The question was:
Should a National Health Reform Plan be Agreed at COAG without a Detailed E-Health Plan?
No Way
- 21 (65%)
Probably Not
- 7 (21%)
Maybe
- 0 (0%)
Seems OK to Me
- 4 (12%)
Votes : 32
Comment:
Well that was utterly clear – not that the Government took any notice.
I wonder what will happen next? Nothing good I fear.
Thanks again to all who voted.
David.
The following report caught my eye the other day.
12-Apr-2010
By Michael East
The use of computers has had little impact on the quality of care GPs provide to their patients, a new study suggests.
Consultation times, the amount of problems managed in each encounter and referral rates to hospitals and specialists were the same among GPs who used computers and those who stuck to pen and paper, the study showed.
Analysing BEACH data, University of Sydney researchers grouped almost 1300 GPs according to their use of computers for test ordering, prescribing and medical recordkeeping.
The two groups were then compared on 34 quality indicators such as consultation times, referrals and ongoing management of conditions.
Writing in Quality in Primary Care (April), the study found the quality of care provided by both groups was almost identical.
More here:
http://www.australiandoctor.com.au/articles/0d/0c06880d.asp
I thought I should track down to original paper. Here is the abstract.
http://www.ingentaconnect.com/content/rmp/qpc/2010/00000018/00000001/art00006
Authors: Henderson, Joan1; Miller, Graeme2; Britt, Helena3; Pan, Ying4
Source: Quality in Primary Care, Volume 18, Number 1, February 2010 , pp. 33-47(15)
Publisher: Radcliffe Publishing Ltd.
Abstract:
Background: There is an assumption expressed in literature that computer use for clinical activity will improve the quality of general practice care, but there is little evidence to support or refute this assumption.
Aim: This study compares general practitioners (GPs) who use a computer to prescribe, order tests or keep patient records, with GPs who do not, using a set of validated quality indicators.
Methods: BEACH (Bettering the Evaluation and Care of Health) is a continuous national crosssectional survey of general practice activity in Australia. A sub-sample of 1257 BEACH participants between November 2003 and March 2005 were grouped according to their computer use for test ordering, prescribing and/or medical records. Linear and logistic regression analysis was used to compare the two groups on a set of 34 quality indicators.
Results: Univariate analyses showed that computerised GPs managed more problems; provided fewer medications; ordered more pathology; performed more Pap smear tests; provided more immunisations; ordered more HbA1c tests and provided more referrals to ophthalmologists and allied health workers for diabetes patients; provided less lifestyle counselling, and had fewer consultations with Health Care Card (HCC) holders. After adjustment, differences attributable solely to computer use were prescribed medication rates, lifestyle counselling, HCC holders and referrals to ophthalmologists. Three other differences emerged - computerised GPs provided fewer referrals to allied health workers and detected fewer new cases of depression, and fewer of them prescribed anti-depressants. Twenty-three measures failed to discriminate before or after adjustment.
Conclusion: Deciding on 'best quality' is subjective. While literature and guidelines provide clear parameters for many measures, others are difficult to judge. Overall, there was little difference between these two groups. This study has found little evidence to support the claim that computerisation of general practice in Australia has improved the quality of care provided to patients.
Keywords: CLINICAL COMPUTER USE; FAMILY PRACTICE; QUALITY INDICATORS; QUALITY OF HEALTH CARE
Document Type: Research article
Affiliations: 1: Senior Research Fellow, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Acacia House, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia. joanh@med.usyd.edu.au 2: Associate Professor, Medical Director, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia 3: Associate Professor, Director, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia 4: Senior Analyst, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia
This study is really pretty much relevance free!
It is another retrospective look at computer use in BEACH responding GPs from over 5 years ago.
It is easy to understand why this took 5+ years to get researched and published – given its relevance to present practice. What computer were you using over 5 years ago – and is that at all that relevant to present practice? I think not.
Breathless reporting from Australian Doctor without mentioning how old the data analysed was does not help.
In the internet age if you can’t get data from the trenches to publication in a year or less just forget it!
David.
The meeting between Prime Minister Kevin Rudd and the premiers on a new health plan has broken up for the day and the talks remain deadlocked.
The Council of Australian Governments (COAG) meeting will resume on Tuesday.
West Australian Premier Colin Barnett says they still haven't gotten to the issue of the GST or pool funding.
Mr Rudd is proposing the commonwealth would claw back about 30 per cent of states' GST revenue and, in return, the federal government would take control of 60 per cent of hospital funding.
The GST is a no-go zone for Victoria, Western Australia and NSW.
-----
Sleep well.
David
We have had NEHTA publish yet another sponsored advertorial from the Royal Australian College of General Practice (RACGP) this week.
16 April 2010. Continuity of care for patients suffering mental health issues could be greatly improved with the introduction of e-health according to the Royal Australian College of General Practitioners.
The potential future individual electronic health record (IEHR) will give healthcare providers better access to patient information and improve information-sharing among different health care professionals, leading to better quality care for patients.
Typically, mental health patients visit a number of healthcare providers and it is possible for a patient to have a GP, psychologist and psychiatrist and also deal with other health professionals, pharmacists and even rehabilitation programs, who all need accurate and up to date information about the patient’s care and medication.
The impact of mental health within the Australian population is substantial with twenty per cent of Australian adults affected by some form of mental disorder every year and GPs are often the first point of contact.
Dr Chris Mitchell, RACGP President and GP in northern New South Wales said that the process of linking information back to the GP is critically important.
“There needs to be a shared understanding of the treatments undertaken for a patient, particularly in relation to medications prescribed and the value of that information for the GP is critical in “closing the loop”.
“A consolidated medicine summary, as will be provided with the e-health system, will allow the GP to see when medication has been changed and lead to a better outcome for the patient with all healthcare providers having access to the same information,” he said.
“Patients with mental health illnesses are part of a vulnerable “at-risk” group and we believe their quality of care can be improved with the introduction of a national e-health infrastructure.
“Individual healthcare identifiers are the key that will unlock e-health for Australians.
“Every person in Australia should receive care that is informed by an electronic health summary. The passage of the Healthcare Identifiers Bill 2010 is an essential step to enable e-health innovation and efficiency,” said Dr Mitchell.
To ensure that GPs can deliver the highest standard of care to their patients, the RACGP is ensuring that the National E-Health Transition Authority (NEHTA) is informed of what is reasonable, workable and useful for GPs when leading the progression of e-health in Australia. NEHTA is the lead organisation supporting the national vision for e-health in Australia.
Dr Caroline Johnson, who is a member of the RACGP National Standing Committee -Quality Care, the RACGP representative on the Mental Health Professionals' Association (MHPA) and a GP, said that patient confidentiality is a very sensitive issue in the area of mental health.
“Awareness of consumer and carer issues is crucial. RACGP members are very aware of the particular sensitivities related to the use of and access to diagnostic labels in this area.
“Mental health patients often already feel stigmatised, so we want to be sure that the information used and shared via e-health is always for their benefit. The whole issue of trust and confidentiality is one to be looked at very closely and quality collaboration between health professionals is a vital part of patient care.
“In situations where the patient is highly distressed or confused, for example, hospital emergency settings, getting accurate information quickly about a patient through e-health could potentially result in better outcomes,” said Dr Johnson.
RACGP
The Royal Australian College of General Practitioners is the professional organisation that sets and maintains the standards for quality clinical practice, education, training and research in Australian general practice and represents Australia’s urban and rural general practitioners.
The release is found here:
http://www.nehta.gov.au/media-centre/nehta-news/626-eheath-mental-health
The astonishing thing about this release is that it targets a group of patients (those with chronic mental health problems) who are one of the most likely groups to want to avoid losing control of their personal health information – second possibly behind those who live with HIV – to some nebulous shared EHR system.
It is even more amazing that they clearly recognise the problem – last 2 paragraphs:
“Mental health patients often already feel stigmatised, so we want to be sure that the information used and shared via e-health is always for their benefit. The whole issue of trust and confidentiality is one to be looked at very closely and quality collaboration between health professionals is a vital part of patient care.
“In situations where the patient is highly distressed or confused, for example, hospital emergency settings, getting accurate information quickly about a patient through e-health could potentially result in better outcomes,” said Dr Johnson.”
But they must know NEHTA is yet to convincingly show they have solid ideas about how to protect such critically sensitive information – going to the extent of wondering whether item level access controls are possible and worth the effort.
The official NEHTA site on privacy is here:
http://www.nehta.gov.au/connecting-australia/privacy
There has not been a new publication added to that area of the site since November, 2008.
What they presently saying is as follows:
The protection of our privacy is one of the key priorities leading up to the widespread adoption of e-health in Australia.
A Privacy Management Framework has been developed to ensure that privacy is integrated across NEHTA's work program into the design, management and policy development associated with our range of e-health initiatives.
Relevant requirements in privacy law were met to determine what privacy standards apply. However, this approach does extend beyond compliance with the legislation, to ensure community expectations around privacy protection are also met, including thorough regular consultation with stakeholders and the broader community.
----- End Quote.
So what we have is a priority area with no update in 17 months and a collection of platitudes as an apparent policy position. They also fail to mention the that the totality of Privacy Law and nationally consistent implementation is still under review – and that there is not yet a clear detailed government view on Health Information Privacy.
You can read the Australian Law Reform Commission Submissions and views here:
http://www.austlii.edu.au/au/other/alrc/publications/reports/108/61.html#Heading64
The government has partially responded – but we still do not have a uniform national privacy code.
See here:
http://www.dpmc.gov.au/privacy/alrc.cfm
The first part report is here:
http://www.dpmc.gov.au/privacy/alrc_docs/stage1_aus_govt_response.pdf
Page 13 covers the Health Information Aspects and has yet to be legislated – the report only being finalised late in 2009.
Here it is:
Part H – Health Services and Research The ALRC made a number of recommendations to clarify definitions and address a range of health privacy issues, while retaining core provisions in line with confidentiality obligations and professional ethics. The Government will amend the Privacy Principles to:
• enact new rights for individuals to have their health records transferred between health service providers (reasonable fees may apply), and to be told what will happen to their health record if their provider closes down or changes hands;
• clarify that providers can share health information that is necessary for healthcare and is within the individual’s reasonable expectations, promoting appropriate information flows in the sector; and
• strengthen options for access through an ‘intermediary’, with a tailored option if direct access to health information seriously threatens life, health or safety.
The Government will also work with other jurisdictions and health ministers to progress national consistency in the public and private health sectors.
The Government’s response also supports two central proposals to facilitate research in the public interest, simplify regulation, and protect community expectations of personal privacy:
• a harmonised set of rules for Government and private sector researchers will replace the two sets of binding guidelines on non-consensual handling of personal information; and
• the research provisions will be expanded to allow such handling for any research in the public interest, not just for health and medical research.
Two important parameters of the current regime will also be maintained:
• the public interest in research must ‘substantially outweigh’ the protection of privacy – requiring a clear choice in favour of the research; and
• the National Health & Medical Research Council and the Privacy Commissioner will retain primary responsibility for issuing and approving the research rules.
---- End Extract
On the basis of what I have read here from NEHTA and in the ALRC response there seems little understanding of the complexity of these issues for some individuals.
The second bullet point above would seem to be open to all sorts of interpretation and possible abuse that was against a patient’s wishes.
Spruiking of the unalloyed benefits of e-Health from the RACGP certainly does not encourage careful consideration of these issues.
David.
Well it seems someone has decided all these deathless anonymous comments – and more worrying all my purple prose is to be preserved for some unsuspecting posterity.
Apparently they wander by every once in a while and take a new snapshot.
I have popped up a search link for the Archive on the blog sidebar.
The direct link to the archive is here:
http://nla.gov.au/nla.arc-118482
One can never tell when one may drop off the twig and this will be pretty much all that is left!
David.
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 payment.
There will only be one major item of interest this week – and that will be the outcome of the Council of Australian Governments (COAG) meeting on Monday April 19, 2010.
For what it’s worth having read a great deal about the proposals I think that neither Rudd or Brumby are even close to addressing the sustainability of our health system over the next 40 years.
Both have proposals which are desperately short on detail, are incomplete and both clearly do not understand the small, but crucial, place Health IT can play as an enabler of true structural reform.
There has to me been a totally inadequate debate on the overall structure of our health system – despite the efforts of the National Health and Hospital Reform Commission (NHHRC) – and the Government has failed to consult on the broader directions preferring to adopt at wandering around the public hospital’s approach to information gathering and consultation.
A really useful amount of work was done by the NHHRC and a detailed Government response to each or the recommendations could have been a useful ‘conversation starter’ towards considered reform – rather we just got a half done plan which does not cover the bases by any means.
See here for some of the interesting work done and only seemingly partly digested.
http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/discussion-papers
On this point I had this pointed out to me a few days ago.
http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.174490v1
Bobby Milstein 1, Jack Homer 2*, Gary Hirsch 3
1 Centers for Disease Control and Prevention
2 Homer Consulting
3 Consultant
Abstract.
Proposals to improve the US health system are commonly supported by models that have only a few variables and overlook certain processes that may delay, dilute, or defeat intervention effects. We use an evidence-based dynamic simulation model with a broad national scope to analyze 5 policy proposals. Our results suggest that expanding insurance coverage and improving health care quality would likely improve health status but would also raise costs and worsen health inequity, whereas a strategy that also strengthens primary care capacity and emphasizes health protection would improve health status, reduce inequities, and lower costs. A software interface allows diverse stakeholders to interact with the model through a policy simulation game called HealthBound.
----- End Abstract.
This is a very interesting paper that reflects the need to look at the whole system coherently.
It seems to me that offering a plan that does not offer a fully integrated view of the primary, hospital, mental and preventive sectors just does not cut it.
It is also good the Opposition has noticed how e-Health has apparently been skipped.
http://news.smh.com.au/breaking-news-national/coag-urged-to-discuss-all-issues-20100418-smaj.html
April 18, 2010 - 4:09PM
With health stealing the COAG spotlight, the coalition is concerned a myriad of other pressing issues will fall off the agenda when leaders meet on Monday.
The first Council of Australian Governments (COAG) meeting of the year has turned into a showdown between Prime Minister Kevin Rudd and some premiers on health.
Mr Rudd has threatened to let the meeting run for days if that's what it takes to get agreement from the states and territories on his health reform agenda.
But opposition COAG spokeswoman Marise Payne is concerned it means many important issues that were meant to be dealt with at the meeting won't get an airing.
.....
"There's work to be done in housing, in roads and transport, in e-health, in urban planning.
-----
QUEENSLAND Liberal Senator Sue Boyce has demanded an explanation from Health Minister Nicola Roxon over "false and wildly optimistic" information about the readiness of the Rudd Government's national Healthcare Identifiers service, which is due to start on July 1.
Senator Boyce said the first stage of the government's e-health program "hasn't a snowball's chance in hell" of being ready from a technical standpoint, while the legislation to establish the system has not been introduced to the Senate - just ten weeks out from the proposed start date.
"This is supposed to be a state-of-the-art nationally integrated system to provide all Australians and all healthcare providers with their own unique identity numbers, but the project has been crippled by inept management, hopeless dithering and a complete lack of political leadership," she said in a statement.
-----
http://www.zdnet.com.au/e-health-record-still-too-unsexy-for-coag-339302431.htm
By Ben Grubb, ZDNet.com.au on April 14th, 2010
Health Minister Nicola Roxon's office has refused to say whether it will take the business case for an individual electronic health record (IEHR) to the Council of Australian Government (COAG) meeting on Monday.
The authority the Federal Government has put in charge of rolling out a 16-digit number for most Australians, the National E-Health Transition Authority (NEHTA), has said that an electronic healthcare record would be a "secure, electronic record of your medical history, stored and shared in a network of connected systems" which would give patients "the opportunity to look at [their] health information using a computer".
-----
http://www.theage.com.au/victoria/baillieus-web-solution-to-hospital-queues-20100417-sliv.html
April 18, 2010
VICTORIANS would be able to check online the waiting times for hospital emergency wards before seeking treatment under an opposition initiative to improve access to emergency care.
The overhaul of emergency department data, to be announced today by Opposition Leader Ted Baillieu, will allow patients to choose from their home a hospital with the shortest waiting time.
The data will also include whether ambulances are being diverted from a hospital and how many patients are waiting to be seen in an emergency ward.
A similar system operates in Western Australia, where patients can compare emergency department waiting times in nine hospitals. The opposition says hospital workers will not be over-burdened with publishing the data because it is already collected and entered into a computer system.
-----
http://star-techcentral.com/tech/story.asp?file=/2010/4/16/technology/20100416154213&sec=technology
KUALA LUMPUR: Many local hospitals are not utilising ICT (information and communications technology) to its full potential, according to healthcare IT company iSoft Health Systems (Malaysia) Sdn Bhd.
Most only have administrative systems and financial software.
These hospitals are not using ICT to assist in clinical applications, such as X-ray record and pharmacy inventory tracking, said Brian Cohen, chief technology officer at iSoft.
-----
By Ian Birks*
The Health Identifiers Bill, tabled on February 10, aims to establish a single 16-digit identifier for individuals, practitioners, and health providers, which will ensure the accurate identification of health recipients and providers, eliminating errors and providing the basis for reduced costs.
It is the first step towards comprehensive e‑health records and full sectoral reform, and a key platform for e-health. AIIA is a strong supporter of the legislation.
E-health offers the opportunity to access and share more comprehensive and accessible healthcare information between professionals and patients than has ever been available in the past.
-----
Technology in healthcare is big business, despite persistent underfunding
E-health is a major opportunity for the ICT sector despite persistent underfunding, according to analyst, IDC.
The firm says that the healthcare industry will spend $2.26 billion on ICT in 2010, with $721 million of that going on telecommunications, $509 million on services, and a further $102 million spent on software.
Top investment priorities during the year will include Electronic Health Records with appropriate standards and privacy, and interoperability and security around integration and compliance with standards.
-----
http://www.computerworld.com.au/article/343094/nsw_south_ready_e-health_identifiers/?eid=-255
South-east area health deploys bottom-up medical records
Walk into any hospital, Emergency Department or outpatient clinic in South-Eastern Sydney & Illawarra, New South Wales, and the clinician will bring up your full medical history on a computer before you sit down.
It’s what more than a million residents can expect through what is likely the biggest implementation of an electronic medical records (eMR) system in the Southern Hemisphere. The massive ground-up IT system has tentacles in almost every facet of healthcare: From surgery and emergency, to pathology and nutrition, to bedside care and discharge.
Phase one of the state baseline build — the standardised foundation for NSW — was quietly completed last month. It introduced eMR into clinics under the massive South Eastern Sydney Illawarra Area Health Service (SESIAHS). The emergency departments and operating theatres at the Prince of Wales, Sydney Children’s and the Royal Women’s hospitals are the latest of 16 hospitals to tap into the eMR system, which supports 14,900 health professionals.
.....
But the deployment of identifiers has become a major point of contention due to the lack of information surrounding how the government will implement the nationwide system by mid-year. A health service manager, who spoke to Computerworld under the condition of anonymity, said it is unclear how the National e-Health Transition Authority (NeHTA) will integrate the e-health identifiers with the melting pot of medical systems across the country.
“It will never get anywhere if NeHTA simply provides the national identifier and each vendor is required to link into it,” the person said.
NeHTA has yet to find a software vendor to integrate the identifiers, although Health Department officials told a Senate committee in November that work was in progress.
-----
National Broadband Network Co. chief executive Mike Quigley told a Senate Committee inquiry yesterday that the national broadband network would not offer retail services, The Australian Financial Review reports.
Rather, the NBN would provide data-only services, encouraging internet service providers (ISPs) to develop their own retail offerings.
In addition, connection of any non-ISP customer will be subject to a parliamentary vote, the inquiry heard.
-----
THE head of the $43 billion national broadband network has warned that the federal government will not make a financial return on its ambitious project for up to 30 years.
Speaking before a Senate select committee, NBN Co chief Mike Quigley raised fresh doubts about the project's ability to attract private investment when he told senators that capital returns from the project to provide broadband at speeds of up to 100Mbps across the country would be long-term.
"The board's role is to get a satisfactory long-term return on the capital the government invests," Mr Quigley said. "Now it's up to the government to determine what that return rate is, but we would hope to generate a return.
-----
Flags roll out of scanned medical record system as a step toward e-health
The Royal Children's Hospital (RCH) has flagged its intention to push ahead with e-health and roll out an Electronic Medical Record.
The Electronic Medical Record is being deployed in response to the Victorian Government’s $360 million whole-of-health ICT strategy aimed at modernising and replacing ICT systems throughout the state's public healthcare sector.
According to RCH documents, the organisation is looking to deploy a scanned medical record system as a major component of the overall Electronic Medical Record.
The system, to be used across the entire organisation and satellite sites, will allow for the scanning of patient notes, which would otherwise be contained in the hard copy medical record, according to RCH documents.
-----
SIX months after assuring a Senate committee that the National E-Health Transition Authority was working with primary care software firms over the proposed national Healthcare Identifier system, the federal Health Department has conceded work is yet to begin.
"Currently there are no implementation projects within primary care being funded," a Health spokeswoman said last week.
The department was unable to supply a list of medical practice vendors previously said to be working with Nehta on an "implementation pathway" -- originally requested by Queensland Liberal Senator Sue Boyce in February amid questions about Nehta's activities.
-----
THE government-owned private health insurer Medibank, which last week acquired phone and web-based call centre leader McKesson Asia-Pacific for an undisclosed sum, will not lay off any workers.
McKesson provides telephone nursing triage services on behalf of federal and state governments through Healthdirect Australia.
Medibank Private has not disclosed the price paid for the firm, which has also managed the insurer's Better Health phone service for the past five years, but said the purchase would boost its health prevention and disease management services business.
-----
April 13, 2010 - 10:01AM
The federal government's plan to bring in a mandatory internet filter is a modest regulatory measure that will combat illegal activity, Communications Minister Stephen Conroy says.
In a speech to The Sydney Institute on Monday, Senator Conroy again defended the plan against opponents who believe it's akin to censorship.
"The internet is an incredible piece of technology and in our lifetime it's unlikely we'll see anything like it again," he said.
-----
TECHNOLOGY often changes with bewildering speed in the personal computing world.
But sometimes, despite a lot of ballyhoo, things seem to drag on for years, with nothing much happening.
That's how it appears to be with USB 3.0, also known as SuperSpeed, a potentially much faster replacement technology for the familiar USB 2.0 cables that connect most PCs with peripheral devices such as printers, scanners, keyboards and external hard drives.
In theory, SuperSpeed cables can transfer data at 4.8Gb/sec, 10 times faster than USB 2.0 and six times faster than the rival FireWire 800 standard.
-----
Enjoy!
David.
