Quote Of The Year

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

or

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

Thursday, September 11, 2014

Review Of The Ongoing Post - Budget Controversy 11th September 2014. It Just Rolls On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs. Some more this week.
Some reviews of the 1st year in office for the Abbott Government also.
Here are some of the more interesting articles I have spotted this 15th week since it was released.
Parliament is now up for a while and apparently do not come back until 22nd September.

General.

1 September 2014, 6.08am AEST

Australian health care: where do we stand internationally?

TThere is an old joke about one fish asking another about the state of the water and the other answering “what’s water?” When you’re immersed in something and that is your daily experience, you are not…

Stephen Duckett

Director, Health Program at Grattan Institute
There is an old joke about one fish asking another about the state of the water and the other answering “what’s water?” When you’re immersed in something and that is your daily experience, you are not able to step outside it – all you see is what you know.
But with all the talk about Australia’s health system being unsustainable, it’s useful to step back and look at the Australian health system in an international context.
So, how do we perform against our peers? The short answer is pretty well.
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AMA raises concerns over university deregulation push

02/09/2014
Australian Medical Association President Associate Professor Brian Owler has written to crucial crossbench senators urging them to oppose the Federal Government's push to deregulate university fees and reduce subsidies for Commonwealth Supported Places.
The AMA holds several concerns about the impact of these budget policy changes on medicine. As a much sought after qualification, there is a significant risk of an explosion in costs for a medical degree under the proposed university overhaul.
In his letter, A/Professor Owler said there was good evidence that high fee levels and the prospect of significant debt deters people from lower socio-economic backgrounds from entering university.
“We also know, in relation to medicine, that a high level of student debt is an important factor in career choice – driving people towards better remunerated areas of practice and away from less well paid specialities like general practice,” he added.
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Joe Hockey welcomes GDP figures, a 'pleasing set of numbers'

Date September 3, 2014 - 8:35PM

Gareth Hutchens, Georgia Wilkins

Treasurer Joe Hockey has cautiously welcomed the latest GDP figures, saying they are a "pleasing set of numbers" that show a "real and building momentum" in the economy, despite a small slowdown in economic activity in the past three months.
But he acknowledged the unemployment rate was "still too high" and economic growth remained weak overall, as Reserve Bank governor Glenn Stevens warned record house prices in Sydney and Melbourne were starting to crimp monetary policy.
The economy grew by just 0.5 per cent in the June quarter, bringing annual growth to 3.1 per cent, with most of that growth coming from firms stockpiling their goods in the face of falling exports.
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Plenty of worries in Hockey's lovely numbers

Date September 4, 2014

Peter Martin

Analysis
Reserve Bank governor Glenn Stevens' warning about house prices is instructive in two ways. One is that while he might want to give the economy a boost, ''further inflating an already elevated level of housing prices seems an unwise route to try to achieve that''.
The other is that he thinks the economy might need a bit of a boost.
It is in sharp contrast with the assessment of Treasurer Joe Hockey delivered just hours earlier. Mr Hockey told Wednesday's traditional national accounts press conference that he had just received ''a pleasing set of numbers''. There was ''real and building momentum in the Australian economy''.
Then why on earth was the governor thinking there might be a case for giving it a boost and thinking he was under pressure to further push up house prices in order to do it?
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Immigration official gets top health job

4 September, 2014 Ruby Prosser Scully
Immigration secretary Martin Bowles, who has been at the centre of controversy over the healthcare of asylum seekers in mandatory detention, is to become the new bureaucratic head of the Federal Department of Health.
Prime Minister Tony Abbott made the announcement on Wednesday, saying Mr Bowles (pictured) would replace Jane Halton, who has moved to the Department of Finance.
In his role as Secretary for the Department of Immigration and Border Protection, Mr Bowles gave evidence at July’s Human Rights Commission hearings into alleged abuses against children in detention.
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The demise of the ANPHA: why it will be ‘drinks all round’ for the alcohol industry and others

Marie McInerney | Sep 01, 2014 10:55AM
A recent seminar at the University of Sydney examined the legacy of the Australian National Preventive Health Agency (ANPHA) in an event also billed by some as “a wake for preventive health”.
In the article below, Stephen Leeder, Emeritus Professor of Public Health and Community Medicine at the University of Sydney and Editor-in-Chief of The Medical Journal of Australia, explains why some industries will celebrate this loss for public health.
We need national leadership to provide “a counterweight to the big-time, burly avarice that drives health-destroying profiteering”, he says.
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First Year Of Abbott Government Review.

Mixed report card on Tony Abbott's first anniversary as prime minister

Date September 6, 2014

Mark Kenny

Chief political correspondent

As world leaders muddled though the frustrating weeks after the downing of Malaysia Airlines flight MH17, few wanted to speak entirely frankly. Commercial contracts, strategic interests, domestic concerns, and evidentiary gaps tempered many comments.
But then, like a foghorn through the mist came a simple unvarnished truth carried on an Australian accent:
"Right at this moment, Russian forces are massing on the border with Ukraine," Australia's Tony Abbott told the world from a Sydney kerbside on August 8.
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Hockey has the right instincts, but has a long way to go to fix the economy

Date September 6, 2014

Peter Martin

Economics Editor, The Age

So confident was the Coalition that it could fire up the economy on winning office that it believed the mere act of getting elected would do much of the work.
"I think companies will unleash their balance sheets, and I think consumers will as well if there is a change of government," Joe Hockey said in the lead up to the election.
His plan was to get out of the way. "I am very mindful that we don't want to be the ones that close down that optimism," he told the business lunch in Sydney.
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Election anniversary: Health

Date September 6, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

It did not rate a mention in the election campaign, but Peter Dutton's controversial proposal for a $7 fee to visit the doctor dominated his first year as Health Minister.
The coalition's proposal, , which would apply to pathology and diagnostic imaging services such as blood tests and X-rays as well as GP visits has been almost universally condemned by health and welfare groups, who say it would hit the poor and sick hardest and increase pressure on already stretched public hospitals.
With Labor, the Greens and the Palmer United Party stridently opposed to the fee, it appears unlikely to pass the Senate, but the government remains hopeful the measure could pass with the support of the mercurial  Clive Palmer and other crossbenchers.
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Education: Abbott government year in review

Date September 6, 2014

Matthew Knott

Communications and education correspondent

It was the education revolution no one saw coming. The Coalition went to the last election without a detailed higher education policy; universities barely rated a mention during the 2013 campaign. As Opposition Leader, Tony Abbott said last year that universities only needed fine-tuning, not re-engineering.
"In an era of busy government and constant change, it's insufficiently recognised how often masterly inactivity can be the best contribution that government can make to a particular sector," Mr Abbott told Universities Australia's higher education conference. "A period of relative policy stability in which changes already made can be digested and adjusted to … is probably what our universities most need now."
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Inconvenient truths about Tony Abbott

Date September 7, 2014 - 12:00AM

Annabel Crabb

Exactly one year has now passed since the day on which Australia woke up early, puttered around for a bit, went up the polling booth, had a sausage in a bit of bread, and elected Tony Abbott as this nation's Prime Minister.
Tony Abbott as Prime Minister, with a dinosaur-collecting loon calling the shots in the Senate. After a turbulent few years aboard the Good Ship Aussie Democracy, this did not seem to be a result exactly guaranteed to restore national equanimity.
And in the past year, we have established many things about Tony Abbott, Prime Minister. Some of them are surprising. Some are not.
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Abbott Government’s first year in office: what’s the verdict on health?

Marie McInerney | Sep 05, 2014 12:27PM
This Sunday marks the first anniversary of the election of the Abbott Government.
We’ll leave it up to Croakey readers to characterise the year in health – feel free to post (publishable) comments and we’ll share them.
This post below from The Conversation by Jim Gillespie, Deputy Director of the Menzies Centre for Health Policy & Associate Professor in Health Policy at University of Sydney provides a great wrap, noting:
Abbott’s small-target election strategy left health with few promises other than the assurance that his would be a “no surprises, no excuses government”. In practice, health has become the largest arena for apparent broken promises and unexpected surprises.
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Medical Research Fund.

Financial Review Sunday transcript, August 31, 2014

Medical research

Deborah Knight, Financial Review Sunday: Well, the future of the government’s planned $20 billion medical research fund is on shaky ground, prompting corporate leaders and medical researchers to band together to try to win over a divided senate. Business argues now is not the time to skimp on health research and Health Minister Peter Dutton has told Financial Review Sunday that a smaller fund will go through with or without the controversial GP co-payment.
Chris Roberts, CEO, Cochlear: The more you invest, the more benefits you get and some of those benefits are companies like Cochlear.
Alastair Lucas, Goldman Sachs vice chair: We all understand we are living in a tight budgetary role and this $20 billion, it is a lot of money. It is our role to explain to the government, to parliamentarians, to all stakeholders, the enormous benefits that $20 billion will bring to our nation.
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Medical future fund will remain even if co-payment blocked: Dutton

Date September 1, 2014

Jessica Gardner and Jemima Whyte

Health Minister Peter Dutton says the government will push through a smaller Medical Research Future Fund if its embattled GP co-payment fails, as business and medical researchers raise the pressure to get the proposed $20 billion fund over the line.
''The medical research future fund without the co-payment will be much smaller, no doubt about that,'' Mr Dutton said on Sunday.
''If the co-payment falls over, then that is going to be a big blow to the medical research future fund.''
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Medical research fund is no gimmick: it will enhance the quality of life for all

MEDICAL research is without doubt one of the most important endeavours in the 21st century, not only because of all the inroads that have been made to date, and millions of lives that have been saved, but also because of all the inroads yet to be made. Invariably, this will save many lives. It will make a big difference to the quality of life of the families of the sick who will be spared the emotional cost of watching a loved one suffer a terminal illness.
Success will come only with continued investment from philanthropists, charitable and religious organisations, the business community and governments.
This issue has been close to my heart since a young age. As a teenager I imagined I would be a medical researcher one day, finding cures for diseases. I even pictured myself in the lab coat carrying out important work that would make a difference to a life dear to me.
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Medicare Sale and GP Trials.

Medibank chief pushes private health for chronically ill

Joanna Heath
Medibank chief executive George Savvides has defended the private health insurer’s aggressive push into primary care as the government makes final preparations for the company’s privatisation.
The diversification of the private health insurer’s business into the primary care space is expected to be a significant feature of the sales pitch to potential investors, though pilot programs are still in their early stages.
“The bigger picture is when you look at what health insurers insure, guess what, where’s the GP? Everybody knows if you want to manage the health and wellbeing of the patient, then the GP is really critical,” Mr Savvides told the Weekend AFR.
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GP Co-Payment.

GP co-payment looks set to fail in Senate

Updated: 6:29 am, Wednesday, 27 August 2014
The Palmer United Party will vote down the $7 Medicare co-payment, suggesting the budget measure will die in the Senate.
PUP senators voted unanimously against a GP charge of even one cent today.
But the government doesn't appear to be giving up the fight easily as speculation continues it's about to make concessions to garner support.
-AAP
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Palmer won't support any co-payment

August 26, 2014, 12:46 pm
The government's $7 Medicare co-payment plan appears dead, with Clive Palmer saying his party will not support a GP charge "of even one cent".
The Palmer United Party voted against the measure at a strategy meeting on Tuesday, assuring $3.5 billion in budget savings will be blocked in the Senate.
Labor and the Greens are also opposed to the unpopular payment.
Mr Palmer said he and his senators had unanimously decided not to support a doctor's charge.
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Federal assistant minister for health Fiona Nash defends $7 Medicare co-payment while on Bunbury health tour

By James Taylor

Sept. 5, 2014, 2:46 p.m.
THE federal assistant minister for health has used a tour of the South West Aboriginal Medical Service clinic to defend applying the government's proposed $7 Medicare co-payment to the service.
Senator Fiona Nash joined Nationals member for the South West Colin Holt MLC and SWAMS chief executive officer Neil Fong for a look at the Bunbury-based clinic on Friday.
The contentious co-payment  would apply to all Medicare-funded consultations, including those provided by 20 Aboriginal health services across regional and metropolitan Western Australia, including SWAMS.
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Pharmacy Related Articles.

Let us do more, say pharmacists

Joanna Heath
The Pharmacy Guild has a rare ­reputation in Canberra’s corridors of power: what it says, goes.
But if you ask the chief executive, George Tambassis, the pharmacy owners’ union gets its influence only if it acts like a model citizen.
“I think I’m at the helm of a very respectful organisation and with respect, others can ponder whether power comes with that. Everywhere I go, and I meet people from inside and outside pharmacy, there is always a lot of respect for the Pharmacy Guild.”
A few people might disagree, namely Roger Corbett, former chief executive of Woolworths, who publicly clashed with the guild in the early 2000s over an attempt to introduce pharmacies into his supermarkets. He described the pharmacy industry as “the biggest anti-competitive ­gerrymander in Australia”.
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Guild push for expansion of remunerated services

2 September, 2014 Christie Moffat
Pharmacy Guild leaders are boosting their ongoing public relations campaign by outlining a range of opportunities that exist for remunerated serivces in community pharmacy.
The push for community pharmacy to take on a greater role in providing health care services was emphasised by Guild NSW president Paul Sinclair, who addressed the International Pharmaceutical Federation (FIP) in Bangkok this week.
Mr Sinclair noted that vaccinations, home support for older people, and pain management services all offered an opportunity for community pharmacy to contribute to the primary health care sector.
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Pharmacists plan plunder of primary care, says AMA

THE federal Government must immediately rule out doing a deal with the Pharmacy Guild of Australia to provide medical health checks at chemist shops, says the Australian medical Association.
Sydney media yesterday (Tuesday, September 2) reported the guild is planning a multimillion-dollar advertising campaign to back up its lobbying efforts for pharmacists to take over the role of doctors in primary care, says AMA president Associate Professor Brian Owler.
The guild is not behaving like a “model citizen” in the health community, he says in a statement today (Wednesday, September 3).
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Keep ‘chemist shop’ owners out of primary care: AMA

3 September, 2014 Christie Moffat
The Australian Medical Association (AMA) says Guild proposals to expand the role of pharmacy are proposing a “dangerous and irresponsible” model of primary care.
AMA president Professor Brian Owler (pictured) said that the Pharmacy Guild of Australia was using primary health care as a “bargaining chip” to secure the best deal for pharmacy owners, not patients, under the upcoming Sixth Community Pharmacy Agreement (6CPA).
The response follows recent reports that the Guild has launched an expansive media campaign to lobby for expanded services in pharmacies, with the aim of receiving government remuneration.
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Professional service caps likely to remain

1 September, 2014 Christie Moffat
Caps on professional service numbers are likely to be retained in the Sixth Community Pharmacy Agreement (6CPA), leading Guild officials believe.
However, negotiations over the Sixth Community Pharmacy Agreement (6CPA) are unlikely to affect current ownership or location rules.
Speaking at a panel discussion at the annual Australian College of Pharmacy conference in Hobart, Guild figures Ian Todd (pictured), John Dowling, Trent Twomey and Tim Logan addressed issues surrounding the upcoming negotiations.
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Pharmacy furore hots up

The furore over pharmacists’ bid to expand into paid primary care has heated up, with the industry’s peak professional body hitting back at the AMA view that the idea is “dangerous and irresponsible”.
The pharmacists want to give vaccinations and receive government funding for checking cholesterol and blood pressure, but AMA head Professor Brian Owler says this will fragment patient care, and undermine the doctor-patient relationship.
Pharmaceutical Society of Australia vice-president Joe Demarte hit back on Friday, saying: “Pharmacists do not want to take over the role of doctors, and to reduce discussion about our future role to that level is a disservice to doctors, pharmacists and the Australian public.”
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Medicare Locals.

Hunter Medicare Local Chair resigns

Posted yesterday at 2:34pmTue 2 Sep 2014, 2:34pm
The board chair of Hunter Medicare Local has become the organisation's latest senior appointment to resign.
Karen Howard has told Hunter Medicare Local today her resignation is effective immediately.
Former chief executive officer Carol Bennett resigned suddenly in June, after a short stint in the top job.
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Hunter Medicare Local appoints Dr Trent Watson as new chair

By ASHLEIGH GLEESON
Sept. 5, 2014, 10:18 a.m.
THE Hunter Medicare Local board has appointed Dr Trent Watson as the organisation’s new chair after the shock resignation of Karen Howard on Wednesday.
Dr Watson is a practicing dietician and the CEO of Ethos Health.
He works in consultancy positions with a number of professional sports organisations. He also works with Channel 10’s the Biggest Loser.
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Comment:
It seems the fuss is not yet settled - and Mr Palmer, who will have a major influence on outcomes, seems more unpredictable than ever.
Lots to browse with all sorts of initiatives seemingly slowed or not being voted on - like the Co-Payment.
One really has to wonder if all this security alarm is not meant to distract from the Budget….
I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day!
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:
Enjoy.
David.

Wednesday, September 10, 2014

There Is An Important Lesson Here For The Management Of Private Health Information - Electronic Or On Paper.

This appeared a few days ago.

Privacy breach in release of records to hostile ex-husband

2nd Sep 2014
A MAJOR Sydney hospital breached a patient’s privacy by giving her hostile ex-husband their children’s medical records containing information about her health, a tribunal has found.
The patient, identified only as AJD, has received treatment from the Royal Prince Alfred Hospital for a serious, chronic illness and also delivered two children at RPA’s maternity wing.
She complained the hospital breached her privacy and made her feel unsafe by handing her former husband the children’s records relating to the time around each of their births, including information describing her health matters as well.
The parents were divorced but retained equal custodial rights and responsibilities for the children.
In an internal review of the matter, the hospital conceded that information about AJD’s health was contained in the children’s medical records it provided to the father. But the review found no breach of Health Privacy Principles (HPPs).
In evidence before the NSW Civil and Administrative Tribunal, AJD stated her ex-husband had a history of hostile and violent behaviour and has used information from the records to attack her.
She contended her ex-husband had not previously been aware of some of the information and he had used it in the Federal Court and the Family Court to pursue sole parental responsibility for the children.
Lots more here:
Clearly the husband had a right to the children’s information but clearly he did not have a right to his divorced wife’s record.
Bottom line is therefore a record may need to be segmented and carefully reviewed prior to release - especially to a previous estranged partner.
You also certainly cannot just hand over an electronic without a careful review to be sure only the appropriate and authorised party’s information is released.
Tricky but important.
David.

Tuesday, September 09, 2014

An Interesting Review Of Implementation Of EHRs In Hospitals. The Obvious, and Important, Seems To Get Up!

This appeared a few days ago:
Research article

Implementing electronic health records in hospitals: a systematic literature review

Albert Boonstra, Arie Versluis and Janita F Vos
BMC Health Services Research 2014, 14:370  doi:10.1186/1472-6963-14-370
Published: 4 September 2014

Abstract (provisional)

Background

The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.

Methods

A systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria.

Results

Of the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process.

Conclusions

Although EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies for hospitals.
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You can access this abstract and the full article in .pdf.
The most obvious comment is that the literature must be of rather low quality if of 364 articles only 21 were worth analysing!
The suggested interventions that appear to make a difference are, to me obvious but for some reason many of them are ignored are really summarised on pages 19 and 20..
“Some of the findings require further interpretation. Contextual finding A1 relates to the demographics of a hospital. One of the assertions is that privately owned hospitals are less likely than public hospitals to invest in an EHR. The former apparently perceive the costs of EHR implementation to outweigh the benefits. This seems remarkable given that there is a general belief that information technology increases efficiency and reduces process costs, so more than compensating for the high initial investments. It is however important to note that the literature on EHR is ambivalent when it comes to efficiency; several authors record a decrease in the efficiency of work practices [25,33,35,38], whereas others mention an increase [29,31]. Finding A2 is a reminder of the importance of carefully selecting an appropriate vendor, taking into account experience with the EHR market and the maturity of their products rather than, for example, focussing on the cost price of the system. Given the huge investment costs, the price of an EHR system tends to have a major influence on vendor selection, an aspect that is also promoted by the current European tendering regulations that oblige (semi-) public institutions, like many hospitals, to select the lowest bidder, or the bidder that is economically the most preferable [45]. The finding that EHR system implementation is difficult because good medical care needs to be ensured at all times (A6) also deserves mention. Essentially, many system implementations in hospitals are different from IT implementations in other contexts because human lives are at stake in hospitals. This not only complicates the implementation process because medical work practices have to continue, it also requires a system to be reliable from the moment it is launched.
The findings regarding the content of the EHR system (Category B) highlight the importance of a suitable software product. A well-defined selection process of the software package and its associated vendor (discussed in A2) is seen as critical (B5). Selection should be based on a careful requirements analysis and an analysis of the experience and quality of the vendor. An important requirement is a sufficient degree of flexibility to customize and adapt the software to meet the needs of users and the work practices of the hospital (finding B1). At the same time the software product should challenge the hospital to rethink and improve its processes.
A crucial condition for the acceptance by the diverse user groups of hospitals is the robustness of the EHR system in terms of availability, speed, reliability and flexibility (B2). This also requires adequate hardware in terms of access to computers, and mobile equipment to enable availability at all the locations of the hospital. Perceived ease of use of the system (B4) and the protection of patients’ privacy (B4) are other content factors that can make or break EHR implementation in hospitals.
The findings on the implementation process, our Category C, highlight four aspects that are commonly mentioned in change management approaches as important success factors in organizational change. The active involvement and support of management (C1), the participation of clinical staff (C2), a comprehensive implementation strategy (C4), and using an interdisciplinary implementation group (C5) correspond with three of the ten guidelines offered by Kanter et al. [46]. These three guidelines are: (1) support a strong leader role; (2) communicate, involve people, and be honest; and (3) craft an implementation plan. As the implementation of an EHR system is an organizational change process it is no surprise that these commonalities are identified in several of the analyzed articles. Three Category C findings (C2, C6, and C7) concern dealing with clinical staff given their powerful positions and potential resistance. Physicians are the most influential medical care providers, and their resistance can delay an EHR implementation [23], lead to at least some of it being dropped [21,22,34], or to it not being implemented at all [33]. Thus, there is ample evidence of the crucial importance of physicians’ acceptance of an EHR for it to be implemented. This means that clinicians and other key personnel should be highly engaged and motivated to contribute to EHR. Prompt feedback on requests, and high quality support during the implementation, and an EHR that clearly supports clinical work are key issues that contribute to a motivated clinical staff.”
The whole paper is useful as a baseline commentary on what to watch out for and suggests many things that can be done to ameliorate potential issues.
I suspect this is going to become a much referred to paper and needs to be ‘on the shelf’ of all implementers!
David.

Monday, September 08, 2014

Weekly Australian Health IT Links – 08th September, 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

A quiet week with no real news from the Government, at its 1st Anniversary on E-Health. Consultation, as it has been called, is over and now we all await an outcome. I wonder will having a new Secretary of the Department of Health have an impact. He does not have the same vested interest in the PCEHR as Ms Halton did!
Otherwise more news on the NBN, and some interesting feedback on doctor / patient e-mail.
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Online CBT could help stop suicides

3 September, 2014 Kate Aubusson
An online CBT program could help combat suicide by effectively treating major depression, Australian researchers say.
Internet-based CBT site ‘This Way Up' not only eased depression but reduced suicidal ideation, found the study of 484 patients.
The prevalence of suicidal ideation dropped from 50% to 27%, while probable major depression dropped from 71% to 28% after treatment, reported the authors at the University of NSW School of Psychiatry.
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GP's drug typo leaves man dead

  • AAP
  • September 01, 2014 3:47PM
A DOCTOR and a pharmacist missed eight opportunities to save an elderly New Zealand man who died because a typographical error on his prescription caused him to overdose.
CORONER Christopher Devonport has criticised a Dunedin medical centre and pharmacy for failing to pick up an error on a prescription for the powerful arthritis drug Methotrexate that should have read "3 x weekly", not "3 x daily".
The medical professionals involved - including a GP, a nurse and a pharmacist - missed eight opportunities to correct the lethal mistake that could have saved the life of 72-year-old Kenneth Douglas, Mr Devonport said.
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NSW pairs up on ehealth approach

Since starting its official duties on 1 July this year eHealth NSW’s specialised ehealth focus is already demonstrating its value in NSW. 
“It was realised that we needed to work in partnership across a federated system to deliver the applications and infrastructure needed to ensure clinicians could undertake their work effectively and that corporate systems were also delivered functional and on time,” said eHealth NSW chief executive and chief information officer, Michael Walsh, at a recent AIIA presentation in Sydney.
While Walsh focused on the non-clinical aspects, Dr John Lambert, formerly Director of Intensive Care for Western NSW Local Health District in Orange. displayed his understanding and passion for all things clinical and technical after just 7 days in the Chief Clinical Information Officer role. 
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La Trobe University Bundoora students develop e-Nurse technology

  • Tessa Hoffman
  • Preston Leader
  • September 02, 2014 12:00AM
THE ‘e-Nurse’ may not possess the milk of human kindness, but its La Trobe University Bundoora inventors say the technology is tipped to revolutionise care for the chronically ill.
Run through wireless mobile phone networks, the e-Nurse enables doctors to monitor patients, view and modify their medical data remotely and connects to a “smart pillbox” which alerts medical professionals and carers when patients do not take their medicine.
The technology, developed by a team of final-year computer and electronic engineering students from La Trobe University’s Bundoora Campus, won the best technical development award and received an overall “highly commended” in Telstra’s 10-week M2M University Challenge for students from across Australia.
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Abbott names new chief for health

As the Abbott government approaches its first anniversary in government, the Prime Minister has moved to fill two of the Public Service’s most glaring top level vacancies, announcing new heads for the Department of Health and the Attorney General’s Department.
Martin Bowles PSM will move across town from the Department of Immigration and Border Protection to take on the top job at the Department of Health on a five year contract from 13 October 2014, an appointment that backfills the appointment of Jane Halton to head the Department of Finance.
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Hackers Are Homing in on Hospitals

Computer criminals are increasingly capturing valuable information stored on hospital computer networks.

Why It Matters

The shift from paper medical records to digital ones brings new security risks.
Cybercriminals are increasingly targeting the computer networks of hospitals—one recently announced theft involved data from 4.5 million people who had received treatment from Community Health Systems (CHS), a company that runs more than 200 hospitals. Malware attacks are on the rise in many industries, but researchers from the security firm Websense say the rate at which attacks on hospitals has grown during the past year is unparalleled.
Data security is often lax within health-care facilities, and hackers are targeting systems that store troves of valuable personal information held in electronic medical records, according to the Websense researchers, who say they’ve observed a 600 percent increase in attacks on hospitals over the past 10 months.
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20 Questions for Health IT

Posted on September 2, 2014 by Grahame Grieve
“20 Questions for Health IT” is a project being run by Chad Johnson from HL7Standards.com:
Beginning Tuesday, Sept. 2., we will begin publishing one health IT topic per day from 20 different individuals with a deep understanding of the topic. The author of each question was generous enough to stick her or his neck out and pose a short answer to the question in the hopes it will encourage further discussion in the comments section and also on Twitter using the #20HIT tag.
I’m honoured to be one of the 20 individuals. I’ve seen some of the topics that are coming, and it looks like it’s going to be pretty interesting. Hopefully Chad will post a summary for non-twitterers.
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To email, or not to email, that is the question

3 September, 2014 Amanda Davey
As a patient, I’d like to be able to email my GP for clinical advice, to request a repeat prescription or to get the lowdown on my test results.
However, my local practice doesn’t seem terribly keen on this idea, which is a shame because email would be so much more convenient for me.
And if done properly, I can’t see why it wouldn’t benefit my doctor as well.
In Australia the general consensus among health professionals is that email makes more work for already hard pressed doctors and threatens patient safety.  And that’s pretty much the thinking in the UK.
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Should patients be able to email their GP?

4 September, 2014
Email services are either more convenient for patients and make better use of clinicans' time, or make more work for already hard pressed healthcare professionals and threaten patient safety, argue two doctors in The BMJ this week.
The UK government sees the use of email contact and e-consultations as a means of boosting patient access to primary care and is piloting these services in 20 general practices in England.
Poll Result:
Do you think your patients should be able to email you?
Yes – as an alternative to a follow-up phone call  22.22%   
No – the idea it fills me with dread  76.67%   
Don't know  1.11%   
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Young entrepreneur wins technology's iAward for helping kids with cystic fibrosis

Date September 1, 2014

Ben Grubb

Deputy technology editor

A 23-year-old University of Queensland engineering student has been rewarded for his creation of a medical device he hopes will improve the lives of children suffering from respiratory problems, winning the Young Innovator of the Year award at information technology's night of nights in Melbourne.
Much like TV's Logies, the peak Australian technology industry bodies hold an awards night each year, called the iAwards.
I thought I could sit there and write Flappy Bird 2 or I could devote myself to something like this and I [ thought] this was the best use of my skills and the resources I have at hand. 
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Privacy breach in release of records to hostile ex-husband

2nd Sep 2014
A MAJOR Sydney hospital breached a patient’s privacy by giving her hostile ex-husband their children’s medical records containing information about her health, a tribunal has found.
The patient, identified only as AJD, has received treatment from the Royal Prince Alfred Hospital for a serious, chronic illness and also delivered two children at RPA’s maternity wing.
She complained the hospital breached her privacy and made her feel unsafe by handing her former husband the children’s records relating to the time around each of their births, including information describing her health matters as well.
The parents were divorced but retained equal custodial rights and responsibilities for the children.
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Healthdirect Australia sees value in open source for security solution

Chief architect Bruce Haefele says it prefers to use open source as it relies on taxpayer funding
Hamish Barwick (Computerworld) on 02 September, 2014 14:15
Commonwealth and state/territory government funded public company, Healthdirect Australia, has used open source software to build an identity and access management (IAM) solution.
The IAM solution allows users to have one identity across all of its websites and applications. For example, users can sign in using their Facebook, LinkedIn or Gmail account.
Healthdirect Australia chief architect Bruce Haefele told Computerworld Australia that a single sign in is important as it runs a number of health advice websites such as pregnancy/baby care for new parents.
“We work with other partners in the [health] industry to make information available that is appropriate for Australians and meets health guidelines. It’s not as random as searching Doctor Google,” he joked.
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YouTube no lifesaver

1 September, 2014 
Among the thousands of YouTube educational videos on CPR, only a handful are consistent with recent health guidelines, research shows.
Published in Emergency Medicine Australasia the study finds that YouTube is no substitute for the real thing when it comes to basic life support instruction.
Of the many thousands of videos produced by the search results "CPR", "cardiopulmonary resuscitation", "BLS" and "basic life support", most were excluded for a variety of reasons, including being irrelevant, being recorded in languages other than English and being accompanied by advertisements.
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Apple creates privacy rules for HealthKit software

  • Clint Boulton
  • The Wall Street Journal
  • September 01, 2014 7:15AM
APPLE has warned developers that they must not provide advertisers with personal data that they collect from applications built using the company’s health software.
The policy — consistent with the practices of companies such as FitBit — establishes a higher standard of privacy for health monitoring devices.
Apple’s HealthKit software is a key component of it next mobile operating system, iOS8, which is expected to launch next month.
With the user’s permission, HealthKit can integrate with and collect data from any health device or app, and share it with electronic health record software that connects patients with caregivers.
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Singapore hospital pilots telehealth for heart patients

Summary: Changi General Hospital launches the country's first tele-heath initiative for heart failure patients, providing them with devices to monitor their health and remotely send the data to healthcare service providers.
By Eileen Yu for By The Way | September 4, 2014 -- 09:49 GMT (19:49 AEST)
A Singapore hospital is piloting the country's first telehealth initiative targeted at heart failure patients that encompasses the use of devices to monitor their health. 
Changi General Hospital (CGH), with the help of healthcare services providers Eastern Health Alliance and Philips Healthcare, said it was rolling out the programme with the aim to provide tele-monitoring, tele-education, and tele-care support. In a joint statement released Thursday, the three partners said the pilot had commenced in June and they are looking to enrol some 160 heart failure patients by October 2015. The programme is aimed at encouraging these patients to take better care of their health and reduce the risk of hospitalization as well as premature death.
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Turnbull's whiteboard NBN-Lite justification doesn't add up

Date September 1, 2014
You can't compare fibre-to-the-premises to fibre-to-the-node without looking at the big picture.
The long-awaited NBN Cost-Benefit Analysis arrived last week and was seized on by the government to justify its preference for a multi-technology mix approach to the NBN, rather than the original plan of running fibre to almost every home. If you're still not convinced that the scaled-back NBN is a bargain, Communications Minister, Malcolm Turnbull, is happy to spell it out for you on a whiteboard – in a video explaining why fibre-to-the-node (FttN) is more cost-effective than fibre-to-the-premises (FttP).
Of all the flak the government copped in the media last week over the NBN, Turnbull singled out my comments – Government low-balling us on second-rate NBN – for rebuke. Turnbull challenged my use of the word "ignored", because I said his whiteboard calculations favouring FttN ignored the hidden costs of the multi-technology mix such as upgrading and maintaining the copper and HFC cable networks. He called on me to correct my mistake and apologise for misleading readers by claiming these costs were ignored.
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Limitations in the NBN cost-benefit review

Comment
David Havyatt
The much anticipated cost-benefit analysis (CBA) into the national broadband network released last week is more informative about the limitations of the methodology than it is about the NBN. It also contains valuable lessons for those in the ICT community who want to sell the value their industry can create.
The good news is that the report found that both the Multi-Technology Mix (MTM) and a Fibre to the Premises (FTTP) rollout would provide a net social benefit. It found the MTM provided a higher benefit.
Despite the report’s 196 pages of words and tables, it is easy to dismiss its conclusions because of the number of assumptions on which it is based. The review has included a range of sensitivity analyses, but as it doesn’t show the detail of its analysis it is hard to determine the impact of any specific assumption.
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NBN fibre rollout was going to be cheaper, faster, pilot results show

Date September 6, 2014 - 1:14AM

David Braue

Labor's all-fibre national broadband network could have been delivered faster and for less money than originally forecast, according to the confidential results of a  pilot study completed last month.
The pilot took into account design changes formulated by network builder, NBN Co, last year as then chief executive Mike Quigley undertook a substantial review of the project and identified initiatives to reduce its cost and length.
The changes, which include adjustments flagged in the "radically redesigned" fibre-to-the-premises option in the government's NBN Strategic Review, were tested for the first time in a scheduled deployment to 2484 premises in Melton, Victoria.
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Enjoy!
David.

Sunday, September 07, 2014

The View From The Coalface Regarding The EPAS in South Australia. Not Good News!

I had an unsolicited e-mail asking about the future in Health IT in OZ and commenting on the clinical user experience of EPAS in South Australia a few days ago.
Here is an edited version of what was written re EPAS - with the identity of the writer obscured totally.
To quote:
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I came across your blog recently after googling e-health in Australia as I am becoming increasingly frustrated by the incompetencies of the government here.
I have recently had the pleasure of being forced into using SA's outsourced, over-budgeted, under-cooked mess of a program called EPAS.
How is it that a government with a budget of >$420M for a single ICT project was unable to, firstly, build the project in-house (and creating hundreds of IT and healthcare jobs in the meanwhile) and, secondly, end up buying such a mess of a program? EPAS is convoluted, it's difficult to use, it's buggy and crashes and it's an absolute user interface nightmare. It makes me cry thinking that this is what we are meant to use for the next 10-20 years. How is this even remotely possible?
I have a clinical background with some knowledge of IT. Not once did we see an ad looking for people who have a background in medicine + IT in order to help them with this project. Not once did they put it out to the public/relevant parties regarding whether this is a viable system.
As it stands, EPAS takes everything we have and makes it significantly more difficult (increasing times to do simple things like write a progress note from simply opening the notes and writing something down to 10+ clicks and multiple sources of possible errors). It appears that we have been taken for a ride and someone has made an awful lot of money off us. 
---- End quote:
Now while I am not sure anyone should be attempting to develop a major hospital EHR from the ground up (as I think that would be a very courageous decision) it is clear that, given the apparent success we have seen here, that some very poor selection and implementation decisions have been made - as the very least in the way clinicians have been treated.
SA Health would really seem to have got into a lot of trouble with all this:
You can read the view from the SA Government here:
The comments following this blog fit very nicely with what is written above - so sounds like we have a disaster in the making.
Sad about that. I hope there are some serious efforts being made to recover!
David.

AusHealthIT Poll Number 234 – Results – 7th September, 2014.

Here are the results of the poll.

Does Provision Of Effective Telehealth Require Fibre To The Premise (FTTP) Or Will The Coalition Plans (FTTN) For The NBN Be Adequate?

FTTP Is Critical 3% (3)

FTTP May Be Required 16% (16)

Neutral 11% (11)

FTTN Is Probably Enough 35% (36)

FTTN Is Perfectly Fine 35% (36)

I Have No Idea 1% (1)

Total votes: 103

This is a pretty clear outcome. 70% seem to think FTTN is OK and only 3% see FTTP as critical.

Again, many, many thanks to all those that voted!


David.