Quote Of The Year

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

or

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

Tuesday, November 07, 2017

The Problems With EPAS At SA Health Do Not Seem To Be Easing Off Just Yet, But Some Positive Impacts Are Being Seen.

This appeared a few days ago:

EPAS cost blows out again

EXCLUSIVE | The cost of SA Health’s troubled electronic patient records system EPAS has blown out to almost half a billion dollars after the department was forced to ask Cabinet for another $49 million to pour into it, InDaily can reveal.
Bension Siebert @Bension1
Adelaide Friday November 03, 2017
The department approached Cabinet last month to request the extra funding for EPAS, raising the cost to taxpayers from $422 million to $471 million over the 10 years to 2021.
SA Health confirmed the increased cost to InDaily this morning. InDaily understands Cabinet has approved the request.
Doctors have repeatedly warned that EPAS slows down emergency carethreatens patient safety and blows out waiting lists.
In August, almost one in five medical staff using EPAS who responded to an Australian Medical Association survey blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.
However, SA Health figures show medication errors have reduced at sites where EPAS has been implemented.
SA Health Deputy Chief Executive Don Frater told InDaily in a statement this morning that the increased budget for the e-health records system would help improve its performance.
“Forecast EPAS expenditure includes the implementation of a major system upgrade to increase efficiencies, provide more advanced security and faster overall system performance,” he said.
“More than 340,000 South Australians have benefitted from having an electronic patient record within EPAS so far, and more than 20,000 staff and students have been trained in the system.
“Implementing the new system is an ongoing process and we continue to work closely with staff and clinicians to resolve concerns and make improvements to EPAS where necessary.”
SA Health expects to install EPAS at Flinders Medical Centre, Hampstead Rehabilitation Centre and Mt Gambier Hospital in 2018.
The system is partially installed at the new Royal Adelaide Hospital, providing administrative support but only some clinical functions.
“As we have previously said, we will implement the remaining clinical functions at the RAH progressively, with a view that all functions will be in use by early 2018,” said Frater.
SA Health figures show sites which use EPAS have enjoyed a significant fall in medication errors since having the system installed.
Errors fell from an average five per cent (one in 20) to 0.003 per cent (one in 3000) at those sites.
The proportion of patients leaving hospital with incorrect medication, without required medication or with medication they did not need fell from 12 per cent before the installation of EPAS to 3.5 per cent afterwards, according to the figures.
And more medical records – 94 per cent at the EPAS sites – now document patients’ medication allergies, up from 84 per cent at those same sites pre-EPAS.
However, an AMA survey, released earlier this year, revealed almost 20 per cent of respondents blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.
Forty per cent of respondents who had been using the system for more than two years said their opinion of EPAS was poor, while 18 per cent reported their opinion of the system was worse after they became familiar with it.
In the category of “near misses”, one respondent – who had been using EPAS for more than two years – reported this anecdote:
A patient had a cardiac arrest during a previous anaesthetic and presented one month later for a repeat try. After 90 minutes of searching by several staff members, the previous anaesthetic chart could not be found. The second anaesthetic had to be conducted without full knowledge of what had happened and why during the previous anaesthetic. (2+ years user)
More here:
There is a lot to this article of which the least important to be is the cost increase. The positive impacts of some clinical measures and the apparent ongoing frustration with the safety and use of the system are much more important.
The article is worth a close read.
David.

Monday, November 06, 2017

Weekly Australian Health IT Links – 6th November, 2017.

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 very quiet week I have to say – but many comments on the blog so many seem engaged which is great!
Enjoy the Melbourne Cup as the main feature of the week – as well as the RBA interest rate decision for the month and hour or two before.
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Making better use of My Health Record data submission

The ‘My Health Record’ data should be made available to policy researchers to improve the quality of health care in Australia. The primary purpose of the My Health Record data is to provide a central, lifelong depository for each patient’s medical records in an electronic format accessible by providers and patients. But the data should also be able to be analysed to understand wider patterns and trends in health care. As the Productivity Commission has noted: “There are compelling grounds to use My Health Record as a platform for providing clinically-proven advice to patients, rather than just as a method for collecting data for clinicians.” But in this submission, Grattan Institute Health Program Director Stephen Duckett cautions that wider release of the data should only happen in ways that appropriately protect the privacy of patients and providers.
30 Oct 2017
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Better use of technology should be the first priority for any healthcare service provider: Tim Kelsey

The cost on society of a paper based health service is enormous, the inefficiencies are tremendous, clinicians find their administrative burden takes them away from those crucial moments in which they can counsel their patients.October 31, 2017, 08:13 IST
interview with ETHealthworld, Tim Kelsey, Chief Executive of the Australian Digital Health Agency, talks about the role of technology in expanding healthcare services. Edited excerpts:

About Australian Digital Health Agency
The Australian Digital Health Agency was setup in July last year and the intention by all the governments of Australia was to harness the power of modern information revolution to empower and enable clinicians to offer the industry, entrepreneurs and innovators a new platform for delivery of new services for patients and citizens and to provide citizens with new ways in which they can engage with the health and wellbeing. The agency has recently had the new national digital health strategy approved by the governments of Australia and that calls out seven key priorities for Australia.
Programme priorities
The first of these is a programme to give every Australian citizen a personal mobile health record which they can access through the mobile telephone. They can access online, which they can share with their clinicians if they choose to. The programme will have given all Australians access to by the end of 2018 unless they choose not to have one. So, that’s the priority and new strategy.
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3 November 2017

First the rugby, now national e-health records

Posted by Jeremy Knibbs
What is it about small countries that are cold, wind beaten, have highlands, and lots of woolly hooved livestock? Both New Zealand and Scotland punch well above their weight in sport, especially rugby. And both do the same in digital health.
If you’d like a few answers to the digital health side of this strange cultural phenomenon Dr Libby Morris, clinical lead on Scotland’s SPIRE program, the pragmatic and so far successful equivalent to our My Health Record saga, might have a few. Dr Morris is the keynote speaker at next week’s annual summit of the Medical Software Industry Association (MSIA) being held in Melbourne.
To offer appropriate contrast, Tim Kelsey, and others from the Australian Digital Health Agency, will be there as well, spruiking the “Australian way”. It will be worthwhile seeing the two countries head to head. The approaches of both are a long way apart, and most commentators have Scotland a long way in the lead, despite starting five years after us. 
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Decluttering your medical history with My Health Record

Under My Health Record, your medical history including prescriptions, GP visits and pathology reports are all stored in the one place – an online database.
The record, rolling out as part of the government’s National Digital Health Strategy, aims to declutter decades of physical records and offer a more personalised approach to care.
Meredith Makeham, Chief Medical Advisor at the Digital Health Agency, spoke at the Health Tech Forum at the University of Technology Sydney about transitioning healthcare online and the origins of the Agency.
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An Introduction to My Health Record

When: Thursday, 23rd November 2017
Time: 5:00 pm - 6:00 pm AEDT
Where: Online - join via your computer!
Your Host: Kris Hazelwood, Senior My Health Record Educator
About the Webinar
This webinar will introduce My Health Record and outline its benefits, features and functionalities. It will be useful for healthcare providers who are new to My Health Record and wanting to learn what it is and how it can enable better information-sharing and improved clinical outcomes.  
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EPAS cost blows out again

EXCLUSIVE | The cost of SA Health’s troubled electronic patient records system EPAS has blown out to almost half a billion dollars after the department was forced to ask Cabinet for another $49 million to pour into it, InDaily can reveal.
Bension Siebert @Bension1
Adelaide Friday November 03, 2017
The department approached Cabinet last month to request the extra funding for EPAS, raising the cost to taxpayers from $422 million to $471 million over the 10 years to 2021.
SA Health confirmed the increased cost to InDaily this morning. InDaily understands Cabinet has approved the request.
Doctors have repeatedly warned that EPAS slows down emergency carethreatens patient safety and blows out waiting lists.
In August, almost one in five medical staff using EPAS who responded to an Australian Medical Association survey blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.
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3 November 2017

The problem with knowing everything

Posted by Felicity Nelson
 “You have to be realistic, with a heart condition like yours.”
“Mom, there’s a chance there’s nothing even wrong with my heart.”
“One chance in a hundred!” 
– Science fiction film Gattaca, 1997
There are uncomfortable moments in history where reality and science fiction collide. The marketing of whole genome sequencing to healthy patients in Australia is one such occasion.
When the first human genome was sequenced 14 years ago, it cost around $3 billion. Since then, the technology has plummeted in price.
Now, for the first time, it is possible for healthy adult Australians to have each letter in their DNA spelled out – for a total cost of $6400.
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Machines can’t replace us: NAPSA

Pharmacy students say the Productivity Commission’s report displays its ignorance on pharmacy

The National Australian Pharmacy Students’ Association issued a statement in which it says it supports some of the recommendations made by the Commission, but condemns others.
“NAPSA supports the review’s recommendation of integrating pharmacists in the healthcare team to combat the rising incidence of complex chronic diseases,” it says.
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Clinical Informatics in Australia: A temperature check

Clinical governance emerged as a key priority in our recent survey of the HISA Clinical Informatics Community of Practice. More than half of the respondents said clinical governance for implementing systems or process changes was a priority for the coming year. The survey was a temperature check on the state of clinical informatics and organised by HISA for the Community of Practice.
  • Nearly half of the 150 members of the Community of Practice responded  (48.7%)
  • Around 80% were mid to late-career, primarily working in public hospitals (50.94%) and 33% of respondents had a clinical background. Most live on the east coast of Australia (NSW, Qld, VIC)
  • Nearly half (49%) of respondents were from organisations that already had an EMR in operation, with another 37.3% progressing towards it (in either procurement planning or implementation mode)
  • Not surprisingly, digital health is spawning a new member of the C-Suite, the Chief “X” Information Officer (CXIO). Around half (51%) of organisations had someone in this role. For those with a CXIO, there was some variation in the clinical discipline of the incumbent which in turn influenced the role title. The most popular CXIO was the CMIO
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Breathing easy, free of pain — all thanks to Aussie 3D technology

  • The Australian
  • 12:00AM November 4, 2017

Sarah-Jane Tasker

American student Penelope Heller was facing a life of chronic pain, with the simple act of breathing a difficult task, but a Google search uncovered a Melbourne medtech company that could build her a 3D sternum and ribcage and transform her future.
The 20-year-old had a jetskiing accident in 2014 and while being treated for her injuries doctors located a tumour, which had to be removed, along with part of her sternum and ribcage. The original reconstruction work on her sternum and ribcage failed and she was not able to breathe properly.
Ms Heller said she was too young to face a life of pain, so she hit the internet and found Australian company Anatomics and its 3D solution.
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Australian Government grants to fund pioneers in 3D printing and precision medicine

Lynne Minion | 02 Nov 2017
Visionaries in the 3D printing of body parts and precision medicine are being urged to apply for $5 million in grants as part of the Australian Government’s investment in cutting-edge ideas and breakthrough discoveries, MTPConnect announced today.
Designed to move revolutionary technologies from proof-of-concept stage to commercialisation, the investments through the BioMedTech Horizons program are aimed at stimulating collaboration between the research, industry and technology sectors.
Minister for Health Greg Hunt said the grants are expected to lead to improved health services and address national health priorities. 
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Robots, Laser Beams Highlight Future of Aged Care Innovation

A state-of-the-art residential aged care facility in Austral in western Sydney sets new standards in the use of technology to support residents’ safety and wellbeing.
Page last updated: 30 October 2017
30 October 2017
A state-of-the-art residential aged care facility in Austral in western Sydney sets new standards in the use of technology to support residents’ safety and wellbeing.
Opening the John Edmondson VC Gardens centre today, Aged Care Minister Ken Wyatt AM said the innovations would help empower residents and staff.
“Technology will never replace the dedication and service of trusted care and health professionals but it can support them to provide even better and more efficient care,” Minister Wyatt said.
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Laser beams, sensors and a robot: new high-tech aged care facility opens in Sydney

Lynne Minion | 30 Oct 2017
A state-of-the-art residential aged care facility in Sydney has deployed laser beams, sensors, telehealth and a robot called Seals as part of a suite of technologies designed to provide cutting edge care.
The new centre by aged care provider RSL LifeCare showcases innovations that prevent falls, monitor residents’ locations, manage medications and set off alarms when urgent care is required.
Opening the centre today, which was built to house 64 low and high care residents, Federal Aged Care Minister Ken Wyatt urged the sector to look at implementing new technologies.
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For an instant man-flu diagnosis on your phone, just swab right

  • The Australian
  • 12:00AM November 1, 2017

Pia Akerman

Household battles over whether Dad is suffering a bad case of the sniffles or “man flu” may soon be over. An Australian firm is developing a digital, self-­administered test to diagnose potentially deadly influenza and allow early treatment to stop its spread.
An international flu symposium in Melbourne this week will hear an update from clinical trials of the device designed to give doctors and patients a simple and quick flu diagnosis. The ellume.lab works through an app instructing the ­patient or GP how to take a nasal swab and put the sample on a test cartridge which is inserted into a smartphone. The result is displayed on the phone along with advice on contacting medical services.
Australia has recorded one of its worst flu seasons in recent history, with more than 500 influenza-associated deaths reported to national disease authorities. In the latest death believed to be linked to flu, Melbourne neonatal nurse and mother of three Ten­nille Smith died on Friday, despite being vaccinated.
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RBA wants banks involved in Australian government digital identity solution

Rather than including banks, the DTA has selected a pair of government departments, one responsible for the robo-debt debacle and the other dealing with consistent IT outages, and a postal service that wants voting to occur via the blockchain.
By Asha McLean | November 1, 2017 -- 23:39 GMT (10:39 AEDT) | Topic: Security
The Reserve Bank of Australia (RBA) has told the House of Representatives Standing Committee on Tax and Revenue that it wants to see Australia's banks involved with building out the federal government's digital identity solution, Govpass, as online banking is considered a better digital experience than the government's contentious myGov portal.
The Digital Transformation Agency (DTA) outlined the process for applying for a Govpass just last month, with the system expected to match a user's photograph, as well as Medicare, driver's licence, and birth certificate details, with information already held by various government entities such as the Attorney-General's Department.
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A great guide, but let's hope you don't have to use it

1 November 2017

APP REVIEW

I have trouble remembering complex algorithms, but the Advanced Paediatric Life Support (APLS) app gives me all the guidance I need in an emergency. 
This free app has all the APLS algorithms, from cardiac arrest management through to hyperkalaemia. 
The flow charts are logical, with detailed colour-coding that makes the algorithms easy to read in an emergency.
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Artificial intelligence software used to spot bowel cancer tumours

Laura Donnelly
Published: October 30 2017 - 8:00AM
London: Artificial intelligence could detect cancer in less than a second, new research suggests.
Trials found that computer programmes were able to distinguish potentially dangerous tumours from harmless growths with high levels of accuracy.
The research involved bowel cancer - the fourth most common form of the disease in the UK, with more than 40,000 diagnoses annually.
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Data breach sees records of 50,000 Australian workers exposed

Doug Dingwall, Finbar O'Mallon, Tom McIlroy
Published: November 2 2017 - 3:22PM
Nearly 50,000 Australians and 5000 federal public servants have had sensitive personal information exposed online as part of one of Australia's biggest ever data breaches.
Employees of the Department of Finance, the Australian Electoral Commission and National Disability Insurance Agency have been caught up in the massive leak caused by a private contractor, along with more than 40,000 private sector workers from insurer AMP, utility UGL and Dutch multinational Rabobank.
The leaked information included names, passwords, ID data, phone numbers, as well as credit card numbers and corporate information including salaries and expenses, IT News reported on Thursday.
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Sharing Information with a Patient Case Manager

Posted on November 1, 2017 by Grahame Grieve
Sharing Information with a Patient Case Manager
This post (which is co-authored with Josh Mandel, thanks) describes a general pattern for a clinician to initiate sharing of a clinical record between an EHR (or more generally, a clinical records system – can be more than just an EHR) and some other clinical information service. These might be one the following:
  • Patient assistance organizations like Medic Alert
  • Patient networks such as ‘PatientsLikeMe
  • Voluntary/professional Clinical case registries (e.g. Vermont Oxford network)
  • Social support services
  • Government and Private Preventative/Management Programs(?)
During the clinical workflow, the clinician with consent from the patient, agrees to ‘refer’ the patient’s case to some kind of case manager, and continue to share information about the patient with the case manager. At some stage, either the clinician or the patient may wish to stop further sharing.
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1st Group Limited (ASX: 1ST)

Record revenue and diversification of revenue streams

Quarterly update - For the quarter to 30 September 2017
 Highlights:
 Revenue of $780k up 66% on the prior corresponding quarter
  • Record sales in Q1 that are anticipated to become revenue in Q2/Q3 and beyond
  • Subscription-based contracted Monthly Recurring Revenue (MRR) increased 55% on the prior corresponding quarter and up 12% ($31k) quarter on quarter
  • MyHealth1st signs significant advertising contract which will increase revenue in Q2 by an additional 10-15% above previously expected revenue growth
  • Established Standby convertible loan facility of $2 million with cornerstone investor
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ACCC announces public inquiry into NBN wholesale service standards

The ACCC has announced "a public inquiry to determine whether NBN wholesale service standard levels are appropriate, and to consider whether regulation is necessary to improve customer experiences."
If the people over at the NBN thought the rest of 2017 would be smooth sailing, the ACCC appears to be coming down upon them like a ton of bricks travelling at 1,000,000Gbps speeds, which would be the polar opposite of speeds many of NBN's customers are experiencing.
Given the NBN has been a "calamitous train wreck", as described by Australia's Prime Minister, Malcolm Turnbull, who was famously ordered by his predecessor, former PM Tony Abbott, to "demolish the NBN", it seems Turnbull's mission has been accomplished, and it falls to the ACCC to finally clean up the mess.
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  • Updated Oct 30 2017 at 7:00 PM

NBN: it's how we don't connect

Anthony Curtin feels trapped in internet limbo-land. He likens the result to being part of the Soviet era economy.
"I feel like I have been forced to trade in my Mercedes for an East German Trabant," he laughs. Except he's not really laughing.
Curtin works from home – a new apartment in the wealthy suburb of Mosman, Sydney. But since he moved into it a few months ago, he's been unable to get access to the internet other than through his wireless dongle.
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Can ACCC's new study solve the NBN mess, or are its '29 recommendations' toothless?

Can a government organisation (ACCC) solve the NBN mess created by the government organisation that caused it (NBN Co), or will we just end up with 29 recommendations spanning a wide range of competition and consumer issues in communications markets?
The ACCC has today published its draft report "detailing its market study of the communications sector, which includes 29 recommendations spanning a wide range of competition and consumer issues in communications markets."
Later this afternoon, iTWire will publish an interview with ACCC Chairman Rod Sims, who will talk about the study and answer some of our questions.
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ACCC casts doubt on future NBN profits

By Ry Crozier on Oct 30, 2017 12:26PM

Lays out three 'medium term' options for govt.

The ACCC has urged the government to reconsider the requirement for NBN Co to recover its costs and turn a profit.
In a draft report [pdf] on the communications sector unveiled today, the Australian Competition and Consumer Commission cast fresh doubt on NBN Co’s “medium term” economic prospects.
In particular, the commission recommended that the government “consider whether NBN Co should continue to be obliged to recover its full cost of investment through its prices".
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Broadband, mobile prices fall: ACCC

The competition watchdog has welcomed falls in the cost of broadband and mobile services but says much more can be done to ease prices.
Paul Osborne, AAP Senior Political Writer
Australian Associated Press October 30, 201710:44am
The price of broadband and mobile services has fallen over the past year, but more can be done by the small number of players in the market, the competition watchdog says.
The Australian Competition and Consumer Commission released a draft market study for the communications sector on Monday.
The study showed while 96 per cent of the broadband market is held by four providers - Telstra, Optus, TPG and Vocus - prices had fallen by 10 per cent in 2016/17.
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Send complainers to the end of the queue, says NBN director

Ben Grubb
Published: October 30 2017 - 8:27AM
People who complain about not being able to get connected to the national broadband network should be sent to the back of the connection queue, according to NBN Co non-executive director Michael Malone.
Mr Malone  —  founder of internet service provider iiNet, which was acquired by TPG in 2015 — was referring to "NBN Service Class 0" customers. Thousands of them are stuck in broadband limbo because of an arbitrary decision set in law that prevents Telstra from connecting customers who should have already been connected to the NBN but haven't been.
"If I was running NBN and they [complaining Service Class 0 customers] went to the media, I would put them to the back of the queue. Personally, that's what I would do," Malone said in an exclusive interview, adding that Service Class 0 issues would all get resolved and that people should be patient.
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Enjoy!
David.

Sunday, November 05, 2017

Sorry To Harp But We Really Need To Rethink The myHR – It’s Just Plain Stupid Not To!

This appeared just a few days ago:
3 November 2017

First the rugby, now national e-health records

Government Technology
Posted by Jeremy Knibbs
What is it about small countries that are cold, wind beaten, have highlands, and lots of woolly hooved livestock? Both New Zealand and Scotland punch well above their weight in sport, especially rugby. And both do the same in digital health.
If you’d like a few answers to the digital health side of this strange cultural phenomenon Dr Libby Morris, clinical lead on Scotland’s SPIRE program, the pragmatic and so far successful equivalent to our My Health Record saga, might have a few. Dr Morris is the keynote speaker at next week’s annual summit of the Medical Software Industry Association (MSIA) being held in Melbourne.
To offer appropriate contrast, Tim Kelsey, and others from the Australian Digital Health Agency, will be there as well, spruiking the “Australian way”. It will be worthwhile seeing the two countries head to head. The approaches of both are a long way apart, and most commentators have Scotland a long way in the lead, despite starting five years after us. 
SPIRE stands for Scottish Primary Care Information Resource. If you’re a GP you’ve got to love the name from the outset – it’s putting primary care at the centre of things up front, where it probably should be. Some would argue that My Health Record is better because it’s patient centric. And that’s where you start to see how Scotland may have got things right and we may have missed the mark somewhat.
Patients don’t care about their EMR and they have no idea why a form of EMR for all citizens might be a good thing. GPs do. Patients and EMRs are the centre of their world. So why not start with them at the centre and work outwards? Scotland seems to have done just that. Get the main professionals engaged first and go outwards to their patients and make sure the stakeholders are in the boat before you start rowing further out to sea.
Much better still, at no point did the SPIRE program ever get close to contemplating a “boil the ocean” approach, which is the path we’ve taken with the MyHR.
Lots more here:
The lesson out of all this is very clear. Don’t push a system that almost no-one wants to use rather than supporting the clinicians and their patient to work optimally together supported by information they both know and care about.
The rest of the Digital Health infrastructure is best optimized by the Government to support the clinician and the patient NOT some data mining and analytic objective of the Government.
The rest of the article just emphasizes how misguided many of the components of the ADHA Digital Health Strategy are and how badly it seems to be being executed and communicated so far.
The positive wrap for the MSIA (Medical Software Industry Association) and its centrality in all this is both true and important. The more time passes, on the other hand, the less aligned with what matters the ADHA seems. Go the smaller and apparently much smarter countries!
Comments welcome!
David.

AusHealthIT Poll Number 395 – Results – 5th November, 2017.

Here are the results of the poll.

Has The NBN Turned Into A Disastrous, Increasingly Obsolete and Expensive 'White Elephant'?

Yes 56% (66)

No 15% (17)

it Is Too Early To Tell 20% (23)

I Have No Idea 9% (11)

Total votes: 117

It seems a majority think the NBN is not going well with only a few true believers!

Any insights welcome as a comment, as usual, especially regarding what might be done to get back on track.

A great turnout of votes!

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

David.