Quote Of The Year

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

or

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

Monday, April 28, 2014

Weekly Australian Health IT Links – 28th April, 2014.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Again a very quiet week as we await the Budget axe to fall. Interestingly there is increasing speculation on just what the shape the PCEHR may take after the announcements.
IF the most recent poll is to believed then most expect at least some, if not major, cuts.
It was interesting to see a spate of reports on Commonwealth Government computer systems needing a lot more funds while not working all that well. Vested interest rent seeking maybe?
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PCEHR model may be revamped

22nd Apr 2014
THE personally controlled electronic health record (PCEHR) could move to an opt-out model under a recommendation believed to be contained in the review of the $1 billion system.
And the findings of the review could be made public before the May budget, a report in Fairfax media suggested. MO understands the review recommends that an opt-out model should replace the current system where patients must register to establish their PCEHR.
The review was ordered late last year by Health Minister Peter Dutton, and earlier this year his office confirmed he had received the report and that its recommendations were under consideration.
In its submission to the review, the AMA had argued that an opt-out model would provide greater incentive for doctors to use the PCEHR and lower the administrative burden on patients.
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Victoria fronts up $24m for electronic medical record

Agrees to partly fund Royal Children’s Hospital tech.

The Victorian state government has agreed to fund half of the Royal Children’s Hospital’s $48 million electronic medical record.
Premier Denis Napthine this week announced work would start on installation of the new system in the middle of this year.
US health software vendor Epic has been selected to roll out the new system across the facility, which was opened in 2011 next door to the site of the former Melbourne children’s hospital.
The implementation is expected to take four years and will track patients in fully electronic form for the first time.
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Post-vaccination texts track side effects

22 April, 2014 David Brill
A Perth GP who found himself at the centre of the Fluvax scare has responded by developing a completely new adverse event reporting system.
Dr Alan Leeb (pictured) decided to take matters into his own hands after belatedly discovering that 62 children developed fever after receiving Fluvax at his practice in early 2010.
At least eight were hospitalised, including three who had seizures, from a total of 335 given the vaccine.
"We were totally unaware [of the adverse reactions]. The only way we'd know is if we received a discharge summary from the hospital or if the patient came back to see us," Dr Leeb, practice principal at the Illawarra Medical Centre, told Australian Doctor.
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Texting vax reactions may boost safety

22nd Apr 2014
A TEXT messaging system that delivers near real-time monitoring of adverse effects from vaccinations is already revealing a higher than expected rate of reactions to scheduled vaccinations among four-year-old children.
A group of researchers led by Perth-based general practitioner Dr Alan Leeb used prototype software called SmartVax to send an SMS to adult patients and parents of children who received vaccines asking if they had experienced an adverse event following immunisation (AEFI).
More than 72% of 3226 patients vaccinated over 19 months responded, with 11% (264) reporting mostly minor systemic or local reactions.
Half the patients responded within 10 minutes of receiving the SMS, and more than 80% of responses were received within two hours.
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Is the new eRx electronic prescription service beneficial to consumers?

About ten years ago I did a locum in an innovative GP practice in The Netherlands. When prescribing medications, the computer system allowed me to either print the script and hand it to my patient, or send it electronically to the pharmacy. Consumers who elected the second option, were able to collect their medications at the pharmacy twenty minutes later.
I’m not sure how secure the system was, but it was easy to use, saved a lot of paper, and prevented lost scripts and medication errors.

ePrescribing in Australia

Here in Australia doctors are printing or handwriting scripts. This month however I noticed a little QR code in the top right corner after printing a script. It took me a while to figure out what it was for: Patients can scan this code with a mobile device, submit the information electronically to the pharmacy of their choice and pick the script up on a preferred day and time.
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In pictures: 3D printing and healthcare

How 3D printing is transforming the world of medicine.
While other industries may still be trying to figure out practical uses for 3D printing, the healthcare industry is already using it to save and improve lives. From implants and prosthetics to home-grown drugs and human organs, the 3D printing revolution has begun in the medical world.
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Australia - E-Health, E-Education, E-Government-Market Analysis, Growth, Trends and Forecast

New Market Research Report Added in MarketResearchReports.Biz Reports Database:Australia - E-Health, E-Education, E-Government
Albany, NY -- (SBWIRE) -- 04/16/2014 -- Digital productivity the next frontier in the economy
……
E-Health
Efficiency levels in the healthcare sector are among the lowest in the economy – estimated by IBM to be minus 40%. Through e-health $30 billion can be saved over a 10-year period. Healthcare is clearly becoming an area where key killer applications emerge – applications that utilise truly high-speed broadband networks.
As the financing of the public health systems in Australia becomes increasingly costly an opportunity exists to lower costs through more effective use of web services for healthcare consumers. With widely available and cost-effective ICT developments in data analytics, M2M and high-speed broadband infrastructure, e-health is enabling customers to benefit from advances in medical technology and medical services.
The Personally Controlled Electronic Health Record (PCEHR) is a key enabler in that policy and a report on these developments is included.
While broader economic conditions in Australia remain subdued, spending on e-health solutions is likely to continue.
In the report we also list the key projects in Australia. We provide an overview of trials, both publicly- and privately-funded, and initiatives in e-health, with an overview of pilot programs as well.
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Grandma Gamers - Virtual Worlds offer aged care solutions

Professor Michael Blumenstein is an artificial intelligence expert at Griffith University’s School of Information and Communication Technology where last month he presented a paper at a Robotic Symposium on research into 3D virtual worlds in health care.
“It’s a really new area for the health space,” he says. “A lot of people have worked in the 3D virtual world area – such as the Second Life experience - but applying it in the way that we are thinking of applying it is quite new.”
Blumenstein was co-author on a recently-published literature review in the Journal of Internet Medical Research on the use of 3D virtual worlds (3DVW) in health care.
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Audit uncovers Medicare data snafus

Problems with Medicare data integrity remain
An audit of Medicare's customer database has found a small number of cases of 'intertwined' customer records where two people's records have been combined, giving rise to "privacy and clinical safety risks", according to an auditor-general report tabled today.
According to the Department of Human Services, 34 instances of 'intertwining' have been discovered since the department started maintaining records on the issue in 2011. The DHS has a working group dedicated to eliminating the issue.
More than 23 million people were part of the Medicare system in 2012-13, including 618,533 new enrolments, the auditor-general's report notes. There were 29.3 million customer records when the Australian National Audit Office (ANAO) accessed the database in September last year.
Details of users of Medicare services are stored in a database called the Consumer Directory. The audit found that the DHS has "not been fully effective in maintaining the integrity of data" in the database.
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Crackdown on Medicare rorting by doctors falls $128 million short

Date April 23, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

The Department of Human Services botched a massive crackdown on Medicare rorting by doctors, leaving taxpayers with a $128 million shortfall.
A damning report by the Auditor-General has raised serious questions about the ability of the department to safeguard the integrity of the $19 billion Medicare program.
In 2008, the Rudd government allocated $77 million over four years to the Department of Human Services to increase the number of audits it completed on doctors' Medicare claiming each year from 500 to 2500. The audits, which examine whether doctors are actually delivering the services they are billing Medicare for, was supposed to recover $147 million to deliver a net saving of $70 million. 
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Medicare crackdown botched: Auditor-General

24 April, 2014 Paul Smith 0 comments
A major crackdown on Medicare rorts backed by millions of dollars for investigations into doctors has been botched.
In 2009, under the Rudd Government, the Department of Human Services was handed $77 million to increase the number of audits on doctors and allied health professionals from 500 to 2500 a year.
A damning audit report released this week said the program was expected to recoup $147 million in savings. But in reality it has so far recovered less than $19 million - meaning it cost taxpayers more than it actually saved.
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Audit report reveals struggle to catch doctors, clinics ripping off Medicare

A DAMNING audit report has revealed the Commonwealth is struggling to catch doctors and corporate clinics ripping off Medicare, raising new questions about plans for a $6 co-payment for GP appointments.
Next month’s federal budget will include a co-payment, capped at 12 visits a year and almost certainly subject to other restrictions, to save the government $750 million over four years.
But Health Minister Peter Dutton is refusing to say how the government would administer a co-payment, which would all but end universal access to bulk-billed appointments fully subsidised by Medicare.
While roughly three-quarters of all GP appointments are currently bulk-billed, some health groups fear an automatic co-payment would remove the incentive for doctors and corporate clinics to keep costs down, leading to profiteering and higher out-of-pocket expenses for patients.
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Rollout shambles in NBN’s first state

THE National Broadband Network rollout in Tasmania — which Labor promised would be the first state fully connected to lightning-fast internet services — has been “so shambolic” and failed “so abysmally” to meet its targets that urgent political intervention is needed.
The Weekend Australian can reveal the state’s peak IT business group, a longstanding supporter of Labor’s original “Rolls-Royce” NBN, has warned there is “no realistic chance” the project will be completed by the end of 2015, as once promised by former communications minister Stephen Conroy and NBN Co.
The Tasmanian ICT sector peak body, known as TASICT, says the process for connecting new customers to the optic fibre network is failing.
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Centrelink computer broken: Hockey

JOE Hockey has warned of a shock multi-billion-dollar hit to the budget to fix the 31-year-old Centrelink computer system, which is in “bad shape” and a drag on productivity that is holding back crucial policy change.
Human Services Minister Marise Payne said the system, based on 1980s technology, was also hampering the government’s efforts to cut red tape and shift Centrelink into the digital world.
The Treasurer said the biggest surprise he had received since coming into power was the ­deterioration in government infra­structure, particularly the Centrelink computer system in Canberra, which would cost “billions” to improve.
Mr Hockey, who is preparing a structural overhaul of welfare and payments in the budget next month, said changes were being stymied by the system.
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Almost All Data Security Breaches In The Past Decade Fit Into These 9 Categories

Alex Heber Apr 23, 2014, 3:46 PM
In one of the most high profile data breaches of late, Edward Snowden, a 29-year-old former CIA technical assistant revealed details of top-secret surveillance conducted by the US’ National Security Agency. (Photo by The Guardian via Getty Images)
Almost all tech security breaches over the past 10 years fit nine basic attack patterns.
Security researchers at Verizon have crunched a decade’s worth of security breach data from law enforcement, public and private sector organisations all across the world and have found while attack patterns vary between industries there are some distinct trends.
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The hidden costs of the Heartbleed security bug

Date April 22, 2014 - 2:52PM

Ben Grubb

Heartbleed has left swathes of websites and users exposed.
The Heartbleed security bug is set to cost millions to clean up, according to an internet company that has crunched the numbers on the extra internet traffic costs imposed by it.
In one case, it is estimated additional internet traffic to fix the problem amounted to $US400,000 ($428,000) for a single operator. Many others are expected to foot similar bills.
Content distribution network CloudFlare said it had revoked all of its clients' SSL certificates after the Heartbleed bug as part of a fix. It followed a challenge it set hackers to see if they could steal a website's private encryption keys using the bug. It found a web server's private keys – its "crown jewels" – could be successfully extracted.
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After Heartbleed, tech giants team up to fund open-source projects

Date April 25, 2014

Jim Finkle

The world's biggest technology companies are donating millions of dollars to fund improvements in open source programs such as OpenSSL, the software whose Heartbleed bug has sent the internet into turmoil.
Amazon, Cisco, Facebook, Google, IBM, Intel and Microsoft are among a dozen companies that have agreed to be founding members of a group known as Core Infrastructure Initiative. Each will donate $US300,000 ($324,000) to the venture, which is recruiting more backers among technology companies as well as the financial services sector.
Other early supporters are Dell, Fujitsu, NetApp, Rackspace and VMware.
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Enjoy!
David.

What An Amusing Report On The NEHTA Website.

Nehta.gov.au - Nehta Website Traffic Estimation

Home - NEHTA
We have pulled stats for you about nehta.gov.au to help your research.
Based on Alexa.com findings, nehta.gov.au has a global traffic rank of 1,656,395. nehta.gov.au also reaches roughly 840 unique users each month and has 164 backlinks according to Alexa. The estimated monthly ad revenue is $ 0.00.
We estimate the website value of nehta.gov.au is currently at $ 0.00. Traffic and Revenue of nehta.gov.au is estimated to be increasing within the last 3 months. The domain nehta.gov.au is a .gov.au domain with the name nehta preceding it.
The Server of nehta.gov.au is powered by the Microsoft-IIS/7.0 webserver software and the server is physically located in Australia (New South Wales) and uses the IP address 125.7.67.18. At the DMOZ open directory project we found no listing for nehta.gov.au at this time.
Updated: 04/28/2014 04:05, 4 hours ago
Worldwide Rank Monthly Users* Monthly Pageviews*
1,656,395 840
28 per day*
2,434
80 per day*

Website Value* Monthly Earnings* Daily Earnings*
$ 0.00 $ 0.00 $ 0.00
*Estimated Traffic and Value Data

Site Title

Home - NEHTA

Site Description

NEHTA's role is to facilitate the transition to a connected eHealth system where every Australian is at the centre of their healthcare.

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Here is the link

http://nehta.gov.au.websitetrafficspy.com/

I have no idea how accurate this is.

The blog seems to get 200 page views per day on average for what that is worth - [smile].

David.


According To The SMH The Centrelink Systems Are Now Down.

See here:

http://www.smh.com.au/it-pro/government-it/centrelink-child-support-suffer-systems-outage-20140428-zr0rd.html

It just seems to get worse and worse.

David.

It Seems The Front End To The PCEHR Portal Is Not As Secure As It Might Be.

This appeared earlier today.

Australians' private government details at mercy of hackers, say IT security experts

Date April 28, 2014 - 7:20AM

Ben Grubb and Noel Towell

Some of the information accessible via my.gov.au when linking it to Medicare.
The private records of millions of Australians – including their doctor visits, prescription drugs, childcare and welfare payments – are at the mercy of cyber criminals because of flimsy IT security around a critical federal government website, IT security experts warn.
And they say the risk will increase from the middle of the year, when the government will make it compulsory for Australians to use the my.gov.au website to lodge their electronic tax returns, potentially also exposing their financial and banking records to hackers.
I expect two-factor authentication for information that is much less valuable. 
Troy Hunt, security expert
The myGov site is used by 2.5 million Australians to access their Centrelink, Medicare, Child Support, Department of Veteran Affairs, e-health, and NDIS government accounts. If users link their different accounts, information accessible includes their name, date of birth, phone numbers, email address, Medicare number, child immunisation records, dates of doctor visits and drugs prescribed, welfare and childcare reimbursement payments.
E-health records, including prescription drugs, are also accessible using my.gov.au.
But Sydney software architect and IT security consultant Troy Hunt said the controls used to protect the site were "insufficient" and "irresponsible" and considerably weaker than many other large websites such as Google, Twitter and note-taking app Evernote.
He called on the government to introduce "two-factor authentication" to better protect the sensitive information. The process is commonly used by banks and other sites, requiring users to put in a token, or code, sent to their mobile phone before they are allowed access to their account.
There are a lot more details found here:
It is a bit of a worry that screens from all these systems are shown indicating they have possibly been accessed inappropriately.
It is also a bit of a worry that the Department is resisting FOI requests from legitimate journalists.
This sort of report points out, yet again, the risk of large centralised systems being attractive to potential information intruders.
Not a great bit of news for public confidence!
David.

Sunday, April 27, 2014

It Looks Like We Have Some Serious Computer Issues At Medicare and Human Services. A Serious Refresh Is Needed Soon And Will Be Expensive!

A very interesting audit was published a few days ago by the Australian National Audit Office.

Integrity of Medicare Customer Data

Introduction

1. Medicare is Australia’s universal healthcare system, which provides people with access to free or subsidised health and hospital care, with options to also choose private health services. Medicare is one of a range of Australian Government health programs administered through the Department of Human Services (Human Services).1
2. In its 2012–13 Annual Report, Human Services reported that as at 30 June 2013, there were 23.4 million people enrolled in Medicare, including 618 533 new enrolments. For an individual to enrol in Medicare, they need to reside in Australia and be either an Australian or New Zealand citizen2; a permanent resident visa holder; or an applicant for a permanent resident visa (excluding a parent visa). Australia has Reciprocal Health Care Agreements with 10 countries and visitors from these countries may also be eligible to enrol.3 Some eligibility types, for example, visitors from Reciprocal Health Care Agreement countries, are only eligible to use Medicare for a limited period of time.
3. In 2012–13, Human Services processed payments totalling $18.6 billion for over 344 million Medicare services. Expenditure under Medicare is expected to continue to grow, with payments estimated to reach $23.7 billion by 2016–17.4
4. In administering Medicare, Human Services collects personal information from customers at the time of their enrolment and amends this information to reflect changes in their circumstances.5 The main repository for this data is the Medicare customer record database, the Consumer Directory.
5. Maintaining the integrity of customer data assists to mitigate key risks associated with Medicare including access to benefits by ineligible people who are enrolled without an entitlement or who are enrolled for a period beyond their entitlement. There is also a risk that ineligible people may obtain an active Medicare card and use it fraudulently to access services and/or make fraudulent claims. In addition, the fraudulent use of Medicare cards as a form of identification is a risk to Medicare and the broader community.6
6. Customer data integrity assists in mitigating these risks and contributes to the effective and efficient administration of Medicare. To maintain data integrity, Human Services has implemented both ‘upstream’ controls at the enrolment stage, and post‑enrolment measures to manage updates to its records arising from changed customer circumstances. The department has also implemented measures to protect the privacy and security of customer data.

Audit objective, criteria and scope

7. The objective of the audit was to examine the effectiveness of the Department of Human Services’ management of Medicare customer data and the integrity of this data.
8. To assist in evaluating the department’s performance in terms of the audit objective, the ANAO developed the following high level criteria:
  • Human Services has adequate controls and procedures for the collection and recording of high quality customer data;
  • Medicare customer data as recorded on Human Services systems is complete, accurate and reliable; and
  • customer data recorded on Human Services systems is subject to an effective quality assurance program and meets relevant privacy and security requirements.
9. The audit scope focused on the integrity of Medicare customer data and included related testing of all Medicare customer records. It did not examine Healthcare Provider Information, the allocation or management of Individual Healthcare Identifiers (IHI) or the operation of Personally Controlled Electronic Health Records.
10. The audit also considered the extent to which Human Services had implemented the six recommendations from ANAO Performance Audit Report No.24 of 2004–05 Integrity of Medicare Enrolment Data.

Overall conclusion

11. Medicare has been in place for 30 years7 and is accessed by almost all Australians and some visa holders and visitors. In 2012­­–13, Human Services reported over 23 million people enrolled in Medicare, including 618 533 new enrolments.8
12. The department’s administration of Medicare is supported by a long‑established database, the Consumer Directory, which contains all Medicare customer records. As the repository of a large and evolving data set incorporating, on an ongoing basis, both new enrolments and changes to customer information, the Consumer Directory requires active management to maintain the integrity, security and privacy of customer data; essential prerequisites for the effective administration of Medicare.
13. Human Services’ framework for the management of Medicare customer data, including procedures and input controls for the entry of new enrolment information and changes to customer information, has not been fully effective in maintaining the integrity of data in the Consumer Directory. ANAO analysis of the department’s Medicare customer data holdings identified9:
  • at least 18 000 possible duplicate enrolments—an ongoing data integrity issue in the Medicare customer database10;
  • active records for customers without an entitlement as well as inactive records and some with unusual activity; and
  • records which had customer information inconsistently, inaccurately and incompletely recorded.
14. In addition, the department advised the ANAO of instances where the records of two different customers are combined (‘intertwined records’)11, giving rise to privacy and clinical safety12 risks.
15. While the number of compromised records held in the database is not significant given the scale of the department’s data holdings, the data integrity issues referred to above indicate that departmental procedures and key elements of the data input control framework require management attention to improve operational efficiency, better protect customer privacy and clinical safety, and reduce the risk of fraudulent activity. The extent of the data integrity issues highlighted by the audit and the length of time these issues have been evident also indicate a need for the department to periodically assess the underlying causes of data integrity issues and implement necessary treatments.
16. The audit identified that additional attention should be given to: the tightening of data input controls, including the full and accurate completion of mandatory data fields in accordance with system and business rules; the adequacy and consistency of staff training and written guidance; addressing duplicate and ‘intertwined records’; and undertaking data integrity testing on a targeted risk basis. Further, Human Services’ procedures for managing the security of Medicare customer data do not comply fully with some mandatory requirements of the Australian Government’s Information Security Manual (ISM)13; significantly reducing the level of assurance of the relevant systems’ ability to withstand security threats from external and internal sources. The department should implement whole‑of‑government requirements in relation to system security.
17. Positive elements of Human Services’ approach to managing Medicare customer data include: unique customer reference numbers within the Consumer Directory, which have a high degree of integrity14; a well‑developed privacy framework which contributes to maintaining the confidentiality of sensitive Medicare customer records; and a Quality Framework comprising a daily program of random checks on completed transactions by customer service officers. As discussed however, a fully effective approach to managing the integrity of data holdings requires that attention be given to the development and consistent implementation of the full suite of procedures and controls.
18. The ANAO last examined the integrity of Medicare enrolment data in 2004–05, making six recommendations.15 Human Services could demonstrate implementation of two recommendations16 but could not demonstrate implementation of the remainder, which were aimed at addressing data integrity issues, including duplicate enrolments, prior to the migration of Medicare customer data to the Consumer Directory. As discussed, the ANAO’s analysis in this audit indicates that the issue of duplicate enrolments has persisted17; and, more broadly, the department has foregone an opportunity to enhance its performance by implementing a number of the earlier ANAO recommendations targeted at improving data integrity.18
19. The ANAO has made five recommendations in the current audit aimed at enhancing the management and integrity of Medicare customer data by Human Services. The recommendations relate to improving training and guidance for customer service officers, addressing data integrity issues and their causes, and complying with the mandatory requirements of the ISM.
The link to more of the Summary is here:
There is a link to the full 98 page report here:
There is some reporting on the Audit here:

Audit uncovers Medicare data snafus

Problems with Medicare data integrity remain
An audit of Medicare's customer database has found a small number of cases of 'intertwined' customer records where two people's records have been combined, giving rise to "privacy and clinical safety risks", according to an auditor-general report tabled today.
According to the Department of Human Services, 34 instances of 'intertwining' have been discovered since the department started maintaining records on the issue in 2011. The DHS has a working group dedicated to eliminating the issue.
More than 23 million people were part of the Medicare system in 2012-13, including 618,533 new enrolments, the auditor-general's report notes. There were 29.3 million customer records when the Australian National Audit Office (ANAO) accessed the database in September last year.
Details of users of Medicare services are stored in a database called the Consumer Directory. The audit found that the DHS has "not been fully effective in maintaining the integrity of data" in the database.
An analysis by the ANAO found at least 18,000 "possible" duplicate customers, "active records for customers without an entitlement as well as inactive records and some with unusual activity" and "records which had customer information inconsistently, inaccurately and incompletely recorded."
"While the number of compromised records held in the database is not significant given the scale of the department’s data holdings, the data integrity issues referred to above indicate that departmental procedures and key elements of the data input control framework require management attention to improve operational efficiency, better protect customer privacy and clinical safety, and reduce the risk of fraudulent activity," the report states.
Lots more here:
Given the reliance if the compulsory IHI Service on the data integrity and security of the Medicare database it is vital more work is done. It is interesting to note a previous 2005 audit covering the same topic got largely ignored by the Department.
I note the population report from the ABS currently suggests there are 23.469M people in Australia so I am not sure why Medicare holds 29.3 million customer records. Must be six million or so (20%+) who have departed this life or have left the country?
 At almost the same time we have this.

Centrelink computer broken: Hockey

JOE Hockey has warned of a shock multi-billion-dollar hit to the budget to fix the 31-year-old Centrelink computer system, which is in “bad shape” and a drag on productivity that is holding back crucial policy change.
Human Services Minister Marise Payne said the system, based on 1980s technology, was also hampering the government’s efforts to cut red tape and shift Centrelink into the digital world.
The Treasurer said the biggest surprise he had received since coming into power was the ­deterioration in government infra­structure, particularly the Centrelink computer system in Canberra, which would cost “billions” to improve.
Mr Hockey, who is preparing a structural overhaul of welfare and payments in the budget next month, said changes were being stymied by the system.
“My overwhelming concern is that it is inhibiting the capacity of the government, to some degree, to roll out policy that properly ­addresses the problems in the economy and the budget,” he told radio station 3AW.
Centrelink’s Income Security Integrated System is vital to the delivery of $400 million in social security payments every day.
Lots more here:
I have to say I am frequently told about issues of inflexibility and other problems in the Medicare environment. Does anyone know if the PCEHR runs on this platform or just the IHI Service?
I note the M204 DMBS is coded in assembler for the IBM System 360 architecture and it 30+ years old but great at transaction processing.
There is useful background found in a useful article from late last year.

Sterrenberg calm in the face of an uphill battle

Human Services CIO shares his to-do list.

Human Services CIO Gary Sterrenberg speaks with an impossible calm about the ageing systems he is responsible for, including one that administers more than $500 million worth of essential payments to Australia’s most vulnerable citizens each day.
That system was built on technology implemented by the department before the technology veteran had even finished university.
He has found himself having to explain to a new government staunchly committed to a ‘budget emergency’ why it should spend tens – if not hundreds – of millions of dollars to replace the system, which for all intents and purposes appears to be working fine.
Sterrenberg's demeanour is such that it all feels part of a well-conceived plan - a plan that aims to deliver online services that will satisfy a demanding modern citizen who refuses to tolerate anything other than instant and pain-free electronic gratification.
All in all - given it seems both Centrelink and Medicare share the same systems and very old data-base management systems running on old IBM and compatible hardware this does all sound just a little brittle towards the end of its useful life.
It is also clear that a lot of the health system relies for money on this elderly ‘big iron’!
Given this environment is similar in complexity to one of the big four banks what it might cost to modernise may very well worry Mr Hockey!
David.

AusHealthIT Poll Number 215 – Results – 27th April, 2014.

Here are the results of the poll.

What Do You Think Will Happen To E-Health Funding In The Upcoming Federal Budget?


Large Rise 2% (1)

Small Rise 0% (0)

About The Same 16% (9)

Small Cut 33% (19)

Large Cut 40% (23)

I Have No Idea 10% (6)

Total votes: 58

It seems the vast majority see less funding with a very substantial number seeing large cuts. We will know very soon given the budget is just over 2 weeks ago.

Again, many thanks to all those that voted!

David.

Wednesday, April 23, 2014

Audit Commission Report Will Be Released In Eight Days Time.

From an AFR Article.

Hockey outlines budget hit-list


Hockey outlines budget hit-list Anticipating widespread anger on budget night, Treasurer Joe Hockey said those who will ask “what’s in it for me’’ would be told “a better future”. Photo: Louise Kennerley
Phillip Coorey Chief political correspondent
The May budget will increase means testing, introduce co-payments for benefits and slash spending on key services as part of a plan to more than halve expenditure growth and return the budget to surplus within six years.
Treasurer Joe Hockey used a speech in Sydney to forecast that reducing real spending growth to 1.75 per cent will eradicate the budget deficit in five years, achieve a small surplus in 2019-20, and a surplus equivalent to 1 per cent of gross domestic product by 2023-24.
Citing findings of the Commission of Audit, which makes 86 recommendations and will be released next Thursday, Mr Hockey identified pensions, health, welfare, education and defence as targets because they are the fastest-growing areas of expenditure.

Here is the link to the much longer article.

http://www.afr.com/p/national/hockey_outlines_budget_hit_list_wOkSKpjKyp24ZW7juXqRzN

Now you know.

David.

Weekly Overseas Health IT Links - 23rd April, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Sorry, Experts. Meaningful Use is a Success

APR 17, 2014 4:13pm ET
A federally funded study finds that criteria under the electronic health records meaningful use program “fall short of achieving meaningful use in any practical sense.” Don’t believe it.
The report contends that interoperability in the meaningful use program is basically meaningless, amounting to “little more than replacing fax machines with the electronic delivery of page-formatted medical records.” And that has some merit, but interoperability isn’t the end-all toward meaningfulness. The report then offers a comprehensive software architecture for Stage 3 of the meaningful use program that would create a truly interoperable health data infrastructure. That’s wonderful if report authors don’t care about what is really feasible for the health care industry during Stage 2 now, and Stage 3 in just three years.
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Study: Cost Largest Barrier to e-Prescribing Adoption Among Physicians

Written by Helen Gregg (Twitter | Google+)  | April 17, 2014
Recent studies have shown e-prescribing to have a host of benefits, including a more streamlined workflow for physicians, a reduction in errors that result from misread handwritten prescriptions and increased patient satisfaction. However, the costs associated with e-prescribing have kept many ambulatory physicians reaching for pen and pad, according to a literature review in Perspectives in Health Information Management.
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ICD-10 Delay: Politics Trump Health Data Quality

With a fresh delay for ICD-10 compliance, US healthcare providers and patients remain trapped in debate. Is higher quality clinical data worth the cost of more detailed data collection?
4/16/2014 09:16 AM
Mark Braunstein
Commentary
Progress toward more specific medical data gathering has been halted, once again.
President Obama recently signed the "doc fix" legislation (HR 4302) to delay scheduled cuts to Medicare physician reimbursement rates. The bill also pushes back the ICD-10 compliance date until at least October 2015, further delaying the switch from ICD-9 to ICD-10, which was endorsed by the Forty-third World Health Assembly in May 1990 and released to WHO member states 20 years ago in 1994.
The switch to ICD-10 means that health care providers and insurers will have to replace 14,000 codes with 69,000 codes. These two numbers are often cited by opponents as an undue burden on already busy hospitals and physicians. Terry Gunn, CEO of KershawHealth in South Carolina, said the delay would give hospitals more time to get ready for the "huge, overwhelming task" of ICD-10 implementation. A senior policy adviser to the Medical Group Management Association said that it is "recognition that the industry is simply not ready for the transition."
On the other side, CMS estimates that a one-year delay could cost between $1 billion and $6.6 billion, according to a blog post by the American Health Information Management Association (AHIMA), which opposes the delay. AHIMA also says that the delay affects some 25,000 of its students who have learned to code only in ICD-10, and that it affects "much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October." CHIME's president criticized Congress, saying, "Further delay of ICD-10 discredits the considerable investment made by stakeholders across the country to modernize health care delivery."
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New health IT architecture requires interactive EHRs, scientists advise

Posted: April 18, 2014 - 2:45 pm ET
To help create a new health-information architecture, the current crop of electronic health-record systems needs to be connected using interfaces that will allow them to communicate with each other, according to recommendations from a group of U.S. scientists reporting on the nation's health-information interoperability needs.
The scientists' group, known as JASON, produced a 65-page report, under contract with the Agency for Healthcare Research and Quality at HHS, advocating health IT infrastructure that provides “a migration pathway from legacy EHR systems,” the report stated. It calls for federal mandates to use what are known as application programming interfaces, or APIs, to connect legacy systems to each other.
“This pathway could be provided by published APIs mandated through the CMS Stage 3 Meaningful Use program,” the report's authors said.
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Mobile Medical Apps Get Short Shrift in Fed HIT Strategy

APR 16, 2014
When federal agencies hold a three-day public meeting next month to get feedback from stakeholders on their health IT report, one technology area that will no doubt garner prominent discussion is mobile medical applications. Though the draft report developed by the Food and Drug Administration, in consultation with the Office of the National Coordinator for HIT and the Federal Communications Commission, contains a proposed strategy and recommendations for a risk-based regulatory framework for health IT, it says very little about mobile technology.
Section 618(a) of FDASIA explicitly directed that the agencies publish a report to Congress that includes mobile medical apps. However, the document simply summarizes in a single paragraph the essence of the FDA's 43-page September 2013 final guidance on mobile medical apps, reiterating the regulatory agency's "narrowly focused approach" to oversight of these products and its intention to concentrate on a "small subset" of the app market--only those apps that present the greatest risk to patients if they do not work as intended.
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4 lesser known problems with EHRs

April 14, 2014 | By Marla Durben Hirsch
Although the healthcare industry continues to transition from paper to electronic health records, many patients and even some providers remain unaware of their imperfections, according to a recent post in the Wall Street Journal's MarketWatch.
The article, which outlines "10 things your medical records won't say" flags several problems endemic to EHRs that have received a lot of media attention, such as high costs and physicians' dissatisfaction with the systems.
However, several of the problems noted have received less attention and are not readily apparent, especially to consumers.
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Why does healthcare resist encryption?

Posted on Apr 17, 2014
By Evan Schuman, Contributing Writer
The most basic security truth in 2014 is that encryption done properly -- a high enough level of encryption, proper safeguarding of the encryption key -- is the best thing an IT department can do.
Sill, many industries resist encryption -- and healthcare is arguably the most strident.
Why? Although the answer changes with the healthcare expert speaking, much of the resistance is based on fear of change. That's not the FDR "fear itself" concern, but fear of what encryption could inadvertently due to sensitive integrated healthcare systems.
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Coventry pathology goes digital

16 April 2014   Lis Evenstad
University Hospitals Coventry and Warwickshire NHS Trust has become one of the first in Europe to deploy an integrated digital pathology system.
The trust has implemented the Omnyx Integrated Digital pathology system from GE Healthcare, which lets clinicians create, manage, store and view tissue samples digitally.
Many experts have predicted that digital pathology could have the same kind of impact on pathology services that picture archiving and communications systems and their related technology have had on digital imaging.
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Disruptive Entrants Changing Health IT Economy

By Nathan Eddy  |  Posted 2014-04-15

The makers of remote sensors and computers will have an eye toward faster, cheaper discoveries and proven value for cost-conscious purchasers.

Technological advances, empowered consumers, disruptive new entrants and rising demand by an aging population are ushering in a new era in health care, according to a report from PricewaterhouseCoopers (PwC).
In what the company calls the New Health Economy, the mere collection of data will be replaced with lightning-fast analysis delivered directly to a care team that anticipates problems before they arise.
The report predicted individuals would be co-creators of their health decisions, spending more of their discretionary dollars on tools that help them live well.
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Stage 2 Vendor Hardship Exception Should Be Viewed as a Tsunami Warning

by Jeff Donnell Thursday, April 17, 2014
I take exception with the meaningful use Stage 2 vendor hardship exception. In the interest of full disclosure, I am president of a patient engagement company that has successfully secured modular certification for its patient portal/personal health record solution.
From a selfish perspective, it is really galling for those of us who have done the hard work and heavy lifting required for timely 2014 ONC-ACB certification to find out after the fact that those health IT vendors that are not certified can now offer their clients an "out." Likewise, provider organizations that moved mountains to prepare for meaningful use Stage 2 may understandably be frustrated to learn the runway has a rest area. The effort required for a provider to step up from meaningful use Stage 1 to meaningful use Stage 2 is significant. Those using certified technology are now prevented from playing the "vendor not ready" card -- a perverse disincentive to partner with vendors that have done the right thing.
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Where will HIT security be in 3 years?

Posted on Apr 16, 2014
By Evan Schuman, Contributing Writer
Security is a nightmare for all companies, but the very nature of healthcare makes it far worse. It's not merely onerous government requirements for medical data, or the popularity of security-adverse mobile devices. It's the need to give tiny medical offices – small, independent businesses, with typically no meaningful IT staff – full network access to all files, physical building access to its employees and privileges to change/add to that ultra-sensitive data.
But are there ways to truly make these accesses more secure and to do so in ways that will be not merely viable, but even profitable? Many industry insiders say there are, but only if participants agree to start taking security seriously.
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Advisory Committee Signals New Phase for SMART Platforms Project

April 15, 2014
Committee members’ organizations, all SMART apps users, will seek to expand impact
The SMART Platforms project at Boston Children’s Hospital, which is developing an apps platform for healthcare, is shifting into a higher gear with the formation of an advisory committee to guide the organization on strategy, technical approach and business development. All of the organizations represented on the board are working with SMART apps.
SMART, which stands for Substitutable Medical Apps & Reusable Technology, has been able to demonstrate that an iPhone-like platform and apps-store approach is viable, said Kenneth Mandl, M.D., M.P.H., a professor at Harvard Medical School and the Boston Children's Hospital Chair in Biomedical Informatics and Population Health. At the most recent HIMSS conference in Orlando, Mandl said, his team saw SMART apps running on multiple EHR systems, such as Intermountain’s homegrown system. (Cerner is also working on SMART apps.) “It is mature enough for organizations to use without our supervision,” he said. “Now we want to bake it into customer demands and have more demonstrations of its use and more apps created,” Mandl said. The advisory committee will help SMART develop some concrete projects in the medication management space. “They will help us find the channels and amplify our voice.” They may also help define a governance model for app standards, he added.
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Is US on the verge of a new health economy?

By Mike Miliard, Contributing Editor
With consumers entranced by fast-evolving technologies and accustomed to price competition, healthcare is set to be transformed by innovations from other sectors of the economy such as retail and telecommunications, according to a new study by PwC's Health Research Institute.
In Healthcare's New Entrants: Who will be the industry's Amazon.com?, PwC suggests that "market disruptors" -- new industries, new technologies -- will soon make a big mark on the $2.8 trillion healthcare sector.
These new players are the leading edge of a what PwC calls a "new health economy" -- one that "over the next decade will see today's siloed healthcare industry become a wide open health marketplace," said Kelly Barnes, PwC's U.S. health industries leader, in a press statement.
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Challenge Fund pilots announced

15 April 2014   Lyn Whitfield
NHS England has unveiled the details of the GP projects that will benefit from the £50m Challenge Fund to improve access to primary care.
The commissioning board says that 7m patients will benefit from the 20 pilot schemes, most of which focus on grouping traditional practices into networks that can offer single points of access in the evenings and at weekends.
A number of the projects add single point of contact telephone numbers, apps offering advice on how to contact appropriate services, email and Skype ‘appointments’ and telehealth to the mix.
For example, six GP surgeries in Wakefield will work together to offer an 8am to 8pm service, seven days a week, supported by an “online signposting service to give patients better access to GP and other community services”, email appointment booking, and real-time phone and web chats.
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Privacy could 'crash' big data if not done right

April 15, 2014 | By Ashley Gold
Privacy has the potential to crash big data before there's a chance to get it right, and finding the right balance is key to future success, experts argued at a Princeton University event earlier this month.
The event, titled "Big Data and Health: Implications for New Jersey's Health Care System" featured four panels exploring health, privacy, cost and transparency in regard to how big data can improve care and patient outcomes, according to an article on the university's website.
"Privacy will crash big data if we don't get it right," Joel Reidenberg, visiting professor of computer science at Princeton and a professor at Fordham University's School of Law, said at the event.
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Study: Telehealth can be disruptive, threatening for nurses

Laura Pedulli
Apr 14, 2014
Implementing telehealth can be both threatening and disruptive to nurses and technical staff, thus managers and service providers should develop strategies to minimize these reactions.
These insights were gleaned from a longitudinal qualitative study—published in the BMC Health Services Research —which followed the implementation of a telehealth service at a United Kingdom-based provider. The study involved extensive focus group discussions with congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers on their perspectives on the telehealth adoption.
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MU gets low marks for improving care

Posted on Apr 16, 2014
By Erin McCann, Associate Editor
Sure, the EHR Incentive Program – with its $22 billion paid out thus far to meaningful users – might have helped bring the healthcare sector out of the Dark Ages and into the 21st Century, but do these systems really improve the quality of patient care? 
For the most part, a new study says, 'no'. 
Researchers at Harvard Medical School and Brigham and Women's Hospital compared physician performance across seven Stage 1 quality measures for five chronic diseases between providers who demonstrated meaningful use of electronic health records and those who did not.
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Meaningful Use Not Correlated With Quality in Study

Ken Terry
April 14, 2014
Showing meaningful use (MU) of electronic health records (EHRs) was not correlated with performance on clinical quality measures, according to a new study published online April 14 in JAMA Internal Medicine.
The study, one of the first of its kind, was performed at clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts. It compared the quality scores of 540 physicians who achieved MU with those of 318 physicians who did not. The healthcare organization computed quality scores on MU measures for all of the 858 physicians, but only some of these physicians met all of the criteria for the government incentive program during the 3-month study period.
Lipika Samal, MD, MPH, from the Division of General Medicine and Primary Care, Brigham and Women’s Hospital, and colleagues looked at 7 metrics for 5 conditions: hypertension, diabetes, coronary artery disease, asthma, and depression. "[MU] was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures," the authors state.
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DeSalvo Calls for Restructuring of HIT Policy Committee Workgroups

APR 14, 2014
National Coordinator for Health IT Karen DeSalvo wants to see changes made to the Health IT Policy Committee's current "somewhat siloed" workgroup structure. In a meeting last week of the HIT Policy Committee, DeSalvo called for fewer workgroups but expansion of their scopes so that they are more "strategic and forward-thinking" with the restructuring slated to begin in May for a couple of the workgroups and the rest of the transition continuing this summer. 
The HIT Policy Committee workgroups meet periodically to address important policy questions, present findings at committee meetings, and make recommendations to the committee. The workgroups that DeSalvo has proposed include: HIT Strategic Planning; Advanced Health Models and Meaningful Use; HIT Implementation, Usability and Safety; and Interoperability and Health Information Exchange. She said the privacy/security and consumer workgroups will continue in a "matrix conversation" with the other workgroups.
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Despite Success, Future of RECs Uncertain

by Ken Terry, iHealthBeat Contributing Reporter Tuesday, April 15, 2014
The 62 health IT regional extension centers have far exceeded their goal of helping 100,000 providers in small primary care practices attest to the meaningful use of electronic health records. As of March 4, more than 150,000 providers had enrolled with RECs. Of those providers, 90% had gone live on their EHRs and more than 93,000 had demonstrated meaningful use, according to the Office of the National Coordinator of Health IT.
An ONC report to Congress in June 2013 pointed out that nearly half of the providers who received Medicaid EHR incentive payments and a fifth of those that got Medicare incentives had enrolled in RECs. Moreover, Medicare providers who worked with RECs were 2.3 times more likely to receive an EHR incentive payment than those who didn't.
Based on these statistics, ONC views the REC program as a success. But it's unclear where the RECs will go from here.
While federal funding for the RECs officially ended on April 15, ONC is allowing the RECs to request "no-cost," one-year contract extensions that will enable them to use any remaining money in their budgets for specified purposes. At latest count, 55 RECs had asked for these extensions and 39 had received them, although other requests were still pending.
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Esther Dyson Launches Population Health Challenge

Scott Mace, for HealthLeaders Media , April 15, 2014

A tech investor with a proven track record of attracting innovation and money to a variety of endeavors is looking for a few good communities to compete for the greatest improvement in five measures of health and economic vitality.

Healthcare ladies and gentlemen, start your communities.
That was the call on April 10 from angel investor and tech advisor Esther Dyson, whose population health dream has taken a big step toward reality with the launch of the Way to Wellville competition.
From now until May 23, Dyson's nonprofit startup, HICCup, is inviting communities to apply to be one of five contestants in a five-year-long competition to get healthy using everything from the latest fitness gadgets to reality TV. Dyson is HICCup's founder and chairman of EDventure Holdings.
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Tips for Healthcare Organizations Migrating to the Cloud

APR 14, 2014
Many healthcare organizations migrating information systems to a cloud-hosted service struggle developing an appropriate strategy for the task, says Ed King, managing director of healthcare consulting services at disaster recovery and cloud-hosting vendor Sungard Availability Services. The Wayne, Pa.-based company split from software and processing services vendor SunGard in March and became an independent entity.
Moving to the cloud is not just a new way of doing computing-on-demand; it’s also a new way for personnel in an organization to use the technology. Almost always, not every system moves to the cloud, particularly legacy systems, King notes. There are a growing number of electronic health records systems and newer ancillary products being cloud-hosted by a remote vendor, while older secondary systems--back-office, financial, pharmacy and laboratory, for instance--may tie to cloud-based systems but remain in-house.  And, some other systems may stay in-house as they need a dedicated server because of how they are coded. The result for providers is that new processes and skill sets are needed to manage a hybrid environment, and the vendor can assist in putting together the plan for cloud computing.
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Healthcare due for technology 'shake up'

Posted on Apr 14, 2014
By Mike Miliard, Managing Editor
With consumers entranced by fast-evolving technologies and accustomed to price competition, healthcare is set to be transformed by innovations from other sectors of the economy such as retail and telecommunications, according to a new study by PwC's Health Research Institute.
In Healthcare's New Entrants: Who will be the industry's Amazon.com?, PwC suggests that "market disruptors" -- new industries, new technologies -- will soon make a big mark on the $2.8 trillion healthcare sector.
These new players are the leading edge of a what PwC calls a "new health economy" -- one that "over the next decade will see today's siloed healthcare industry become a wide open health marketplace," said Kelly Barnes, PwC's U.S. health industries leader, in a press statement.
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ECRI rallies stakeholders with focus on HIT patient safety

April 14, 2014 | By Susan D. Hall
The ECRI Institute Patient Safety Organization is calling for collaboration on patient safety to create a "a non-punitive learning environment" to bring about improvement.
Its Partnership for Promoting Health IT Patient Safety, it recently announced, will involve healthcare providers, health IT vendors, professional societies and patient safety organizations in creating a national framework for identifying and addressing health IT safety issues.
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Study shows quality of health-related info on internet searches varies

ANI  |  Washington 
April 13, 2014 Last Updated at 14:50 IST
A new study has shown that the quality of the information related to the diagnosis and treatment of physical disease or injuries available on web searches could be hazardous to health.
According to University of Florida researchers, web searches related to physical disease or injuries tend to yield higher-quality information than online searches for preventive health and social health information, and when it comes to health information, search results may vary.
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Enjoy!
David.