And Now For an Interesting Point of View on E-Health Standards. Tom Beale Ruminates!

Thomas Beale let me know he had posted a new piece today.

Ruminations on ‘design’ in e-health

I have often bemoaned the state of standards for the e-health sector. Earlier posts provide details. The main argument is that the key specifications the sector needs are for interoperable data, information and knowledge, but that the main approach to getting these is via standards agencies, whose processes almost guarantee failure. Hence the ‘standards crisis’ in health informatics. The failure is not innate in standards agencies as such; it is just that standards agency committees in the e-health sector are doing the wrong thing. They are acting as de facto R&D fora rather than as a choosing mechanism on proven designs from industry. In my view (and experience) this is because among the members and leaders of those committees are almost no engineers, i.e. people who understand a) how standards actually work in other industries and b) that design is an essential element of what is being standardised. The consequence of the situation in e-health standards is ‘design-by-committee’.

Read the full blog post here:

http://wolandscat.net/2010/12/19/design-in-ehealth/

The full post is well worth a browse.

The paragraph I have italicised I have to say I have an especial fondness for. If only we could be developing Standards on the basis of proven implementations I have the feeling we might have a smaller collection of Standards, but that collection would be trustworthy and reliable.

As some other sites often finish a post.

What do you think?

David.

Physician Productivity and the EMR - What is the Latest?

This report popped up a few days ago.

EMRs have varying effects on productivity: UC Davis study

By Joseph Conn

Posted: December 17, 2010 - 12:01 am ET

A study of about 100 primary-care physicians found that using an electronic health-record system yielded mixed results in physician productivity after the doctors had climbed the learning curve and become fully acclimated to the systems.

The bottom line of the study by Hemant Bhargava, associate dean and professor of management and computer science at the University of California Davis Graduate School of Management, and his colleagues is that EHR system specialization by medical specialty matters in that the differing needs of internists, pediatricians and family practitioners in an EHR made a difference in whether the systems helped or hindered workflow.

The study was conducted from 2003 to 2006 following the rollout of an electronic health-record system across six care sites of a large primary-care network affiliated with an academic medical center.

“Our research suggests that a ‘one-size-fits-all' design does not work—the ideal technology design should vary by physicians' requirements and work-flow demands,” Bhargava said in a news release.

More here:

http://www.modernhealthcare.com/article/20101217/NEWS/312179998/

I thought it would be worth chasing down the original study, but am told (Hi Joanne) that it will be a little while before the details are released. Here is the UC Davis press release

UC Davis study finds e-medical records have varying effects on productivity

December 16, 2010

The introduction of electronic medical records in hospitals and clinics — dubbed the “silver bullet” of health care reform — appears to have varying effects on different types of primary care physicians, a UC Davis study has found.

“Our research suggests that a ‘one-size-fits-all’ design does not work — the ideal technology design should vary by physicians’ requirements and work-flow demands,” said Hemant Bhargava, associate dean and professor of management and computer science at the UC Davis Graduate School of Management.

Bhargava and his research colleagues recently completed a study of a multimillion-dollar information technology project installed at six primary care offices from 2003 to 2006. The offices were part of a large primary care physician network affiliated with an academic medical center.

The study, one of the first to measure the impact of electronic medical record-keeping on doctors’ productivity, was conducted with Abhay Mishra, an assistant professor of health administration at Georgia State University, and research assistant Shuang Liu, a Ph.D. student in applied mathematics at UC Davis.

The system that was studied digitized patient records and allowed for electronic prescriptions and messaging.

The federal government has shown its support for developing electronic health records by setting aside $19.2 billion in stimulus funds to help pay for such conversions across the country.

“Prior to our study,” Bhargava said, “there was controversy regarding the benefits of health care IT investments. In fact, there was some anecdotal evidence that these technologies reduced physician productivity.”

For the study, researchers analyzed the impact the technology had on physician productivity, collecting data on work hours and output before and after the introduction of EMR technology. The data was collected for about 100 physicians spread across three primary care categories — internal medicine, pediatrics and family practice — and six clinics.

The researchers found that the initial implementation of the EMR system resulted in a 25 percent to 33 percent drop in physician productivity. While significant, the drop was anticipated, Bhargava said.

“Initially, physicians and their staff had to learn the system,” he explained. “After a month of utilization, physicians and their staff became more comfortable with the technology and productivity overall increased to just below starting levels, with interesting variations by unit.”

Over the next few months, the researchers found that the impact of the new technology on productivity varied by physician group. Internal medicine units adjusted to the new technology and experienced a slight increase in productivity. In contrast, pediatricians and family practice doctors did not return to their original productivity levels and experienced a slightly lower productivity rate.

“These differences by unit suggest that there is a mismatch between technology design and the work-flow requirements and health administration expectations for individual care units,” Bhargava said.

The findings, he explained, can be more easily understood by breaking EMR technology use into two categories — information review and information entry.

The use of electronic medical records makes information review — patient history, notes from previous visits, charts of test data and radiological images — more efficient. These features are useful to internal medicine doctors, who tend to see a greater proportion of ill patients.

In contrast, pediatricians’ work tends to involve more information entry and documentation for which EMR technology can be more time-consuming.

Bhargava suggests vendors and medical centers consider implementing different versions of electronic record keeping systems, tailoring the user interface, information entry and visualization features for different groups of physicians.

About UC Davis

For more than 100 years, UC Davis has engaged in teaching, research and public service that matter to California and transform the world. Located close to the state capital, UC Davis has more than 32,000 students, more than 2,500 faculty and more than 21,000 staff, an annual research budget that exceeds $679 million, a comprehensive health system and 13 specialized research centers. The university offers interdisciplinary graduate study and more than 100 undergraduate majors in four colleges — Agricultural and Environmental Sciences, Biological Sciences, Engineering, and Letters and Science. It also houses six professional schools — Education, Law, Management, Medicine, Veterinary Medicine and the Betty Irene Moore School of Nursing.

Media contact(s):

* Hemant Bhargava, Graduate School of Management, (530) 754-5961, hemantb@ucdavis.edu

* Jim Sweeney, UC Davis News Service, (530) 752-6101, jpsweeney@ucdavis.edu

The release source is here:

http://www.news.ucdavis.edu/search/news_detail.lasso?id=9665

What to say. Some of the results are pretty obvious such as suggesting that using the EMR for looking up information is a more useful activity than data entry. Hard to argue!

The finding that different specialities get different outcomes is interesting.

It is a bit sad the data being reported on (2003-2006) is so old!

The study shows clearly that EMR usability and work flow support is vital and good training is critical, as well as also indicating the need for some much more modern studies reported much more quickly!

David.

What On Earth is DoHA Thinking With This Crazy Tender? It is Utter Madness!

I mentioned this tender last week and said I would have a close look over the weekend. All I can say I am glad I no longer have to respond to ill-considered and incompetent nonsense like this. It is a nightmare that, if the requirements are actually enforced I can’t see many able to honestly respond. The requirement of having to have done this sort of work for eight (yes 8) similar projects leaves me gasping since this is the first PCEHR that has ever been proposed in this form as far as I know!

See here:

http://aushealthit.blogspot.com/2010/12/now-this-will-be-fun-tender-to-watch-i.html

(There is also a link to download the tender at the bottom of the post).

The important part of the tender - other than the routinely oppressive Terms and Conditions - is here (Page B9 on)

SERVICE REQUIREMENTS

5.1 Overview of Services

5.1.1 The successful Tenderer will provide all resources, facilities, systems, tools, processes, infrastructure and knowledge necessary to deliver the scope of services specified in the following sections.

5.1.2 The successful Tenderer will provide the following services:

a) develop and deliver a Benefits Realisation and Evaluation Framework for the whole PCEHR Program;

b) design and deliver a program monitoring and measurement capability for the whole PCEHR Program, including eHealth Sites;

c) a deep and thorough analysis and evaluation capability for the whole PCEHR Program; and

d) a complementary research capability to provide the Department with data that is relevant and of value to the build and rollout of the PCEHR Program.

5.1.3 In delivering the services, the successful Tenderer must work closely with NEHTA, the National Change and Adoption Partner, the National Infrastructure Partner and eHealth Sites. However, coordination of all of these activities must align with operational direction provided by NEHTA as the managing agent.

5.2 Benefits Realisation and Evaluation Framework

5.2.1 The successful Tenderer will develop a thorough, detailed, fit for purpose Benefits Realisation and Evaluation Framework for the whole PCEHR Program. The Framework will be mapped and aligned to the project plan described in section 6.1.1 B13.

5.2.2 In developing the Benefits Realisation and Evaluation Framework, the successful Tenderer will:

a) review, build on and operationalise the Benefits Realisation and Evaluation Frameworks developed by The Department and NEHTA (the successful Tenderer will be provided with copies of these documents);

b) sufficiently understand the government’s broader Health Reform agenda to facilitate explicit tracking of PCEHR Program outcomes to Health Reform outcomes;

c) understand and link lessons learnt from other major programs of relevance to the PCEHR Program, for example the National Broadband Network; and

d) where possible, consider state and territory eHealth activity which is of relevance to the PCEHR Program.

5.2.3 The Benefits Realisation and Evaluation Framework will:

a) map the program logic which enables the PCEHR Program objectives to be achieved, both short term (till June 2012) and long term (till 2020);

b) describe how the PCEHR Program fits into other national health initiatives within The Department, including the National Health and Hospital Network reforms;

c) ensure that the benefits of the PCEHR Program align with the broader health policies of the Australian Government;

d) align with the high level PCEHR Program planning and implementation documentation which details expected benefits from the PCEHR Program;

e) include detailed specifications for monitoring and measurement across the whole PCEHR Program;

f) allow for the early capture of lessons learnt regarding all aspects of the design and implementation of eHealth Site projects; and

g) include a clear and concise document detailing the benefits of the PCEHR Program for external stakeholders (including consumers and clinicians) which may be used to inform The Department’s communication strategy.

5.3 Program Monitoring and Measurement

5.3.1 The successful Tenderer will develop and deliver a strategy for monitoring and measuring all PCEHR Program activity.

5.3.2 This work will incorporate the detailed specifications developed as part of the Benefits Realisation and Evaluation Framework (see section 5.2 page B9).

5.3.3 The successful Tenderer will develop software, tools and templates that allow for the effective capture and communication of PCEHR Program information. Tenderers to note: Tenderers should be specific about how they will utilise software, tools and templates for the required services and whether this involves developing new software, tools and templates or customising and applying existing ones.

5.3.4 The successful Tenderer will undertake monitoring and measurement activity using an approved Monitoring Plan (see section 6.1.4 page B14).

5.3.5 Monitoring and measurement services should be informed by, but not duplicate, PCEHR Program management progress tracking undertaken by The Department and each of its partners.

5.3.6 Monitoring and measurement services should ensure the capture of baseline data that:

a) draws on existing sources of information available; and

b) obtains further information necessary to allow a full program of baseline monitoring.

5.3.7 In developing the baseline the successful Tenderer should note the following current tendering activity (released on Austender on 12 November 2010) that may produce information of value once the work is complete:

a) RFT148/1011: Consultancy to evaluate the electronic health (eHealth) readiness of Australia’s allied health professional sector; and

b) RFT 149/1011: Consultancy to evaluate the eHealth readiness of Australia’s medical specialist sector.

5.4 Analysis and Evaluation

5.4.1 The successful Tenderer will provide analysis and evaluation services including an interpretative capability of the information collected under the Monitoring Plan (see section 6.1.4 B14).

5.4.2 Analysis and evaluation services will met the following needs:

a) scheduled analysis and evaluation that provides regular tracking and associated feedback to the Department on the PCEHR Program against the Benefits Realisation and Evaluation Framework on a quarterly basis;

b) unscheduled analysis and evaluation needed to meet the short term needs of The Department and NEHTA in various forms from time to time; and

c) analysis of trends that may impact on the development and rollout of the PCEHR Program including PCEHR system uptake by consumers and clinicians, the level of eHealth interactions between clinicians, and any improved health outcomes for patients.

5.4.3 In relation to eHealth Sites, the Benefits and Evaluation Partner will evaluate:

a) how effectively the sites have deployed and tested the eHealth infrastructure and standards in real world healthcare settings;

a) how effectively NEHTA’s foundations are informing the development and rollout of the eHealth Sites and allow for further enhancement and rollout of the PCEHR Program;

b) whether eHealth Sites have been set up for success and how effectively they are operating under standard project management criteria, for example:

i. governance processes are suitable and effective;

ii. the project is appropriately resourced;

iii. the project is tracking to scope, timelines and budget;

iv. effective and transparent issues, risks and configuration management processes are in place;

v. quality management processes are in place;

vi. there is regular and clear reporting and communication to key stakeholders; and

vii. the various parties are working together effectively towards a common goal;

c) stakeholder support and uptake (both consumers and clinicians);

d) outcomes and benefits including, but not limited to, the following clinical outcome measures:

i. improved health outcomes for consumers, in particular people who have the most contact with the health and hospital system (for example people with chronic and complex health conditions, older Australians, Aboriginal and Torres Strait Islander peoples and mothers and their newborn children);

ii. improved self-management for consumers, in particular people who have the most contact with the health and hospital system (for example people with chronic and complex health conditions, older Australians, Aboriginal and Torres Strait Islander peoples and mothers and their newborn children);

iii. increased access to healthcare and information for both consumers and clinicians;

iv. improved coordination and continuity of healthcare; and

v. improved quality and safety of healthcare;

e) the impact on clinical practices including ease of use of the system, effectiveness and cost effectiveness, changes in roles and relationships with health professionals (both with other health professionals and consumers);

f) impact on workplace efficiency and flow; and

g) impact on workplace education and training.

5.5 Research

5.5.1 The successful Tenderer will provide a research capability which ensures that national and international experiences and learnings relevant to the PCEHR Program are captured and communicated to the Department.

5.5.2 The successful tenderer must undertake a preliminary scoping study to ensure that the objectives of research activities are clear and that research activity is aligned with the needs of the PCEHR Program.

5.5.3 Research will include the following:

a) desk studies that gather published knowledge and learnings from around the world (incorporating international learnings already known to the PCEHR Program);

b) an understanding of what relevant research is being undertaken that may impact on the PCEHR Program, for example the Primary Health Care Research and Information Service (PHC RIS) and the Australian Primary Health Care Research Institute (APHCRI) websites are useful information sources for current research projects;

c) a capability to answer research questions developed by the Department as the PCEHR Program progresses through sourcing data from existing studies and undertaking research that is relevant to the build and rollout of the PCEHR Program; and

d) a capability to undertake targeted testing and modelling (for example economic, benefits and workflow) either "on-site" or in a controlled environment.

The other important part, as I see it, is here where the actual program is defined.

PROGRAM DEFINITION

3.1 All of the work undertaken for the PCEHR Program needs to align with the Government’s commitment, as defined by the Minister for Health and Ageing on 11 May 2010:

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia.

The national e-Health records system will be a key building block of the National Health and Hospitals Network.

This funding will establish a secure system of personally controlled electronic health records that will provide:

· summaries of patients’ health information – including medications and immunisations and medical test results

· secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;

· rigorous governance and oversight to maintain privacy; and

· health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.

A personally controlled electronic heath record will have two key elements:

· a health summary view including conditions, medications, allergies, and vaccinations; and

· an indexed summary of specific healthcare events.

Implementation of personally controlled electronic health records

Personally controlled electronic health records will build on the foundation laid by the introduction of the Individual Health Care Identifiers later this year. Under this, every Australian will be given a 16-digit electronic health number, which will only store a patient’s name, address and date-of-birth. No clinical information will be stored on the number, which is separate to an electronic health record.

Implementation will initially target key groups in the community likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.

Reforms to take health system into 21st century

A national e-Health records system was identified as a national priority by the National Health and Hospitals Reform Commission and the draft National Primary Health Care Strategy. It was also supported by the National Preventative Health Strategy.

The Government’s reform plans in primary, acute, aged and community care also require a modern e-Health infrastructure. It is a key foundation stone in building a health system for the 21st century.

A personally controlled electronic health record will not be mandatory to receive health care. For those Australians who do choose to opt in, they will be able to register online to establish a personally controlled e-Health record from 2012-13.

And to really be amazed - here are the benefits to be expected:

I leave it to the reader to assess just how many of the benefits listed here are likely to be realised in the time allowed for this contact - (about 18 months). The short answer will be pretty much none as the system won’t even begin enrolling clients until then!

Lastly, it is important to note that without Global experience in the area you can forget about bidding:

8.1.1 The Tenderer must provide in its Tender up to eight (8) project sheets demonstrating its corporate track record in delivering benefits realisation and evaluation services to programs of a similar nature, size and complexity.

Please stand up any Company who has evaluated the implementation of 8 national PCEHR systems when there has never been one implemented?

Oh, they want a fixed price for the work to be done in the first 3 months and an estimate of each quarter after that. A bit of a trick since as a bidder it is not even clear just what ‘it’ is.

Really the desire for money is going to have to be pretty intense to try and fake your way into this ill-defined absurdity!

David.

Weekly Australian Health IT Links – 20 December, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. 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:

Well, we have almost made it to Christmas and 2011 and sadly I really don’t see much progress has been made.

The minority Government is fixated on executing a deeply flawed PCEHR strategy and tele-health while not coming to grips with the basics. I believe this approach is just utterly flawed and doomed.

On a lighter note this will be the last commentary for 2010, so all I can do is wish all readers everything they hope for, for Christmas and 2011.

It has been fun trying to pierce the relentless spin and deception coming from DoHA and NEHTA and I hope I have helped a few readers with the odd useful educational titbit along the way.

My heavens we will soon be in the second decade of the 21^st Century! Amazing - we have made it to the teens - maybe we will grow up this decade! I sure hope so!

All the best!

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http://www.theaustralian.com.au/australian-it/doctors-ready-for-online-consultations/story-e6frgakx-1225970511129

Doctors ready for online consultations

• Karen Dearne
• From: The Australian
• December 14, 2010 12:00AM

AUSTRALIANS can expect a rapid rollout of online health consultations when new Medicare tele-health rebates commence next July.

Existing services will be expanded and new videoconferencing facilities built to boost access to doctors and nurses in the bush -- and also ease pressure in cities through innovations such as home care for the elderly, remote monitoring of chronic conditions and routine tele-health check-ups.

And the Gillard government isn't waiting for the National Broadband Network to push the initiative, despite committing a further $4 million for telehealth trials at "first release" sites in NSW this month.

During the election campaign, Julia Gillard committed $250m over four years to fund the Medicare rebates -- removing a huge financial barrier to widespread adoption -- plus $57m for incentives for GP and specialist uptake, and $35m for training.

A Health Department spokeswoman told The Australian that while these measures would be enhanced by the NBN, "they are not totally dependent on it".

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http://www.australiandoctor.com.au/articles/b5/0c06dfb5.asp

Telehealth payments proposed

15-Dec-2010

By Michael East

GENERAL practices could receive lump sum payments to buy software and high-speed internet access to perform online consultations with specialists under the Federal Government’s $402 million telehealth investment

The proposal is outlined in a discussion paper released by the Federal Department of Health and Ageing last week.

Under the scheme to be rolled out from July next year, the government will offer cash incentives for GPs to perform online consultations and establish video link-ups with specialists in their practices.

It will also introduce Medicare rebates for online consultations in rural and remote areas. Training will also be made available for GPs who want to take part in the scheme.

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http://www.zdnet.com.au/govt-wants-firm-to-grade-e-health-roll-out-339308079.htm

Govt wants firm to grade e-health roll-out

By Josh Taylor, ZDNet.com.au on December 17th, 2010

The Department of Health and Ageing has issued a tender calling for a vendor to establish an oversight framework for the implementation of personally-controlled e-health records in Australia.

According to the tender documents, published today, the successful company will develop software and tools to monitor the roll-out of the program. From there, the company will be required to analyse the roll-out and produce five quarterly evaluation reports over the life of the program. The successful tenderer will also be required to evaluate how well e-health test sites have implemented the e-health record infrastructure within their organisations.

Health Minister Nicola Roxon said the company would be responsible for ensuring the government's $466.7 million investment in e-health realises its full benefits.

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http://www.arnnet.com.au/article/371718/doha_begins_search_ehealth_rollout_partner_/

DoHA begins search for eHealth rollout partner

The Department of Health and Ageing (DoHA) has released tender documents for the $466.7 million eHealth program rollout

• Julia Talevski (ARN)
• 17 December, 2010 14:13

The Department of Health and Ageing (DoHA) has launched a tender process, searching for a partner to help build and rollout its Personally Controlled Electronic Health Record Program (PCEHR). The Federal Government allocated $466.7 million towards the e-Health initiative in this year’s Budget.

The DoHA stated the partner will develop and deliver the benefits realisation and evaluation aspects of the PCEHR Program, which includes a framework for the whole program, monitoring and measurement capabilities along with deep and thorough analysis, and evaluation of the entire program. This should also include a complementary research capability to provide the Department with relevant data.

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http://www.aeroscout.com/content/news-and-events/press-releases/bendigo-071210/bendigo-health-implements-aeroscout-s-real-tim

Bendigo Health Implements AeroScout’s Real-Time Location System to Improve Patient Flow, Temperature Monitoring and Staff Safety

Australian Hospital is Using Wi-Fi RFID Solutions to Increase Operational Efficiency and Patient Safety and Care

REDWOOD CITY, Calif., December 7, 2010 - AeroScout, the leading provider of Unified Asset Visibility for the healthcare industry, today announced that Bendigo Health, located in Victoria, Australia, has implemented AeroScout’s Real-Time Location System (RTLS) to automate and improve hospital processes. Bendigo has deployed AeroScout’s Patient Flow and Temperature Monitoring solutions and is in the process of rolling out its Staff Safety solution. The solutions are Wi- Fi-based and thus enable Bendigo to utilize its standard wireless network to increase operational efficiency and enhance patient safety and care.

As the largest, multi-service healthcare organization in the region, Bendigo Health is dedicated to providing high quality care to the community. The hospital uses AeroScout’s Patient Flow solution to track the journey of orthopaedic patients through their surgical processes. With more than 10,000 surgical procedures performed at Bendigo Health each year, knowing the location and status of patients is essential to improving patient care and departmental workflow. Upon arrival, orthopaedic patients receive an AeroScout Wi-Fi Tag that provides staff visibility into a patient’s location and movement. This helps ensure that scheduled procedures start on time and that patients are receiving proper care.

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http://www.computerworld.com.au/article/370950/myhospitals_website_could_go_further_qama/?eid=-255&uid=25465

MyHospitals website could go further: QAMA

The Queensland Australian Medical Association says the federal government's new MyHospitals website doesn't go far enough.

• AAP (AAP)
• 10 December, 2010 16:17

The Queensland Australian Medical Association says the federal government's new MyHospitals website doesn't go far enough.

The federal government's MyHospitals website, which includes information on 922 public and private hospitals around the country, went live at 11am (AEDT) on Friday.

It gives nationally-consistent performance data for almost 1000 Australian hospitals online for the first time.

QAMA president, Dr Gino Pecoraro, told AAP it would help the public make decisions.

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http://www.smh.com.au/national/website-will-divulge-the-number-of-infections-caught-in-hospitals-20101213-18vhz.html

Website will divulge the number of infections caught in hospitals

Mark Metherell HEALTH CORRESPONDENT

December 14, 2010

THE rate of infections caught by hospital patients will be published on the My Hospitals website as part of the planned release of more sensitive information.

The Health Minister, Nicola Roxon, has told the Herald that the waiting-time information published nationally on the new My Hospitals website last Friday was ''just the beginning''.

''We are working with the states and territories to expand the website to include a wide range of hospital data that we know consumers are after, including safety and quality data such as infection rates,'' Ms Roxon said.

However, she would not say whether the expansion would include details on waiting times for outpatient services such as chemotherapy.

Public hospitals and consumer groups say that while the My Hospitals site is a welcome start, there is much more information realistically available which should be published.

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http://media.crikey.com.au/dm/newsletter/dailymail_2af18cc3384ddc944b8b26d2bfd5b200.html#article_8461

11. MyHospitals site just a baby step, needs help to grow up

Melissa Sweet writes: MYHOSPITALS, NICOLA ROXON

In health policy, it is rare to find an initiative that is universally blessed.

This is partly because health policy is frequently about finding the "least worst option", there being few measures that don’t have some downside, and also reflects the "strife of interests" that so often drown out reasonable intentions.

So it’s not surprising that the new MyHospitals website -- which enables us to compare waiting times for elective surgery and emergency department care at public hospitals and some private hospitals, and to source some other limited information -- has drawn somewhat mixed reviews.

But it would be premature to consider these the final word; as health minister Nicola Roxon’s statement and the website itself make clear, MyHospitals should be seen as work in progress.

In which case, a critical question seems to be, how should the website be evaluated? This is important if it is to be improved and made more useful.

Croakey today publishes suggestions from a range of experts. The consensus is that MyHospitals is but a baby step and needs a lot more work if it is to really make a difference.

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http://blogs.crikey.com.au/croakey/2010/12/16/what-should-we-make-of-the-myhospitals-website/

What should we make of the MyHospitals website?

December 16, 2010 – 10:00 am, by Melissa Sweet

In health policy, it is rare to find an initiative that is universally blessed.

This is partly because health policy is frequently about finding the “least worst option”, there being few measures that don’t have some downside. It also reflects the “strife of interests” that so often drown out reasonable intentions.

So it’s not surprising that the new MyHospitals website – which enables us to compare waiting times for elective surgery and emergency department care at public hospitals and some private hospitals, and to source some other limited information – has drawn a somewhat mixed review.

But it would be premature to consider these the final word; as Minister Roxon’s statement and the website itself make clear, MyHospitals should be seen as work in progress.

In which case, a critical question seems to be, how should the website be evaluated? This is important if it is to be improved and made more useful.

Croakey asked a range of contributors for their views on this. (We’ve also asked the AIHW to tell us exactly what they’re planning in this respect, and will post the response if and when they get back to us).

----- Comment - Great Stuff - Lots of Ideas to Consider!

http://www.smh.com.au/digital-life/smartphone-apps/a-doctor-in-your-pocket-20101215-18xlf.html

A doctor 'in your pocket'

Dan Nancarrow

December 15, 2010

Finding a doctor will soon become easier for iPhone users with the launch of a new app that will pinpoint the nearest GP.

The free application allows users to pinpoint the location of their nearest AMA-affiliated doctor and, by utilising GPS technology, can direct patients to the clinic.

A web-based version of the application is also available on browsers at www.amafindadoctor.com.au.

AMA Queensland president Gino Pecoraro said with Christmas approaching, many families would be on holidays away from their local doctor.

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http://ama.com.au/node/6277

AMA plan to get the ‘e-health revolution started

10 December 2010 - 3:00pm

AMA President, Dr Andrew Pesce, said today that the Government should concentrate its efforts on delivering the most easily achievable aspects of an electronic medical record in order to get Australia’s much-anticipated ‘e-health revolution’ started.

Dr Pesce said that the AMA has long been a supporter of the Government’s e-health agenda but it is time that people started seeing some results.

"The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

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http://biomedme.com/general/ama-plan-to-get-the-e-health-revolution-started-australia_25356.html

AMA Plan To Get The ‘e-health Revolution Started, Australia

Written By: sara on December 12, 2010 0

AMA President, Dr Andrew Pesce, said that the Government should concentrate its efforts on delivering the most easily achievable aspects of an electronic medical record in order to get Australia’s much-anticipated ‘e-health revolution’ started.

Dr Pesce said that the AMA has long been a supporter of the Government’s e-health agenda but it is time that people started seeing some results.

“The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

-----

http://www.nehta.gov.au/media-centre/feature-story/778-iphone

NEHTA develops iPhone application to show patient journey

NEHTA has developed an iPhone application to show how doctors could access a patient’s record easily with eHealth records including X-ray results and allergies, making diagnosis quicker and safer.

The simulation shows a patient journey of a man, Mr Frank Harding, and his wife travelling interstate with interaction with multiple health services as they holiday. (See graphics below)

At a press conference after opening the national Revolutionising Australia’s Health Care conference in Melbourne in November, Minister for Health and Ageing Nicola Roxon said new technology is driving how healthcare will be delivered in the future in Australia.

“The iPhone app is in the concept stage, but is a good example of how we can harness technology to help health professionals deliver better patient outcomes,” she said.

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http://www.theaustralian.com.au/business/city-beat/isoft-sells-ibs-to-britains-capita-group-shares-jump-87pc/story-fn4xq4cj-1225970797844

iSoft sells iBS to Britain's Capita Group, shares jump 8.7pc

• Michael Bennet
• From: The Australian
• December 14, 2010 11:05AM

STRUGGLING iSoft has sold its financial management solutions arm to British outsourcing company Capita Group.

iSoft Group, now on a long road towards reducing its debt pile of about $240 million, said today it had sold iSoft Business Solutions (iBS) to Capita for £23.2m ($36.95m), after it classified it as non-core in an ongoing strategic review; UBS is assisting in the program.

Australia’s largest health IT company today also revealed it had sold its GP administration software asset, Monet. From the two sales, iSoft said it would use $28.5m to reduce group debt.

For the year to June 30, 2010, iBS generated revenue of £17.7m, and £5.8m in earnings before interest, tax, depreciation and amortisation.

“While iBS is a profitable business, its key products, Oracle’s e-business suite and Integra financial accounting solutions, have little overlap with iSoft's proprietary core patient-focused healthcare IT business,” said chief executive Andrea Fiumicelli.

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http://www.abnnewswire.net/press/en/64802/iSOFT_Group_Limited_%28ASX:ISF%29_Announces_Sale_Of_Non_Core_Assets_To_Enable_Debt_Reduction_Of_A285_Million.html

iSOFT Group Limited (ASX:ISF) Announces Sale Of Non-Core Assets To Enable Debt Reduction Of A$25 Million

Sydney, Dec 14, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the following to the market:

iSOFT has sold iSOFT Business Solutions (iBS), its financial management solutions business to Capita Group plc (LON:CPI) (PINK:CTAGY). The business was classified non-core as part of iSOFT's ongoing strategic review. Together with the proceeds from another smaller asset sale, Monet, a GP administration software, iSOFT has A$28.5 million available to pay fees related to the refinancing and reduce the senior bridge revolver facility in our group debt.

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http://www.computerworld.com.au/article/371261/isoft_sells_off_business_solutions/?eid=-255&uid=25465

iSoft sells off Business Solutions

Struggling e-health provider will use the proceeds to pay down debt

• Tim Lohman (Computerworld)
• 14 December, 2010 16:32

Embattled e-health provider iSoft (ASX:ISF) has begun selling off the farm to pay down its debts.

The company has sold its financial management solutions unit, iSoft Business Solutions (iBS) to Capita Group PLC.

According to an iSoft statement, the iBS unit was classified as a non-core business under its ongoing strategic review.

The company has also sold off is GP administration software business unit, Monet, to an undisclosed buyer.

The two businesses were sold for $28.5 million and will be used to pay fees related to the refinancing and reduction of a “senior bridge revolver” debt facility.

“While iBS is a profitable business, its key products, Oracle’s e-business suite and Integra financial accounting solutions, have little overlap with iSoft’s proprietary core patient-focused healthcare IT business,” chief executive, Andrea Fiumicelli, said in an ASX statement.

-----

http://www.mtbeurope.info/news/2010/1012030.htm

iSOFT moves into life sciences market

16 Dec 2010

iSOFT Group Limited (ASX:ISF) has moved into the life sciences market with software that extracts and de-identifies clinical data from electronic medical records for clinical research and other secondary uses.

The move follows a co-marketing agreement with US-based CliniWorks for its AccelFind solutions. CliniWorks has developed the technology behind AccelFind, and provides it as a service, to extract medical knowledge from any type of data, including free text notes, discharge summaries or the structured data contained in electronic medical records and laboratory systems.

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New Zealand Watch.

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http://computerworld.co.nz/news.nsf/news/national-eprescribing-trial-launches

National ePrescribing trial gets underway after delays

With security issues raised by pharmacists addressed, trial will go ahead

By Randal Jackson | Wellington | Wednesday, 15 December, 2010

After years of debate and dispute between the various parties involved, the new National Health IT Board has launched a national geographic trial for community ePrescribing.

Simpl Group, which had developed an engine for a similar programme in Australia, has won the business. There were five responses to the tender.

Previously, there had been resistance to ePrescribing by the Pharmacy Guild, which was concerned about security. Those concerns have been addressed.

There will be a 12-month trial over four geographic regions that will cost somewhat less than $1 million, says project lead Shane Hunter.
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http://www.zdnet.com.au/nsw-axes-cio-role-rodriguez-leaves-339308087.htm

NSW axes CIO role, Rodriguez leaves

By Renai LeMay, ZDNet.com.au on December 18th, 2010

New South Wales whole of government chief information officer Emmanuel Rodriguez will leave his post on the wings of a wide-ranging restructure within the State Government which will see his office devolved into the Department of Technology, Services and Administration (DSTA) super-agency.

In a statement, the DSTA confirmed the CIO's departure, first reported by the Australian Financial Review online on Friday afternoon.

The department's statement also detailed an associated wide-ranging overhaul of the state's technology governance structure, which had previously been shared between Rodriguez' government Chief Information Office, the DSTA itself, the Executive Council of agency CIOs and even shared services agency ServiceFirst.

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Enjoy!

David.

The Government Is Heading In the Wrong Direction with the PCEHR - AMA.

The following appeared a few months ago and I sadly missed it. Maybe not such a bad thing considering 3 months and a Summit have now passed and we don’t seem all that much further ahead.

Too soon for hallelujahs?

24th Aug 2010

Are personalised e-health records truly the solution to the system’s ills? In the final of her series, Caroline Brettingham-Moore finds the experts are less than confident.

Caroline Brettingham-Moore

AFTER a decade of stalls and setbacks, calls for a national electronic healthcare records system may have finally been answered.

But what sort of record we get for the amount of money the Federal Government has committed to the project is something the experts are still arguing over.

In May, Health Minister Nicola Roxon announced all Australians would be able to regis­ter for a personally controlled electronic health record (PCEHR) by 2012.

And with only $467 million to invest over two years it would appear the minister has pulled a rabbit out of her hat.

At the time of the announcement, sceptics branded it “misleading” and “hot air” after the Government failed to provide any detail as to how the money would be spent. But just last week, the Minister revealed that $12.5 million of this budget would be given to three divisions in Queensland, NSW and Victoria to pilot a national rollout of PCEHRs.

Brisbane division GPpartners, while welcoming the funds, remains wary of whether the two years of funding will be enough to get the project working. Others have also expressed concern over the total $467 million package.

Health IT consultant Dr David More warns the money, which is well below the Deloitte’s recommendation of $1.5 billion over five years, will not deliver what is promised.

He says the shallow period allocated for funding the project will turn off possible IT vendors.

“What will happen after two years and who would bother if there is no confidence of some reasonable follow-on?” he asks.

“Surely this is an emergency fig leaf to cover the naked lack of e-health policy...”

Tricky definitions

So what does “personally controlled electronic health record” actually mean? Ms Roxon told a news conference in June that “the easiest way to think of it is how you access your bank details online”.

Unfortunately, this explanation was not well received by industry insiders, who questioned whether the minister actually understood the concept herself.

“Do banks ever hand over bits of their records to random third parties on request of their patients, I mean customers, with or without consent,” said one comment on Dr More’s blog, Australian Health IT, said.

Another said: “If you link your health record to your home loan, you might avoid account fees.”

So why does Australia need a PCEHR?

Ms Roxon says the record will provide summaries of a patient’s health information, including medi­cations, immunisations and test results. It will also give patients and healthcare providers secure access to their e-health records via the Internet.

It is estimated 8% of medical errors in Australia are due to inadequate patient information. Between 2% and 3% of hospital admissions in Australia are linked to medication errors. This equates to about 190,000 admissions a year, costing the health system $660 million.

According to an analysis by Booz and Company, the benefits of a comprehensive e-health system could save between 5000 and 10,000 lives by 2020 by reducing medical errors .

Obviously clear, quickly available information will help to reduce adverse events, avoid unnecessary tests and save scarce health resources.

Much more here:

http://www.medicalobserver.com.au/news/too-soon-for-hallelujahs

Clearly things were not clear at that point. Move forward 3 months, and while again it took me a few days to catch up this appeared just over a week ago.

http://ama.com.au/node/6277

AMA plan to get the ‘e-health revolution started

10 December 2010 - 3:00pm

AMA President, Dr Andrew Pesce, said today that the Government should concentrate its efforts on delivering the most easily achievable aspects of an electronic medical record in order to get Australia’s much-anticipated ‘e-health revolution’ started.

Dr Pesce said that the AMA has long been a supporter of the Government’s e-health agenda but it is time that people started seeing some results.

"The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

“This is basic information, yet critical to patient care. It is currently available in electronic format, but it is not easily or instantly accessible to doctors in all situations when they are providing care for patients.

“If it were possible for doctors to electronically access this patient information in ‘real time’, while protecting patient privacy, a significant amount of the e-health ambition would be realised.

“Over time, other aspects of electronic health records could be developed to fully realise the potential of e-health to improve patient care.

“To be successful, the electronic medical record must be easy to use, support what doctors already do, and be compatible with current clinical practice methods.

“The AMA e-health plan satisfies these criteria and would give e-health in Australia the kick-start it needs," Dr Pesce said.

10 December 2010

The source is the AMA web site here:

http://ama.com.au/node/6277

The post by the AMA was reported here

AMA Plan To Get The ‘e-health Revolution Started, Australia

Written By: sara on December 12, 2010 0

AMA President, Dr Andrew Pesce, said that the Government should concentrate its efforts on delivering the most easily achievable aspects of an electronic medical record in order to get Australia’s much-anticipated ‘e-health revolution’ started.

Dr Pesce said that the AMA has long been a supporter of the Government’s e-health agenda but it is time that people started seeing some results.

“The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

“This is basic information, yet critical to patient care. It is currently available in electronic format, but it is not easily or instantly accessible to doctors in all situations when they are providing care for patients.

“If it were possible for doctors to electronically access this patient information in ‘real time’, while protecting patient privacy, a significant amount of the e-health ambition would be realised.

“Over time, other aspects of electronic health records could be developed to fully realise the potential of e-health to improve patient care.

“To be successful, the electronic medical record must be easy to use, support what doctors already do, and be compatible with current clinical practice methods.

“The AMA e-health plan satisfies these criteria and would give e-health in Australia the kick-start it needs,” Dr Pesce said.

Source: Australian Medical Association

More here:

http://biomedme.com/general/ama-plan-to-get-the-e-health-revolution-started-australia_25356.html

So let us be quite clear here. The organisation that NEHTA and DoHA will have to most rely on to gain traction with their PCEHR initiative are saying the major thrust of the plan is wrong.

These two paragraphs say it all:

“The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

“This is basic information, yet critical to patient care. It is currently available in electronic format, but it is not easily or instantly accessible to doctors in all situations when they are providing care for patients.”

The bottom line here is that we need to address the grey before the beige on this NEHTA (from the Summit presentation) graphic! (It is fun to have the odd funny graphic to brighten things up). Let’s get the information flows between providers really working and reliable and then worry about indexes, summaries and the like.

All this just confirms the view I have been putting for a while now. This is the same we might be hearing from all sort of others if they were not so busy trying to work out if all these funds on offer from DoHA and NEHTA are an huge opportunity or a disastrous threat!

You know where I stand on that!

David.