Ms Roxon Talks – Without Understanding - to the Medical Technology Association of Australia (MTAA)

On the 23^rd of September our Federal Health Minister spoke at the Annual MTAA Conference.

This speech is reported here:

Nicola Roxon takes whip to 'cowboy' marketing

Siobhain Ryan | September 24, 2009

Article from: The Australian

CANBERRA will target its $14.8 billion Medicare system for major savings and crack down on "cowboy" marketing practices for flashy new medical technologies.

Federal Health Minister Nicola Roxon has issued a strongly worded challenge to doctors, drug and medical device makers to stop resisting reform and to help trim costs by backing more cost-effective technologies.

"It is frustrating that wherever I go I find almost universal agreement that we need reform and to use taxpayer funds more wisely, but it is always with a 'not in my backyard' caveat," Ms Roxon told the annual conference of the Medical Technology Association of Australia in Sydney yesterday.

"When we spend $14.8bn a year on the MBS, there are clearly some major savings to be made," she added.

Doctors, pathologists and drug companies all suffered cuts to their taxpayer-funded fees in this year's budget, with the government signalling more pain could follow next year to help finance its ambitious health reform agenda.

Last month, Kevin Rudd outlined plans to regularly review the effectiveness of subsidised medical treatments and cut funding from those found to be ineffective.

Ms Roxon said the current review of the way Canberra assesses health technologies, to report at the end of this year, would drive the Prime Minister's push for accountability. She said one area of savings would be to wean doctors and patients off the "flashiest technologies" in favour of better-value ones.

More here:

http://www.theaustralian.news.com.au/story/0,25197,26117209-23289,00.html

For those of us interested in e-Health we find the following in related to e-Health.

“What savings can pay for

All of this is just by way of explaining that we need to look at a smarter use of our health budget because the reform directions proposed by the Commission, whilst exciting and far reaching, do not come cheap.

The Commission estimates its recommendations could cost more than $5 billion per annum, plus $4 billion a year for a national dental scheme, and system wide capital costs of up to $7 billion. Others have already indicated these costs may be rather low estimates.

Think of the potential offered by the introduction of person-controlled electronic health records. The Commission recommends we do this by 1 July 2012, and estimates the cost at somewhere between $1.1 and $1.8 billion.

An electronic health record really does have the potential to revolutionise how we deliver health care services.

It is estimated that 30 to 50 per cent of patients with chronic disease are hospitalised because of inadequate care management.

An Electronic Health Record would mean patients will be able to present for health service treatment anywhere in the country, and with patient approval, the treating health professional will be able to access a summary of the patient’s treatment and medication history at the touch of a button.

For health professionals, this will mean that less valuable time is lost, expensive tests are not being re-ordered or duplicated at a cost to the taxpayer, and knowledge is shared.

In fact, it has been estimated that up to 18 per cent of medical errors are attributed to inadequate availability of patient information, and between 9 and 17 per cent of pathology and diagnostic tests are unnecessary duplicates. When we spend $14.8 billion a year on the MBS, there are clearly some major savings to be made.

The Commission’s report is quite clearly excited by the potential shift towards more personal, patient-centred health care that e-health and medical technology can help create.

I said earlier it will require leadership from the profession and the industry to help us realize this potential.”

The full speech is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr09-nr-nrsp230909.htm?OpenDocument

I am really getting a little tired of this approach of linking the fate of e-Health in Australia to savings being made elsewhere in the budget.

This is genuinely 19^th Century thinking in my view. The government has cost benefit studies from NEHTA, The Allen Consulting Group and KPMG, among others, all of which show e-Health done properly will actually save money in considerable quantities.

The evidence for this (in Australia) is quite well summarised here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

as well as in the NHHRC final report (in a slightly confused way) and here:

http://www.accesseconomics.com.au/publicationsreports/getreport.php?report=201&id=257

Ms Roxon needs to just stop running this silly line and get the Health Sector’s share of the Stimulus Funds spent in this area! (given health has missed out totally to date!)

David.

It Is About Time This Patchwork Was Properly Fixed.

The following excellent review appeared a few days ago.

IT Advocate: The privacy minefield

There are significant differences between state and federal privacy legislation. CIOs who deal with government agencies or other public sector organisations must determine the privacy laws applicable to them – and how best to accommodate them.

Emma Weedon 15 September, 2009 08:05:00

It is clear to most businesses that deal with personal information that the Privacy Act 1988 (Cth) (Privacy Act) and National Privacy Principles (NPPs) impact in some way or another on them in terms of rights and obligations under the Act. Conversely, consumers dealing with private sector organisations can be relatively certain of the procedures by which they can access personal information held by private sector organisations, or make a complaint in respect of the information handling practices of such an organisation.

However, if consumers or service provider businesses find themselves dealing with government-owned corporations, universities, local governments, state governments or a raft of other state-based public sector bodies, they will need to undertake a significant amount of research to determine the privacy laws applicable to them, and how to best deal with those privacy laws.

At least one thing is clear -- all jurisdictions recognise a definition of personal information that is roughly the same and that such information must be protected, and used only in certain ways.

Commonwealth and Australian Capital Territory government agencies

Commonwealth and ACT government agencies are required to comply with the provisions of the Privacy Act in so far as they relate to Commonwealth and ACT government agencies. In general, this means complying with the requirements of the 11 Information Privacy Principles (IPPs).

Interestingly, the ACT also has the Health Records (Privacy and Access) Act 1997 which covers health records held in the public sector in the ACT and also seeks to apply to acts or practices in the private sector not covered by the Privacy Act. There is no such legislation dealing separately with the handling of health information at the Commonwealth level.

The Privacy Act requires that an agency entering into a contract with a service provider (whether private sector or otherwise) must take contractual measures to ensure that a contracted service provider does not do an act, or engage in a practice, that would breach an IPP if done or engaged in by the agency. If an individual considers that the contractor has breached their obligations in the handling of personal information about them, they may make a complaint to the Privacy Commissioner who has jurisdiction to directly investigate the actions of the contractor.

Individuals may apply for access to personal information held about them by a Commonwealth or ACT Government Agency either under the Privacy Act or the Freedom of Information Act 1982 (Cth), but the Privacy Commissioner has accepted that most agencies will deal with such requests in accordance with the procedures under the Freedom of Information Act, and has not initiated a separate regime for dealing with access requests under the Privacy Act.

Queensland Government Agencies

Until 1 July 2009, Queensland government agencies were bound by the requirements of ‘information standards’ which essentially did not have the force of law. As of 1 July 2009, Queensland government agencies are bound to comply with the Information Privacy Act 2009 (Qld) which sets out obligations similar to the IPPs mentioned above for most agencies, and obligations similar to the NPPs for the Queensland Department of Health.

Interestingly, and despite this new regime, Queensland does not have separate privacy legislation to regulate private sector health providers.

Under the Information Privacy Act if a service provider is contracted to provide services to a government agency, and the provider is bound to comply with the provisions of the act under the contract, then it becomes a ‘bound service provider’ for the purposes of the legislation, and it is answerable to the Privacy Commissioner under that legislation, regardless of the fact that it is not originally bound to comply with the requirements of that legislation.

Access to information held about individuals by the Queensland government is now facilitated under the Information Privacy Act. However, if an individual incorrectly makes an application for access under the Right to Information Act 2009 (Qld) (the new freedom of information legislation) -- then the relevant government agency must the individual of their error, and ask the individual if they would like to amend their application so that it is made under the correct legislation.

The other States and Territories are covered here:

http://www.cio.com.au/article/318565/it_advocate_privacy_minefield?eid=-601

Quite alarming is the following paragraph at the end of the article.

“Both Western Australia and South Australia are currently without legislative privacy regimes. Various confidentiality provisions cover government agencies in Western Australia and the South Australian government has issued an administrative instruction requiring its government agencies to generally comply with a set of IPPs.”

With the current plans for legislation surrounding the IHI etc it seems we have a few hurdles to cross first! It is very hard to know how what the Commonwealth is planning can be expected to remedy this mess other than a full legislative override of all State Health Information Privacy regimens.

My comments on the request for submissions are found here:

http://aushealthit.blogspot.com/2009/07/commonwealth-department-of-health.html

The Commonwealth Privacy Commissioner has also commented. This – with my comments can be found here:

http://aushealthit.blogspot.com/2009/08/privacy-commissioner-administers.html

I understood the submissions on this topic were all to be made public, but I have not seen them yet. If you have please provide the URL as a comment.

It will be very interesting to see what the final legislation looks like!

David.

Talk About the Ignorant Consulting the Uninformed.

I spotted this page from the Commonwealth the other day which purported to be consulting on the e-Health aspects of the NHHRC Final Report.

e-health

National Health and Hospitals Reform Commission Fact Sheet

Electronic health records are one of the most important opportunities to improve the quality and safety of health care, reduce waste and inefficiency and improve continuity and health outcomes for patients.

A person-controlled electronic health record

A person-controlled electronic health record should be available for each Australian – as one of the most important systemic opportunities to create person-centred health care and improve quality and safety. Giving people better access to their own health information through a person-controlled electronic health record is vital to promoting consumer participation, and supporting self-management and informed decision-making.

By 1 July 2012, every Australian should be able to have and control their own electronic health record with a provider of their choice. People should also be able to approve health care providers and carers to have access to their records.

Privacy in e-health

The Australian Government should legislate to ensure the privacy of electronic health data. Additionally it should be responsible for the development of a national policy and open technical standards framework for e-health.

Encouraging take up of e-health

The payment of public and private benefits for all health and aged care services should be dependent on their ability to accept and provide patient data electronically and this should occur by 2013.

The Australian Government should develop and implement an appropriate national marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health model.

What do you think?

The Government is undertaking a series of face-to-face consultations and is using this website to seek the views of Australians on these and other options.

What do you think? Tell us at a consultation visit or complete the Tell us what you think form to provide your views.

These views will be compiled and reported to Government prior to deciding what health reform should be undertaken.

Individual responses will not be posted to the views provided on this site.

More information

This is a summary of some of the major recommendations of theNational Health and Hospitals Reform Commission. Full recommendations can be found in A Healthier Future For All Australians – Final Report of the National Health and Hospitals Reform Commission – June 2009

----- End Page

The page is found here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/E-Health

Now hang on just a moment!

Here is what the NHHRC recommended on E-Health.

Implementing a national e-health system

We recommend that, by 2012, every Australian should be able to:

• have a personal electronic health record that will at all times be owned and controlled by that person;
• approve designated health care providers and carers to have authorised access to some or all of their personal electronic health record; and
• choose their personal electronic health record provider.

We recommend that the Commonwealth Government legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers.

We recommend that the Commonwealth Government introduce:

• unique personal identifiers for health care by 1 July 2010; unique health professional identifiers (HPI-I), beginning with all nationally registered health professionals, by
  1 July 2010;
• a system for verifying the authenticity of patients and professionals for this purpose – a national authentication service and directory for health (NASH) – by 1 July 2010; and
• unique health professional organisation (facility and health service) identifiers (HPI-O)
  by 1 July 2010.

We recommend that the Commonwealth Government develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach.

Ensuring access to a national broadband network (or alternative technology, such as satellite) for all Australians, particularly for those living in isolated communities, will be critical to the uptake of person-controlled electronic health records as well as to realise potential access to electronic health information and medical advice.

We recommend that the Commonwealth Government mandate that the payment of public and private benefits for all health and aged care services depend upon the ability to accept and provide data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record, such that:

• hospitals must be able to accept and send key data, such as referral and discharge information (‘clinical information transfer’), by 1 July 2012;
• pathology providers and diagnostic imaging providers must be able to provide key data, such as reports of investigations and supplementary information, by 1 July 2012;
• other health service providers – including general practitioners, medical and non-medical specialists, pharmacists and other health and aged care providers – must be able to transmit key data, such as referral and discharge information (‘clinical information transfer’), prescribed and dispensed medications and synopses of diagnosis and treatment, by
  1 January 2013; and
• all health care providers must be able to accept and send data from other health care providers by 2013.

We recommend that the Commonwealth Government takes responsibility for, and accelerates the development of a national policy and open technical standards framework for e-health, and that they secure national agreement to this framework for e-health by 2011-12. These standards should include key requirements such as interoperability, compliance and security. The standards should be developed with the participation and commitment of state governments, the IT vendor industry, health professionals, and consumers, and should guide the long-term convergence of local systems into an integrated but evolving national health information system.

We recommend that significant funding and resources be made available to extend e-health teaching, training, change management and support to health care practitioners and managers. In addition, initiatives to establish and encourage increased enrolment in nationally recognised tertiary qualifications in health informatics will be critical to successful implementation of the national e-health work program. The commitment to, and adoption of, standards-compliant e-health solutions by health care organisations and providers is key to the emergence of a national health information system and the success of person-controlled electronic health records.

With respect to the broader e-health agenda in Australia, we concur with and endorse the directions of the National E-Health Strategy Summary (December 2008), and would add that:

• there is a critical need to strengthen the leadership, governance and level of resources committed by governments to giving effect to the planned National E-Health Action Plan;
• this Action Plan must include provision of support to public health organisations and incentives to private providers to augment uptake and successful implementation of compliant e-health systems. It should not require government involvement with designing, buying or operating IT systems;
• in accordance with the outcome of the 2020 Summit and our direction to encourage greater patient involvement in their own health care, that governments collaborate to resource a national health knowledge web portal (comprising e-tools for self-help) for the public as well as for providers. The National Health Call Centre Network (healthdirect) may provide the logical platform for delivery of this initiative; and
• electronic prescribing and medication management capability should be prioritised and coordinated nationally, perhaps by development of existing applications (such as PBS online), to reduce medication incidents and facilitate consumer amenity.

---- End Quote

So what happened to asking about the necessary implementation of the National E-Health Strategy (see the parts in italics that are being ignored). Without that and the associated improvements in governance and leadership there simply won’t be the information to load up the Person Controlled Records.

In my view it is much more important – as a first step – that we conclude the infrastructure work and the provision of quality applications to healthcare providers. Obviously we also still have to address issues like information quality and governance as well.

Similarly the Draft National Primary Care Strategy specifically recommends implementation of the National E-Health Strategy.

Just because it might actually require some investment and some serious management is no reason to just ignore these when seeking public comment. Frankly it is just dishonest and sneaky.

It should be noted I still think applications of penalties via the Medicare system for not sharing information whose quality is yet to be properly validated and that there has not been discussion with providers regarding what is sharable and what is not. It is my belief the timelines in the NHHRC report are just absurdly optimistic.

David.

Here is the Standard of Openness and Transparency NEHTA Must Match.

Regular readers will be aware I am intensely critical of the way NEHTA conducts itself and especially in the way it fails to meet the most basic standards for public organisations in the way of openness and transparency.

It seemed to me it could be pretty instructive to see how the US hands similar issues as a benchmark. This reveals the utter failure of NEHTA in this regard.

As a reference the Health IT Standards Committee is charged under recent US stimulation legislation (The ARR Act) with developing the standardized way forward for US Health IT.

You can also read about the system HIT Policy Committee – mentioned below - (which is similarly august and open) here:

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1269&parentname=CommunityPage&parentid=5&mode=2

The Policy Committee is chaired by Dr David Blumenthal – the US Federal National Coordinator of Health IT.

You will understand the level of these committees when you note they report direct to the Secretary of Health and Human Services who is in Cabinet and reports to the President.

Here is the committee mandate and membership of the Standards Committee.

Health IT Standards Committee (a Federal Advisory Committee)

The Health IT Standards Committee is charged with making recommendations to the National Coordinator for Health Information Technology (HIT) on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the HIT Standards Committee will focus on the policies developed by the Health IT Policy Committee’s initial eight areas. Within 90 days of the signing of ARRA, the HIT Standards Committee must develop a schedule for the assessment of policy recommendations developed by the HIT Policy Committee, to be updated annually. In developing, harmonizing, or recognizing standards and implementation specifications, the HIT Standards Committee will also provide for the testing of same by the National Institute for Standards and Technology (NIST).

Membership

The HIT Standards Committee’s membership reflects a broad range of stakeholders, including providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information.

Chair

• Jonathan Perlin, Hospital Corporation of America

Vice Chair

• John Halamka, Harvard Medical School

Members

• Dixie Baker, Science Applications International Corporation
• Anne Castro, BlueCross BlueShield of South Carolina
• Aneesh Chopra, Chief Technology Officer, OSTP
• Christopher Chute, Mayo Clinic College of Medicine
• Janet Corrigan, National Quality Forum
• John Derr, Golden Living, LLC
• Linda Dillman, Wal-Mart Stores, Inc.
• James Ferguson, Kaiser Permanente
• Steven Findlay, Consumers Union
• Linda Fischetti, Department of Veterans Affairs
• Douglas Fridsma, Arizona State University
• Cita Furlani, National Institutes of Standards and Technology
• C. Martin Harris, Cleveland Clinic Foundation
• Stanley M. Huff, Intermountain Healthcare
• Kevin Hutchinson, Prematics, Inc.
• Elizabeth O. Johnson, Tenet Healthcare Corporation
• John Klimek, National Council for Prescription Drug Programs
• David McCallie, Jr., Cerner Corporation
• Judy Murphy, Aurora Health Care
• Nancy J. Orvis, Director, Health Standards Participation, Department of Defense
• J. Marc Overhage, Regenstrief Institute
• Gina Perez, Delaware Health Information Network
• Wes Rishel, Gartner, Inc.
• Richard Stephens, The Boeing Company
• Sharon Terry, Genetic Alliance
• James Walker, Geisinger Health System

Here is a recent listing of meetings and associated material

Past Meetings

• 9/15/2009
• Agenda
• Meaningful Use Quality Measure Grid Update [PPT]
• Meaningful Use Quality Measure Grid [XLS]
• Report from Privacy & Security Workgroup: Implementation Specifications Recommendations [PPT]
• Implementation Specifications Handout [XLS]
• Discussion on Standards Implementation Specifications (Clinical Operations Workgroup) [PPT]
• Clinical Operations Workgroup Detailed Recommendations [XLS]
• Identifying Implementation Specifications & Gaps (HITSP) [PPT]
• 8/20/2009
• Agenda
• Update on HIT Policy Committee and its Workgroups
• Report on Clinical Quality Workgroup
• Meaningful Use Grid
• 2011 Measure Recommendations
• Report on Clinical Operations Workgroup
• Recommendations
• Report on Privacy and Security Workgroup
• Privacy and Security Standards Applicable to ARRA Requirements
• Meeting Webconference

To view the webconference, an up-to-date version of Adobe Flash Player is required. To download the latest version for free, visit the Adobe Flash Player Download Center.

The full page is here:

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1271&parentname=CommunityPage&parentid=6&mode=2#Meetings

Note the level of the Committee, its breadth and the transparency of the paperwork provided. Take it from me there are some really serious heavy hitters on this Committee – and it is with this sort of leadership one can actually make progress

Here we have instructions for the public to be able listen to and even watch the meetings.

Health IT Standards Committee Meetings: How to Participate

Webconference:

• At least 10 minutes prior to the meeting start time, please go to: http://altarum.na3.acrobat.com/HITstandards
• (If for any reason the link does not work, simply copy and paste the URL into your browser's address bar)
• Select "enter as a guest"
• Type your first and last name into the field
• Click “enter room”
• Test Your System:
• You will need to have an up-to-date version of Flash Player to view the webconference. Please test your system prior to the meeting by visiting http://altarum.na3.acrobat.com/common/help/en/support/meeting_test.htm
• When running this system test, you do not need to install the Adobe Connect Add-in (step 4 of the test), as that is not relevant to this meeting.

* Please note: Space in the Web conference is limited. If for any reason you are unable to log in, you can still dial in via phone to listen to the audio (numbers below).

Audio:

• You may listen in via computer or telephone.
• US toll free: 1-877-705-6006
• International Direct: 1-201-689-8557
• Confirmation Code: HIT Committee Meeting

If you have any technical questions, please send an email to webmeeting@altarum.org

Full page is here:

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1272&parentname=CommunityPage&parentid=0&mode=2&in_hi_userid=10741&cached=true

What you have here is how things should be done. A fully funded co-ordinating office for National Health IT within the Federal Government and high level open and accountable advisory committees where meetings are fully publicly accessible.

It is not hard, it just requires the will to involve the whole Health Sector. This sort of openness is just the norm in Washington, but apparently anathema here! I wonder why that is?

David.

Useful and Interesting Health IT News from the Last Week – 20/09/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

The NHHRC final report: view from the hospital sector

Ian A Scott

eMJA - Rapid Online Publication - 14 September 2009

Abstract

• The National Health and Hospitals Reform Commission (NHHRC) report attempts to deal in the short term with hospital access block by funding more beds in emergency departments, while, over the longer term, reforms aim to improve hospital efficiency, transfer care of patients to non-hospital settings, optimise use of outpatient clinics, fund hospital activities on the basis of efficient cost, and improve governance and accountability.

· The single most potentially effective recommendation is the considerable investment in and expansion of subacute and non-acute services, which will free up acute-care hospital beds for urgent cases. Population-based chronic disease management driven by Primary Health Care Organisations can also reduce future hospitalisations considerably.

· What the NHHRC could have dealt with more fully is the need to: (i) prioritise clinical interventions and the need for hospitalisation using evidence of cost-effectiveness obtained from clinical trials and longitudinal patient data; and (ii) move quickly towards funding of all health care by one level of government.

· Even the most effective reforms will not have a significant impact on future bed demand if professional and public expectations remain unsustainably high and do not acknowledge the need to change the role of hospitals within a reconfigured health care system.

More here:

http://www.mja.com.au/public/issues/191_08_191009/sco10877_fm.html

Interestingly we also find the following paragraph in the document.

“Making hospital care more safe and effective

The patient-held electronic health record proposed by the NHHRC will allow busy ED and clinic doctors to more quickly retrieve past history and investigation results and render care safer and more effective. The NHHRC report could have given more emphasis to computer-based clinical decision support systems, referral and triage algorithms, and interprovider information transfer and telecommunication systems designed to make hospital referrals more clinically appropriate and collaborative. Evaluating outcomes of hospital care at a national level using patient-level longitudinal data from various sources (hospital episode of care data, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, death registries, etc) linked by a unique identifier (Medicare number) is welcome, given the benefits of such data.”

My emphasis. Seems most commentators agree that personal health records are at best only a part of what is needed.

Second we have:

Is Brown Qld Health's white knight?

Suzanne Tindal, ZDNet.com.au

15 September 2009 09:12 AM

CIO profile Ray Brown stepped in two weeks ago as the latest chief information officer for Queensland Health, hoping to bring some stability to a division that has seen a number of faces move through the head technology spot in quick succession.

The health department's technology leadership game of musical chairs started in July last year when Paul Summergreene, who had moved over to health in the closing months of 2007 from his CIO position at the state's Department of Transport, left after less than a year in the chief information officer job.

His contract had been terminated, Queensland's Health informed the press at the time. There had been reports that his expenses were being examined, but the department wouldn't comment on the issue.

His position was filled briefly in an acting capacity by the clinically adept Dr Richard Ashby. Ashby had served in several hospitals in emergency medicine and medical administration roles. The Australian Medical Association was pleased of the appointment because of Ashby's clinical experience.

"We have seen millions of dollars in health IT funding wasted over the years in Queensland, so the appointment of a highly regarded senior hospital clinician who is acutely aware of exactly what is required to provide optimal patient outcomes is very welcome," it said at the time.

Yet Ashby didn't remain long, leaving in January to become the executive director and director of medical services at Princess Alexandra Hospital.

Queensland Health again had to fill the void with an interim appointment, reaching into the ranks of its information division. Brown had been acting as the executive director ICT service delivery since June 2008, before which he had been pursuing an IT career in the Queensland public service, holding senior roles in the Police, Corrective Services and the former Department of Families.

Queensland Health may have hit the jackpot this time. Brown hasn't followed the pattern of leaving after only a brief stint on the job. Instead, he was appointed formally to the chief information officer position last week.

And despite much attention being directed at the leadership turmoil, the CIO doesn't believe that it has damaged the long-term technology strategy of Queensland Health.

Since 2006, the IT gurus of Queensland Health have had a mission: to bring the state's hospitals into the modern world of state of the art clinical information systems. Summergreene's predecessor Sabrina Walsh had primed the way by obtaining funding of upwards of $650 million over four years for e-health initiatives.

Whichever leader was in the hot spot, the e-health holy grail was never out of sight, according to Brown. "The e-Health strategy has stood the test of time and remained sound. Each incumbent of the Queensland Health CIO role has built on the direction and progress of the e-Health Strategy without the need to re-visit significant elements of the strategy or the project artefacts delivered," he tells ZDNet.com.au in an interview last week.

When the CIO started in the role in the acting capacity, it had been his focus and it would continue to be so for the next few years, he says.

Around 20 per cent ($243 million) of the funding first made available in the 2007/2008 financial year had been spent, Brown says. The remaining 80 per cent would be spent by 2011/2012.

So far one of the standout successes has been getting an enterprise discharge summary system up and running, a national first, Brown says. The system sees hospital reports go out to GPs who can use them to service outpatients. Brown says, 55,000 summaries have already gone out from 56 hospitals, with June next year seeing 120 facilities being capable of issuing the summaries.

Much more here:

http://www.zdnet.com.au/insight/software/soa/Is-Brown-Qld-Health-s-white-knight-/0,139023769,339298502,00.htm?omnRef=1337

Given it is already in place this really supports the points I have been making about the over-egging of approaches to simple issues such as discharge summaries being taken by NEHTA. I am pretty sure what Qld Health has done does not implement the NEHTA approach to either content or messaging methodology. Once you have things actually going then you can incrementally improve.

Third we have:

Deal struck on access to patient records

17-Sep-2009

By Michael East

THE Federal Government has backed down on plans to allow Medicare bureaucrats to access patients’ medical records.

The Health Insurance Amendment (Compliance) Bill 2009 was introduced into Parliament today by the Federal Human Services Minister, Chris Bowen.

The Bill gives Medicare Australia the power to obtain documents from doctors to substantiate Medicare rebates, which includes handing over private and personal patient details if necessary as evidence for auditing of Medicare claims.

Under the earlier draft bill, administrative staff employed by Medicare would have been able to access medical records without the patient’s permission.

However, an 11th hour deal struck between the Federal Government and “key medical stakeholders” means that only “medical advisers” employed by Medicare can view the records.

More here (registration required):

http://www.australiandoctor.com.au/articles/93/0c064093.asp

This is very good – as it sees some sanity return to the management of investigations requiring patient record access.

Fourth we have:

e-Health: Patients Manage Chronic Diseases Better through Enabling Broadband in Australia

Date: 15 Sep 2009 - 23:10

Source: Government of Australia

The Minister for Broadband, Communications and Digital Economy, Senator Stephen Conroy, today launched a new e-health project improving chronic disease patient care.

"CDM-Net is a great example of the digital revolution taking place in healthcare as the Government establishes Australia's 21st century broadband foundation," Senator Conroy said.

"Patient care plans are an important part of chronic disease management and providing online and real-time collaboration means they are easier and more effective to use."

"These types of innovations have significant positive implications for the economics of healthcare and patient welfare."

The Minister launched CDM-Net today at Geelong Hospital. The project is a collaboration between Precedence Health Care and partners and received funding under the Government's Clever Networks program.

Trials of CDM-Net in the Barwon South-Western Region of Victoria and the Eastern Goldfields of Western Australia have shown significant improvements in care plan use and collaboration.

More here:

http://www.egovmonitor.com/node/28177

I wonder where one can read the evaluations of these trials? I have not seen much to date. Links welcome!

Fifth we have:

Technology closes in on hospital botches

DANIEL HURST

September 14, 2009 - 5:13AM

Queensland hospital managers will be forced to provide feedback to staff members about botched medical procedures when the health department's flawed computer reporting system is upgraded.

The improvements, scheduled to be rolled out by the end of the year, come after a review found health workers were struggling to log clinical incidents and near-misses in the state's hospitals.

Doctors and nurses using the web-based PRIME CI system cannot track the progress of their own reports and receive feedback, according to the Prince Charles Hospital's executive director of medical services, Stephen Ayre.

Dr Ayre, who investigated the handling of incident reports at Bundaberg Hospital in the lead up to the March state election, wrote the system flaws were partly responsible for the "poor feedback" provided to staff.

The review was sparked by allegations hospital management failed to properly deal with dozens of incident reports, including claims an elderly patient died while waiting for an emergency bed and a baby was thrown on the floor.

Full article here:

http://www.brisbanetimes.com.au/queensland/technology-closes-in-on-hospital-botches-20090913-fm60.html

Seems to me a working system to handle this area is vital for understanding emerging issues in safety and quality are critical. Should have been in place ages ago.

Sixth we have:

8153.0 - Internet Activity, Australia, Jun 2009

NOTES

INTRODUCTION

• The Internet Activity Survey (IAS) collects details on aspects of internet access services provided by Internet Service Providers (ISPs) in Australia.
• The scope for the June cycle of IAS has been expanded to contain results for all ISPs operating in Australia with more than 1,000 active subscribers at the end of the reporting period (i.e. as at 30 June 2009). Previously in the June cycle, data have only been collected from ISPs with 10,000 or more subscribers at the end of the reporting period.
• This is an electronic release of Internet Activity, Australia. More detailed and historic information is available in the accompanying datacubes.
• When comparing historical data care should be taken due to the change in scope to ISPs with more than 1,000 active subscribers.

HIGHLIGHTS

• At the end of June 2009, there were 8.4 million active internet subscribers in Australia.
• Digital subscriber line (DSL) continued to be the major technology for non dial-up connections, accounting for 57% (4.2 million) of these connections. However, this percentage share has decreased since December 2008 when DSL represented 63% of non dial-up access connections.
• Mobile wireless subscribers had the next highest share, increasing significantly from 20% of all non dial-up connections (1.3 million) in December 2008 to 27% (2 million) in June 2009. This represents an increase of 51% over the six month period. (Note that mobile wireless subscriptions to the internet via a datacard or USB modem are included in the scope of this survey, but connections to the internet via mobile telephones are excluded).
• Northern Territory subscriber numbers continued with an upward trend increasing by 20% since December 2008 to 83,000.
• The general trend towards higher download speeds continued, with 57% of subscribers now using a download speed of 1.5Mbps or greater, compared with 51% in December 2008.

More details here:

http://www.abs.gov.au/ausstats/abs@.nsf/mf/8153.0?OpenDocument

Given the importance of broadband to e-Health it is useful to keep an eye on these figures. The rate of wireless uptake is pretty impressive as are the number of broadband connections overall.

Commentary is here:

Opposition: wireless scrambles NBN plan

DAN OAKES

September 15, 2009

THE explosion in the use of wireless broadband has undermined the rationale for the $43 billion national broadband network, according to the Federal Opposition.

The claim comes as Telstra waits to see what punishment the Government will inflict on it through legislation that BusinessDay believes will be introduced to Parliament today.

The legislation will outline the regulatory measures the Government will impose on Telstra to increase competition as the new network is built.

The prevailing opinion seems to be that the Government will enforce a functional separation of the telecommunications giant's wholesale and retail arms, but will not force it to sell its 50 per cent stake in Foxtel or the high-speed cable network it uses to deliver pay TV.

The Australian Competition and Consumer Commission is likely to be given greater powers to make binding pricing decisions.

More here:

http://www.smh.com.au/business/opposition-wireless-scrambles-nbn-plan-20090914-fnx2.html

Seventh we have:

Baby bonuses claimed for dead people

AAP

September 17, 2009 05:09pm

A MEDICARE worker has been sentenced to four years' jail for using dead people's identities to claim more than $300,000 in baby bonus payments and sending some of the money to relatives overseas.

Bernard Monyenye, 34, pleaded guilty to 24 counts of obtaining financial advantage by deception, attempting to obtain financial advantage by deception and sending proceeds of crime to accounts in Kenya, Uganda and the United Arab Emirates.

The Perth court heard Monyenye used Medicare records to claim baby bonus payments and the maternity immunisation allowance, totalling $318,286.70, between June and November last year.

District Court Judge Kevin Sleight described the act as a "grave breach of trust'' and sentenced him to a non-parole period of two and a half years.

More here:

http://www.news.com.au/story/0,27574,26086963-421,00.html

One wonders why it took so long for these breeches to be detected. Clearly the Department of Human Services and Medicare should be looking closely at this. That Medicare is to operate the IHI service is a worry if this can happen.

Lastly the slightly more technical article for the week:

5 open source project management apps to watch

Five tools to help CIOs and IT project managers keep their projects on-track and on-schedule -- without blowing the budget!

Rodney Gedda (CIO) 14 September, 2009 13:40

Managing projects is hard work at the best of times, but there are a number of free and open source (FOSS) applications available that can help CIOs and other managers streamline the administrative aspects of project management.

CIO found five tools to help CIOs and IT project managers keep their projects on-track and on-schedule -- without blowing the budget:

1. OpenProj

OpenProj is a cross-platform desktop project management application that paints itself as an alternative to Microsoft Project, including file compatibility. OpenProj features Gantt charts, network diagrams (PERT charts) and earned value costing. Parent company Serena Software also offers commercial project management solutions.

URL: http://openproj.org

Licence terms: CPAL

Read about the other 4 here:

http://www.computerworld.com.au/article/318425/5_open_source_project_management_apps_watch?eid=-219

A useful list to assist get those projects under control!

More next week.

David.

Report and Resource Watch – Week of 14, September, 2009

Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.

First we have:

A Better Model for Health Care

An innovative experiment in Florida shows the potential for more systemic collaboration as the catalyst for lower costs and improved quality.

by Gary D. Ahlquist, Minoo Javanmardian, and Sanjay B. Saxena

In 2009, U.S. health-care reform moved rapidly to the front burner, and it will stay there. President Barack Obama and his advisors have made it clear that reducing health-care costs is a necessary prerequisite to achieving their broader economic goals.

The levers that the new administration plans to pull will address the obvious issues: treatment variability (standardized procedures tend to be more cost-effective), value-in-use analysis (evaluating costs and benefits), chronic disease management, enhanced information technology, and utilization rates. (Utilization rates measure the amount of health care delivered and received per capita. Preventive medicine and other means of reducing long-term utilization while maintaining overall public health thus represent a major cost-saving opportunity.) The reforms are all expected to involve both public and private initiatives, reassuring voters that “if you have insurance you like, you can keep it.”

But it isn’t yet obvious how the government’s changes will actually work in the current industry structure of health-care delivery and finance. Today’s health-care system in the U.S. is set up to optimize everyone’s interests except the consumer’s. Unlike other industries, in which products and processes tend to be about 80 percent standardized, and a purchaser has a reasonable sense of what to expect, the U.S. health-care industry is full of fragmentation, friction, unnecessary customization, and excessive costs. Reducing those costs would require holistic change in the practices and structures of the industry. It would mean reshaping everything from the patient care experience to the methods of gathering and sharing data.

In short, even if the new government health-care policies are well designed and effective, the U.S. will still be a long way from having a health-care finance and delivery system that can offer the right combination of incentives and relationships among sponsors (such as employers and associations), payors (health-care insurance companies and reimbursement plans), providers (including hospitals and physicians), and consumers. The federal government alone has the scope and authority to mandate top-down change across the United States, but only the industry can implement it. The challenge facing the U.S. health-care industry is thus significant: Its many varied components must cooperate to rebuild their programs and structures from the bottom up.

To use an analogy to American football, the government “kicking team” is getting ready for the game to begin. But will the “receiving team” of employers, plans, providers, and consumers be ready?

Fortunately, there are some models that the industry can draw on to answer that question. One of the most promising is an innovative experiment just getting under way in Florida. The model, dubbed Healthcare of the Future (HOF), addresses health-care reform from the ground up and engages plans, providers, and consumers. Although it has started modestly with three initial services (involving cardiac care, lung cancer treatment, and hip and knee surgery), the program is expected to expand to as many as 25 offerings, covering the great majority of services and costs.

Compared with other health-care reform efforts, HOF is distinctive because it is both comprehensive (involving multiple participants in potentially broad-scale reform) and organic (evolving from current efforts and priorities). That makes it a relevant model for any country or health-care system. Different countries have their own approaches to the way health care is funded, but they are all wrestling with the same cost and effectiveness issues, and they must all figure out how to embrace technological innovation and best-quality science. In addition, many nations face the challenge of an aging population that will have an increasing need for care and thus raise utilization rates.

If the United States is fortunate, and if models like HOF prove influential, there is a genuine possibility that the receiving team members will not just accept the ball from the government; they will change the very nature of how the game is played.

Much, much more here:

http://www.strategy-business.com/article/09301?gko=09f34-27802017-27863320

This is an interesting and sophisticated article on a possible re-design of Healthcare delivery. Experiments such as described here are vital.

Second we have:

Australian Health Issues Centre.

eHealth

Australian Government – Department of Health and Ageing eHealth Incentive Guidelines (PIP)

The PIP eHealth Incentive aims to encourage practices to keep up-to-date with the latest development in eHealth

E-Health: Empowering clinicians and consumers

This is a power point presentation by Marion J.Ball Ed.D, while its is set in an American context some of the points are relevant to the eHealth debate in Australia. In this power point eHealth is also used to mean not only personal electronic health records but also the vast amount of information that is now available on the internet which is used by consumers to make decisions about their health care.

Electronic Health Records: An International Perspective

Development of electronically linked patient records or Electronic Health Record schemes (EHRs) is a priority for governments in many countries, including Australia, as part of a vision for future health care services using call centres, web-based patient information and telehealth. This article discusses the privacy framework needed for EHRs and the role of Privacy Commissioners. It reviews nationally significant EHR schemes in Canada, England, Germany, France and Ireland and the privacy frameworks they operate within.

Electronic health records – People centred or technology centred

The National Health and Hospitals Reform Commission say that electronic health records which can be accessed by health professionals and across all settings, with the persons agreement, is arguable the most important enabler of truly person centred care.

Health Information on the Internet: Retrieval and Assessment Strategies for Consumers

The Internet is the fastest growing source of health information with over five million websites worldwide, of which 100,000 are health related. There is a need for a consumer guide on how to find health information on the Internet and evaluate its quality and the quality of the website providing the information. This article attempts to meet this need by describing a systematic approach for an Internet search where the consumer is encouraged to: identify the type of information being sought; identify the most appropriate search software; and discover tools for assessing the quality of the information retrieved and technical quality of websites.

Healthcare identifiers and privacy

All Australian governments recognise the potential benefits of changing how information is accessed and shared across the healthcare system through the use of electronic communication and information technology to ensure that information is available when it is needed to provide patient care.

The adoption of this technology, commonly described as e-health, is expected to transform the way in which healthcare providers practise and consumers interact with the health system and improve the safety and quality of healthcare and patient outcomes.

Legislative Developments in Privacy of Health Information

Electronic communication and management of information is receiving increasing attention in the Australian health sector. With this comes increasing concern about how to manage the risks to privacy generated by these developments. This article explores recent legislative responses to health privacy concerns in Australia, comparing the Commonwealth and Victorian approaches in detail.

NEHTA - National E-Health Transition Authority

Across Australia there is a groundswell of support for a better, more connected healthcare system. More than 80 percent of Australians are in favour of electronic health records and are increasingly aware of the safety and quality benefits that e-health can deliver. NEHTA has been tasked by the governments of Australia to identify and foster the development of the right technology necessary to deliver the best e-health system.

New Frontiers Old Cowboys: A Consumer Perspective on eHealth Initiatives

The move to an efficient, patient-focused health system could be greatly assisted by an integrated electronic health record. However, examination of the recent uses of technology within the health system has raised concern. This article focuses on two areas of concern, ePrescribing and the patenting of health software, and the sorts of protections that need to be instituted to ensure that any new system of electronic record keeping serves the needs of the health system and consumers.

New Resources added for September 2009-eHealth

Electronic Health Records resources and links

Privacy and Public Confidence in an eHealth Era

Australian Health Ministers have approved the development of HealthConnect, a comprehensive national scheme linking health records. Media statements emphasise participation is voluntary but public confidence in the scheme will depend on rigorous privacy protection. At the same time, amendments to the Commonwealth Privacy Act are winding their way through federal Parliament. This article looks at the adequacy of the proposed privacy legislation drawing on the concerns raised by consumers.

Privacy of Health: The Consumer’s Perspective

Privacy issues remain at the top of the political agenda in Australian health care and globally. This and the increasing push towards electronic health records make understanding consumer views about handling their health information essential. This article analyses data gathered from interviews and a survey that investigated consumers’ views about sharing their health information.

The Australian eHealth research centre

A joint venture between CSIRO and the Queensland Government, the Australian e-Health Research Centre is a leading national research facility in ICT for healthcare innovations.

More here:

http://www.healthissuescentre.org.au/subjects/list-library-subject.chtml?subject=7

This is an interesting collection of resources.

Third we have:

SCR evaluation data shows added value

08 Sep 2009

Data from the evaluation of the Summary Care Record shows the SCR sometimes adds value in out-of-hours consultations but so far has made a limited contribution in secondary care, according to a report presented to Connecting for Health.

The SCR evaluation team from University College, London, have collected data from 108 consecutive medical encounters where they examined use of the SCR and its added value, both in the view of the UCL team and the clinician using the record.

Prof Trisha Greenhalgh, who leads the independent evaluation team, told EHI Primary Care that it was impossible to draw conclusions from the data at this stage with much more data to be collected and analysed before the final report in published in May 2010.

She added: “These are not findings it is just data and the final report will not say either the SCR is of no use or it’s the best thing since sliced bread. It will be a nuanced report on what is a very complex area.”

The evaluation team presented its provisional conclusions from the data so far to an extraordinary meeting of the Summary Care Record Advisory Group at the end of June and minutes of the meeting have been published by CfH this week.

Dr Gillian Braunold, clinical lead for the SCR project, said the SCRAG was clear that there was a big difference between use of the summary record in A&E at the moment and in out-of-hours centres where the SCR was integrated into the out-of-hours software.

She added: “We had a lot of discussion with Prof Greenhalgh on the emerging benefits in primary care where there is increasing evidence that the SCR is providing benefits in terms of clinician confidence in decision making and changes in therapeutic decisions which echoes our own findings.”

More here:

http://www.ehiprimarycare.com/news/5185/scr_evaluation_data_shows_added_value

It is worth browsing these notes as they show the US Summary Care Record is starting to show some benefits.

Fourth we have:

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care

Jane Sarasohn-Kahn, THINK-Health

September 2009

Of the $2.2 trillion in total U.S. health care spending in 2007, 75% ($1.7 trillion) went to care for patients with chronic conditions. Despite this staggering expenditure, there are pervasive problems with the quality of chronic disease care.

Chronic disease is most effectively managed through frequent, near continuous monitoring. Yet many patients spend only a few minutes a year with their clinicians. According to the National Council on Aging, a third of all chronically ill people say they leave a doctor's office or hospital feeling confused about what they should do to manage their disease, and 57% report that their providers have not asked whether they have anyone to help implement a care plan at home. New technology tools are emerging to bridge these gaps. This report describes some of the online and mobile platforms and applications that can assist patients in managing their health care -- not only at home, but almost anywhere else outside their clinician's office. Sources include extensive interviews with stakeholders in the field, whose experiences and views are presented throughout the report.

More here:

http://www.chcf.org/topics/chronicdisease/index.cfm?itemID=134063

Document Downloads

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care (821K)

This is a very interesting report. There are certainly some in Australia pushing similar lines.

Fifth we have:

JAMA - Vol. 302 No. 10, pp. 1033-1130, September 9, 2009 - Commentaries

Electronic Medical Records at a Crossroads: Impetus for Change or Missed Opportunity?

Leonard W. D’Avolio

JAMA. 2009;302(10):1109-1111.

EXTRACT | FULL TEXT | PDF

Eight Rights of Safe Electronic Health Record Use

Dean F. Sittig; Hardeep Singh

JAMA. 2009;302(10):1111-1113.

EXTRACT | FULL TEXT | PDF

More here:

Links above in text. The second article especially is worth chasing down.

Further coverage is here (with links):

http://www.fierceemr.com/story/jama-series-attempts-bring-ehrs-back-reform-discussion/2009-09-10?utm_medium=nl&utm_source=internal

'JAMA' series attempts to bring EHRs back into reform discussion

September 10, 2009 — 11:57am ET | By Neil Versel

It can't be said enough: EHRs alone won't fix healthcare. We got some more peer-reviewed ammunition behind this statement with a pair of articles in this week's Journal of the American Medical Association, and the authors even managed to put their arguments in the context of health reform, despite the politicians' seemingly singular focus on the insurance market.

Sixth we have:

Implementing a Successful Health Care Pilot Project

Regional focus aligns constituents and leads to success.

By Emad Rizk, MD

It is difficult to have a conversation about health care these days without discussing the national topics of reform and change. But it is important to remember that the most effective changes in health care occur on a regional basis with pilot projects. Within a single region, we have the greatest opportunity to learn what works and what doesn't, and how to align constituents and achieve success. After all, each region has its own practice patterns, insurers, government structures and population characteristics. In this article, I will draw upon my 25 years of industry experience to share some important strategies for developing a meaningful and successful pilot program that can then be deployed on a larger scale.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206110

This is an interesting article and given its scope the book on which it is based looks to be well worth a read.

Dr. Rizk is president of McKesson Health Solutions. This article is based on material from his latest book, The New Era of Healthcare: Practical Strategies for Providers and Payers.

Second last we have:

Medical automation market expected to grow to $23.2B by 2014

September 08, 2009 | Bernie Monegain, Editor

WELLESLEY, MA – The market for medical automation technology is forecast to grow from $13.1 billion this year to $23.2 billion in 2014, according to BCC Research.

The report, Medical Automation Technologies, Products and Markets, pegs the compound annual growth rate (CAGR) at 12.2 percent.

The market is broken down into segments for therapy, diagnostic and monitoring and logistics and training. The therapy segment currently has the largest share of the market, worth an estimated $9.5 billion in 2009. This should increase at a CAGR of 11.9 percent to $16.7 billion in 2014.

The diagnostic and monitoring segment has the second-largest share of the market, worth an estimated $3.3 billion in 2009. This segment is expected to generate nearly $5.9 billion in 2014, for a CAGR of 12.4 percent.

The logistic and training market is expected to be worth $272 million in 2009 and increase to nearly $652 million in 2014, for a CAGR of 19.1 percent.

More here:

http://www.healthcareitnews.com/news/medical-automation-market-expected-grow-232b-2014

Report etc here:

• BCC Research
• Report highlights

Lastly we have:

Database Lists Device Standards

HDM Breaking News, September 8, 2009

Four standards development organizations have jointly launched a database listing standards for more than 1,300 medical devices.

Founders of the Medical Device Standards Portal include the Association for the Advancement of Medical Instrumentation, American National Standards Institute, ASTM International and the German Institute for Standardization. The site includes documents from the organizations as well as the Food and Drug Administration, International Electrotechnical Commission, International Organization for Standardization and various European regulations.

More here:

http://www.healthdatamanagement.com/news/standards_devices-38938-1.html?ET=healthdatamanagement:e999:100325a:&st=email

More information is available at medicaldevicestandards.com.

Enjoy!

David.