many thanks to all those that voted!

David.
Posted by Dr David G More MB PhD at Sunday, June 22, 2014 0 comments
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