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."

Thursday, September 30, 2010

Weekly Overseas Health IT Links - 30 September, 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.

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http://googleblog.blogspot.com/2010/09/google-health-update.html

A Google Health update

9/15/2010 06:00:00 AM

Google Health launched a bit over two years ago, and since then we’ve been listening to our users, analyzing feedback and conducting research. We’ve learned a lot from you! You’ve confirmed that having a central place online to store and share medical data with whomever you want is important and a step in the right direction. And we’ve added a number of features based on what you’ve asked for so far. But you’ve also told us that it’s not enough; that you’re also looking for tools that will help you act on all your health and wellness concerns. We’ve heard you ask for easier data tracking, more personalization and the ability to set and track progress toward your health goals. We’ve listened, and today we’re announcing a new design and new features for Google Health.

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http://www.ncbi.nlm.nih.gov/pubmed/20841813?dopt=Abstract

Stud Health Technol Inform. 2010;160:889-93.

Implementation of a Secure and Interoperable Generic e-Health Infrastructure for Shared Electronic Health Records based on IHE Integration Profiles.

Schabetsberger T, Wozak F, Katt B, Mair R, Hirsch B, Hörbst A.

ITH icoserve technology for health care GmbH, Innsbruck, Austria.

Abstract

Introduction: The ubiquitous availability of medical or care data for authorized clinicians and nurses is expected to increase quality while reducing costs in the health care sector. The standardized, distributed provision of medical or care data is capable to support the vision of patient centered shared electronic health records (SEHRs). A main contribution to cross-institutional data exchange is provided by Integrating the Healthcare Enterprise (IHE). However, holistic implementations of IHE based eHealth infrastructures for SEHRs are currently rare and security and privacy regulations are not fully covered by existing IHE Integration Profiles. This work aims to point out our experiences and lessons learned from five years of development and the implementation of IHE compliant products. Methods: Cross-Enterprise Document Sharing (XDS) describes the base components for exchanging medical or care data. A unique patient Identification is described by the Patient Identifier Cross-referencing (PIX) and the Patient Demographics Query (PDQ) Integration Profile. All interactions are logged in an "Audit Record Repository" deployed once per Affinity Domain and defined in the Audit Trail and Node Authentication (ATNA) Integration Profile. Results: Based on the IHE Integration Profile XDS and other Integration Profiles high-level components for eHealth infrastructures and applications, supporting a holistic, secure concept and, based on these concepts, software products for a technical cooperative care infrastructure, has been developed. The products are practically evaluated in a project for setting up an IHE XDS Affinity Domain in the Austrian district of Tyrol and a number of lessons have been learned.

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http://health.caledonianmercury.com/2010/09/21/doctors-call-for-stricter-rules-to-protect-patient-confidentiality/00873

Doctors call for stricter rules to protect patient confidentiality

September 21, 2010 by Jennifer Trueland

The BMA has called for tougher safeguards for electronic records to protect patient confidentiality – partly because doctors themselves might share user names passwords with each other.

Speaking ahead of a parliamentary debate on e-health, doctors’ leaders warned that current measures to protect patient information might not be enough.

Specifically, the doctors say that the Clinical Portal Technology project – which allows patient information to be viewed electronically by a wide variety of clinicians and, in some cases, by others as well – requires tighter controls.

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http://govhealthit.com/newsitem.aspx?nid=74699

Blumenthal: 2013 meaningful use to ramp up HIE, decision support

By Mary Mosquera

Tuesday, September 21, 2010

Dr. David Blumenthal, the national health IT coordinator, sent a strong signal to healthcare providers and vendors to expect that more complex requirements for health information exchange and clinical decision support tools will be among forthcoming requirements for the next stage of meaningful use.

The Office of the National Coordinator for Health IT is now beginning to do “early reconnaissance” around development of stage 2 meaningful use requirements, according to Blumenthal.

“We know there were a set of unfinished tasks, things we passed over in the effort to get the first stage of meaningful use out the door,” he said at an industry event Sept. 21 about states which are leading in electronic prescribing and where he took the opportunity to communicate some future plans.

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http://govhealthit.com/newsitem.aspx?nid=74711

CMS to publish meaningful use clarifications

By Mary Mosquera

Thursday, September 23, 2010

The Centers for Medicare and Medicaid Services plans to correct a few inconsistencies in the meaningful use final rule it published in July and will post on its Web site more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

The minor revisions, including more detailed descriptions of each of the meaningful use objectives and measures, “should help clarify issues and help the (Health IT Policy Committee) plan for recommendations for future stages,” said Tony Trenkle, director of CMS’ Office of e-Health Standards and Services.

Trenkle, who spoke at a Sept. 22 meeting of the policy committee’s meaningful use workgroup, did not offer further information on the clarifications. They would be released, “shortly,” he said.

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http://www.fierceemr.com/story/practice-fusion-touts-growth-free-emr/2010-09-23

Practice Fusion touts growth of 'free' EMR

You've no doubt heard of Practice Fusion by now. That's the San Francisco vendor that provides a free, advertising-supported EMR to a roster of physicians that the company says numbers 43,000.

But does that model represent the future of EMRs, and is "free" really free? Practice Fusion's business partner sure thinks so.

"Advertising is a natural fit in the healthcare sector," Bill Jennings, CEO of Good Health Media, which serves up targeted, mostly pharmaceutical advertising to Practice Fusion users, says in a press release. "Doctors get it; they're comfortable with discreet advertising inside their medical practice. The advertising programs give a small medical practice the chance to add a time-saving, life-saving technology solution for free. It's a benefit for the advertiser, the doctor and the patient."

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http://www.e-health-insider.com/comment_and_analysis/637/stick_with_the_programme_tcq

Stick with the programme?

23 Sep 2010

It’s been two weeks since health minister Simon Burns announced the outcome of the review of the National Programme for IT in the NHS. His statement has left trusts in the North, Midlands and East needing clarity on exactly what comes next. Equally, it has given many the final push to go it alone. Sarah Bruce reports.

Six months ago, trusts were understandably cautious when they were asked where they stood in relation to implementing the long awaited Lorenzo electronic patient record system under the National Programme for IT in the NHS.

Now, something has changed. Trusts in the North Midlands and East that traditionally said they remained committed to the programme are openly saying they are fed up of waiting and will follow their own destiny.

And who can blame them. Last year, Christine Connelly, the Department of Health’s director general for informatics, said that if local service provider CSC failed to get Lorenzo working smoothly across an acute care setting by the end of March 2010 the DH would look for a “new plan for delivering informatics in healthcare.”

Following University Hospitals of Morecambe Bay NHS Trust’s failure to go live with the latest version of the system on schedule, the ‘new plan’ announced by health minister Simon Burns seemed to amount to more local ownership.

In a ministerial statement, Burns said there would be more locally-led procurement and more modular implementations. However, trusts that go outside the programme will not get central funding. And the DH is being very clear that existing LSP contracts will be honoured.

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http://www.fierceemr.com/story/extormity-breach-shows-theres-fine-line-between-fiction-and-reality/2010-09-23

Extormity 'breach' highlights fine line between fiction, reality

September 23, 2010 — 2:48pm ET | By Neil Versel

Extormity struck again this week. The fictional, satirical EMR vendor emailed a "press release" with the headline, "Extormity Proudly Announces Breach." (If the people behind Extormity were as diligent with updating their website as they are with needling the major EMR vendors, I'd have a link for you, but I guess they'd charge me a consulting fee for that.)

According to the phony announcement: Electronic health record vendor Extormity today announced a data breach that compromised the demographic and health information of more than 80,000 patients.

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http://www.e-health-insider.com/news/6260/nme_trusts_look_to_portals

NME trusts look to portals

23 Sep 2010

The effective end of the National Programme for IT in the NHS at a time of economic constraint is likely to mean fewer big EPR deployments and more focus on integration.

An E-Health Insider telephone poll of trusts in the North, Midlands and East of England, suggests that many will focus on enhancing existing clinical functionality and business cost reduction.

EHI conducted the poll to gauge reaction to the Department of Health's announcement that a 'national' approach to IT is no longer required and that the future lies in more local procurement and module deployment.

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http://www.healthleadersmedia.com/content/TEC-256857/FCC-Approves-Spectrum-for-SuperWiFi

FCC Approves Spectrum for 'Super Wi-Fi'

John Commins, for HealthLeaders Media , September 24, 2010

The Federal Communications Commission has unanimously endorsed a proposal to free up for unlicensed use the so-called TV white spaces—vacant airwaves between TV channels—that supporters predict will improve the availability of new technologies such as "super Wi-Fi" for underserved areas, including rural healthcare providers.

It's the first significant block of spectrum made available for unlicensed use in more than 20 years.

"This new unlicensed spectrum will be a powerful platform for innovation. And as we've seen time and again, when we unleash American ingenuity, great things happen," said FCC Chairman Julius Genachowski, after Thursday's 5-0 vote.

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http://healthcareitnews.com/news/survey-docs-show-little-concern-meaningful-use-penalties

Survey: Docs show little concern for meaningful use penalties

September 23, 2010 | Molly Merrill, Associate Editor

ROSLYN, NY – A recent survey finds physicians are not well-informed about financial penalties for complying with meaningful use – and that they may have little effect on the decision to implement an EMR.

Physicians' Reciprocal Insurers (PRI), headquartered in Long Island, NY, released the results of the survey, which polled more than 500 physicians regarding the implementation of EMR systems.

One significant finding of the study revealed physciains' awareness of financial incentives and penalties for implementing EMR systems. While 85 percent of physicians were aware of the financial incentives for implementing the systems, more than 35 percent did not know that they face government-assessed financial penalties for not complying beginning in January 2015. The penalties are equal to a one percent reduction of the physician's annual Medicare payments per year up to five percent. The survey found that more than 65 percent of physicians who were unaware of the financial penalties said this would not cause them to implement EMR.

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http://www.e-health-insider.com/news/6258/scotland_plans_key_information_summary

Scotland plans Key Information Summary

23 Sep 2010

NHS National Services Scotland has announced it will develop a Key Information Summary that will be fully integrated with its Emergency Palliative Care Summary record.

Speaking at the BCS Health Scotland conference, Jonathan Cameron, programme manager of the National Information Systems Group for NHS NSS, told E-Health Insider that the new summary would build on the success of the EPCS but would add considerably more information to the record.

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http://press.himss.org/article_display.cfm?article_id=5258&instance_code=HIMSS&view_id=4861

23 September 2010

Keep Track of Information Technology with HIMSS State HIT Dashboard

This online, free, publicly-available resource makes it easy to find information on state-centric information technology resources, health information exchanges, and state-based health information technology policy.

The HIMSS State HIT Dashboard gives healthcare professionals, policy makers and stakeholders a snapshot of major health information technology initiatives underway across the Nation. HIMSS designed the dashboard as an easy and comprehensive online tool for timely access to credible and comprehensive information about relevant health IT programs and initiatives across the United States and its territories.

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http://www.ihealthbeat.org/perspectives/2010/mobile-health-forecasts-are-promising-but-who-will-buy.aspx

Thursday, September 23, 2010

Mobile Health Forecasts Are Promising, but Who Will Buy?

By asserting that 40% of U.S. adults would be "willing to pay" for mobile health applications, valuing the market at $7.7 billion, PricewaterhouseCoopers has opened up a dialogue on Twitter, in blogs and even in the mainstream press on whether consumers would really open up their wallets and spend money on personal health information technology.

A growing array of other influential industry analysts are offering promising mobile health forecasts. For example:

  • Deloitte Center for Health Solutions' survey found that 50% of consumers want a "personal monitoring device" to alert and guide them to make improvements in their health or treat a condition;
  • McKinsey's 2009 survey on mobile health asserted that "willingness to pay is high" for mobile health services such as a "phone doctor" and medication reminder. They estimate the mobile health market at $50 billion to $60 billion worldwide and $20 billion in the U.S.;
  • Remote patient monitoring via mobile networks will be a $2 billion market by 2014, according to Juniper Research; and
  • Parks Associates projects the wireless home health monitoring market will reach $4.4 billion in 2013.

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http://healthcareitnews.com/news/hospital-emr-sales-almost-doubled-2008-2009

Hospital EMR sales almost doubled from 2008 to 2009

September 21, 2010 | Bernie Monegain, Editor

OREM, UT – The sale of hospital EHR systems nearly doubled in 2009 over 2008, driven by the American Recovery and Reinvestment Act (ARRA), according to a new report by research firm KLAS. Epic and Cerner captured nearly 70 percent of the new large hospital sales.

KLAS' eighth annual clinical market share report details the wins and losses of acute care electronic medical record (EMR) vendors at large hospitals with more than 200 beds.

CIS Purchase Decisions: Riding the ARRA Wave, reflects data collected from more than 1,600 hospitals with more than 200 beds in the United States and Canada. During the economic downturn in 2008 EMR sales reached a seven-year low.

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http://www.modernhealthcare.com/article/20100922/NEWS/309229959

At UN summit, calls to use IT as global health tool

By Shawn Rhea / HITS staff writer

Posted: September 22, 2010 - 12:00 pm ET

Global health officials attending a healthcare information technology roundtable in New York on Tuesday called on information technology providers to create "scalable, cost-effective" mobile-health solutions for low-resource countries.

"I think what everybody has discovered is that mobile technology is a cheap and effective way to provide everything from a reminder letting a woman know that she is due for a checkup to identifying stock-outs on drugs and condoms so they can be replenished in a timely fashion," said Kathy Calvin, CEO of the United Nations Foundation, a founder the global mHealth Alliance. "What we haven’t gotten is a scaled-up market place that will help us understand what is needed and how to do it," added Calvin.

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http://www.ehealtheurope.net/comment_and_analysis/635/expert_view:_nigel_strang

Expert view: Nigel Strang

22 Sep 2010

In healthcare, the use of ICT to increase patient safety has so far been remarkably limited. The European Commission is encouraging the development of meaningful ICT solutions geared towards increasing patient safety by offering funding to safety-relevant ICT projects.

No human life is without risk; and there is certainly no healthcare without risk. Modern healthcare has contributed enormously to increased life expectancy and more so to the fall in the number of lasting disabilities that we have witnessed in recent decades.

Nevertheless, healthcare brings with it new risks that need to be addressed by healthcare providers, particularly the risk of medical errors. These include adverse drug reactions or drug interactions, surgical complications, faulty diagnoses or the accidental transmission of a nosocomial infection.

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http://www.ehealtheurope.net/comment_and_analysis/636/expert_view:_colin_jervis

Expert view: Colin Jervis

22 Sep 2010

There are many explanations for the failure of healthcare information systems to deliver the benefits expected of them. To succeed, they must change practice – and that means challenging the status quo, argues Colin Jervis, one of the speakers at eHealth Insider Live 2010.

I joined the NHS full of enthusiasm for the integration of human and technical systems; but I was soon deflated. It seemed everyone knew all about it and was “getting the clinicians on board” or had a chief executive who has told staff IT was “not optional” and that it was definitely coming.

I was influenced by Professor Enid Mumford, who worked at Manchester Business School investigating the human and organisational effects of computer systems. Rare among academics, she had gained practical experience working in personnel for an aircraft manufacturer and as a production manager for a clock manufacturer.

She noticed that the implementation of large computer systems often failed to produce the expected outcomes, even when the technology was sound. Other researchers reached similar conclusions, and the phenomenon eventually became known as the ‘IT Productivity Paradox’. Decades later, this is still being rediscovered by healthcare academics.

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http://healthcareitnews.com/news/privacy-hindering-ehr-progress-say-researchers

Privacy hindering EHR progress, say researchers

September 21, 2010 | Molly Merrill, Associate Editor

RALEIGH, NC – Privacy concerns remain the key obstacle in the widespread adoption of electronic health records in the U.S., according to researchers from the North Carolina State University.

The paper, "Privacy and Security in the Implementation of Health Information Technology (Electronic Health Records): U.S. and EU Compared," outlines steps that could be taken to boost privacy and promote the use of EHRs.

"Electronic health records could reduce costs in the U.S. by an estimated $80 to 100 billion each year," says David Baumer, head of the business management department at NC State and co-author of the paper. "Using electronic records allows the healthcare system to operate more efficiently, minimizes duplicative testing, et cetera. But you can only get those cost reductions if everyone, or nearly everyone, makes use of the records, from healthcare providers to pharmacies to insurance companies."

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http://www.who.int/goe/ehir/2010/21_september_2010/en/index.html

E-Health Intelligence Report

21 September 2010

Scientific Articles

Studies in Health Technology and Informatics - Volume 160

- A New Approach for Goal-oriented Analysis of Healthcare Processes

The development of efficient e-services for patient-centered healthcare requires insight into concrete problems in administrative and clinical work processes as well as an understanding of the strategic goals that should guide these healthcare processes. However, considering both concrete processrelated problems and high-level strategic goals during process analysis and solution design can be problematic. To address this, we propose a structured approach for analyzing both high- and low-level goals in a healthcare process and relating these to identified problems.

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http://www.reuters.com/article/idUSTRE68K0FF20100921

More U.S. doctors moving to e-prescriptions: report

CHICAGO | Tue Sep 21, 2010 12:24am EDT

CHICAGO (Reuters) - U.S. doctors increasingly are ditching pen and paper and sending prescriptions to pharmacies electronically, lured by up to $27 billion in government funds aimed at speeding the switch to electronic medical records.

There are now 200,000 doctors who use e-prescribing, or roughly one in three office-based doctors.

That compares with 156,000 at the end of last year, and 74,000 at the end of 2008, according to new data released on Tuesday by Surescripts, which operates the largest U.S. electronic prescribing network.

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http://www.ehiprimarycare.com/news/6248/qresearch_to_predict_patient_cancer_risk

QResearch to predict patient cancer risk

20 Sep 2010

A score to predict the risk of patients developing common cancers is to be developed by the QResearch database.

Prof Julia Hippisley-Cox, professor clinical epidemiology and clinical practice in Nottingham University and a co-director of QResearch, told the EMIS National User Group annual conference that QCancer scores were being developed from the database which has already led to the creation of risk scores for cardiovascular disease, diabetes, kidney disease and fracture risk.

More than 600 EMIS practices covering more than 12 million patients contribute to the QResearch database, a not-for-profit partnership between Nottingham University and healthcare IT supplier EMIS.

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http://www.ehiprimarycare.com/news/6247/vision_360_brought_to_isle_of_wight

Vision 360 brought to Isle of Wight

17 Sep 2010

NHS Isle of Wight is to use INPS’s Vision 360 to share summary information from GP records with its walk-in centre, out-of-hours service and A&E department from the beginning of November.

The primary care trust this week wrote to all 149,000 patients registered with a GP on the island to inform them of the information sharing plans and their right to opt out.

The letter, which includes an opt-out form, says information sharing will help clinical decision making, reduce duplication of tests and requests for information and reduce the risk of errors.

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http://www.healthleadersmedia.com/content/TEC-256696/5-Ways-to-Avoid-CPOE-Pitfalls.html

5 Ways to Avoid CPOE Pitfalls

Gienna Shaw, for HealthLeaders Media, September 21, 2010

An increasing number of organizations are implementing computerized provider order entry (CPOE) systems in order to help physicians make decisions based on evidenced-based best practices. There are a number of benefits to such systems, from streamlined ordering of clinical tests, labs, and medications, allergy and drug interaction alerts, and, of course, an end to the errors caused by physicians' notoriously poor handwriting.

But there are a number of pitfalls, as well. Improperly deployed systems are at risk to cause more harm than good. Here are five common pitfalls of CPOE and how to avoid them.

1. Make it easy to use

Look for graphic displays that are easy to read and understand says Ron Short, vice president of operations at Good Shepherd Medical Center in Longview, TX. Physicians like "touch, enter, and go" software, he says.

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http://www.daily-times.com/ci_16120761

College ends medical transcription program

By Ryan Boetel The Daily Times

Posted: 09/19/2010 11:09:27 PM MDT

FARMINGTON — Fearing it may be preparing students for a diminishing profession, San Juan College will shut down its medical transcription program at the end of the school year.

Many health care professionals anticipate computer programs will soon replace medical transcriptionists.

The School of Health Sciences will focus on modernizing the coding and health information technologies degrees instead. Students with those degrees are qualified for better paying jobs, said Oliver Borden, the dean of the health sciences school.

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http://www.modernhealthcare.com/article/20100920/NEWS/100929997/

CCHIT to begin taking vendor applications

By Joseph Conn / HITS staff writer

Posted: September 20, 2010 - 11:45 am ET

The not-for-profit Chicago-based Certification Commission for Health Information Techology will begin taking vendor applications today for testing electronic health-record systems against federal standards for "meaningful use" under the federal EHR subsidy program of the American Recovery and Reinvestment Act of 2009, a CCHIT spokeswoman said.

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http://www.fiercehealthit.com/story/study-social-networks-can-help-predicting-epidemics/2010-09-20

Social networks can help in predicting epidemics

September 20, 2010 — 10:09am ET | By Neil Versel

Facebook and Twitter aren't just idle distractions. In fact, those sites and other social networks--even ones not based in cyberspace--can help epidemiologists predict flu outbreaks and other epidemics, researchers from Harvard University and the University of California, San Diego, report in the journal PLoS One.

By asking more than 300 randomly chosen Harvard students to name some of their friends and then tracking the two groups independently, the researchers were able to speed up detection of influenza in the group of friends by two weeks with one method. Another method helped them detect an outbreak 46 days before the epidemic peaked, according to HealthDay News. The success is likely due to the fact that those at the center of a social network often are more likely than the average person to contract a contagious illness. "Hence, the careful collection of information from a sample of central individuals within human social networks could be used to detect contagious outbreaks before they happen in the population-at-large," the report reads.

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http://www.fiercehealthit.com/story/new-hipaa-rules-need-more-clarification/2010-09-20

New HIPAA rules need more clarification

September 20, 2010 — 11:06am ET | By Neil Versel

When it comes to the new HIPAA privacy and security standards, it seems like everybody has an opinion. Quite a few organizations are spreading the word about the comments they've filed in response to the changes HHS proposed in July.

The American Health Information Management Association wants the HHS Office for Civil Rights to add some detail to the stewardship role providers must play in determining the "minimum necessary" use and disclosure of patient-specific protected health information, Health Data Management reports. Specifically, AHIMA wonders whether one alternative in a forthcoming final rule on HIPAA attachment standards would effectively force providers to violate the "minimum necessary" standard.

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Commerce Department Funds Telehealth Networks

Projects in California and Georgia are among recipients of $482.4 million in grants to boost economic growth, create jobs, and improve healthcare through broadband infrastructure.

By Nicole Lewis, InformationWeek

Sept. 16, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227500045

Telehealth networks in California and Georgia have received funding to improve and expand their broadband infrastructure, which will help these states bridge the technological divide in healthcare delivery.

Announced on Monday by U.S. commerce secretary Gary Locke, investments totaling $482.4 million in grants will go toward 35 projects across the country that will help boost economic growth, create jobs, and improve education and healthcare.

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http://govhealthit.com/newsitem.aspx?nid=74676

ONC names InfoGard as third EHR certifier

Friday, September 17, 2010

By Mary Mosquera

The Office of the National Coordinator for Health IT has named InfoGard Laboratories, Inc., of San Luis Obispo, Calif., as the third organization to test and approve electronic health records under ONC’s temporary certification program.

InfoGard Labs tests and validates the security of IT products and networks for approval and use by the federal government and large financial institutions, including Visa International and MasterCard International. The company also offers independent third-party security testing services.

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http://healthcareitnews.com/news/deloitte-it-essential-investment-medical-home

Deloitte: IT essential investment for medical home

September 16, 2010 | Molly Merrill, Associate Editor

CHICAGO – Healthcare IT is the essential front-end investment for organizations participating in the patient-centered medical home (PCMH) initiative, according to a new report released by the Deloitte Center for Health Solutions.

The report, "Medical Home 2.0: The Present, The Future," reviews several PCMH pilots and provides insights on the future evolution of the medical home. It highlights the expansion of medical home pilots as part of the Patient Protection and Affordable Care Act of 2010 (PPACA) to help reduce costs and improve population-based health by leveraging clinical information technologies, care teams and evidence-based medical guidelines.

The report concludes that the medical home will likely be a permanent, near-term fixture on the U.S. healthcare landscape due to rising health costs, an aging and less healthy population, payment reforms that are shifting volume to performance, and increased access to clinical information technologies.

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http://govhealthit.com/newsitem.aspx?nid=74675

VA beefs up data security of network devices

Friday, September 17, 2010

By Mary Mosquera

By the end of September, information security managers at the Department of Veterans Affairs will have the electronic tools in place that will let them see how vulnerable the one million computers and other devices connected to the VA network are.

For the last six months, VA has been deploying multiple software applications and data scanning tools “to get visibility on every device on our network,” said Roger Baker, VA CIO.

The tools will enable the department to do a better job of protecting its network and veterans’ sensitive data, reducing the potential for data breaches.

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http://healthcareitnews.com/news/healthcare-workforce-training-receives-130m-boost

Healthcare workforce training receives $130M boost

September 17, 2010 | Bernie Monegain, Editor

WASHINGTON – The federal government will give the healthcare workforce $130.8 million in grants, Department of Health and Human Services Secretary Kathleen Sebelius announced Friday. The awards include $50.5 million for state-of-the-art training equipment and technology, such as e-learning tools, video, audio and interactive learning systems and simulators.

Six areas are targeted: primary care workforce training, oral health workforce training, equipment to enhance training across the health professions, loan repayments for health professionals, health careers opportunity programs for disadvantaged students, and patient navigator outreach and chronic disease prevention in health disparity populations.

The grants include $88.7 million in funding from the American Recovery and Reinvestment Act of 2009.

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http://www.ft.com/cms/s/2/9d0bd394-c41c-11df-b827-00144feab49a.html

Web group to screen bogus drug sellers

By Joseph Menn

Published: September 19 2010 20:31 | Last updated: September 19 2010 20:31

In a victory for the fight against criminal networks distributing counterfeit and adulterated drugs over the internet, the world’s second-biggest seller of website addresses is to begin screening customers for unapproved drug sales.

Under pressure from security professionals, the internet governance group Icann and the White House, the domain-name seller eNom last week quietly retained LegitScript, a company that vets internet pharmaceutical concerns to make sure they are licensed to do business in the US.

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Enjoy!

David.

Wednesday, September 29, 2010

The View From The E-Health Front Line. One Man’s View.

This is what I found to be a wonderful note from someone on the ground. Posted with his permission. (It is in note form - but the intent is clear!)

---- Begin E-Mail.

David,

Thanks for your article in the AUSTRALIAN this weekend.

Have visited http://www.aushealthit.blogspot.com/

Could not see where/how to add to the blog discussion.

As a medico about to retire [at 65] and having spent some 36 years in anaesthetics, may I comment:

Commenced a Health Informatics course with UTAS ... which disappointed me as the curriculum ran out of steam.

Prof did not even answer my letter.

The core prescribed reading texts for that course informed us of the billions of dollars euros and pounds wasted on ehealth.

Why don't we all learn?

Why don't "stakeholders" and "significant persons" building ehealth read the established facts/history?

I support ehealth ...

Some thoughts:

I vehemently and steadfastly support the:

"Girl in the short black skirt" interfacing ...

It is inappropriate and an ergonomic interruption to the work habits and practices of health carers/professionals to assume that they sit at a desk and use a keyboard.

The "Girl in the short black skirt" at a restaurant whips out her card on a slip string, swipes, hits the touch screen and goes.

That fast.

I witnessed Epworth Hospital Box Hill attempt to introduce a paperless system, driven essentially by pharmacy, in Melbourne.

Try as we did, and we did speak to the CEO, the Medical Director, the medico from ACT who contributed to the [hopeless] software, the full time trouble shooter from pharmacy, and others at the coal faces.

Having witnessed the CEO wishing to personally rip the wires from the walls, and the medical staff planning to jump [private] ship, I did give the IT guys a loan of my Health Informatics course texts, and suggested they read the basics.

Now, as an imminent retiree I assist the Tasmanian Medical Retrieval Service, and RFDS with medical retrievals:

Having offered my services in public as a rural locum since Oct 07 I found a Mac Air + Telstra dongle ergonomically "perfect".

Now, I have an iPad ...

{And iMac and Mac Book Pro},

Ergonomically convenient pad which does not interrupt my work flow and is a window to the net world.

On my ICU rounds I can access any net and wifi data within seconds bedside.

{And offer to ventilated patients to tap out their messages to us}

When called out on an urgent retrieval I can record the case details, communicate, look up medical conditions, refresh details of procedures such as inserting an intercostal drain, check out details of medications etc etc all on my lap in the King Air 200 RFDS aircraft, or in the back of an ambulance, en route to the patient.

All I need is my databases and a Telstra signal.

Any person involved in setting up "work stations" with keyboards in hospitals just does not understand work habits/ergonomics of healthcare workers .... especially proceduralists in theatres ...

I recall comments by midwives at Griffith Hospital in NSW in 2008:

"It takes only x time to deliver the baby and clean up and then we spend an hour and a half at the [ping] computer entering the details"

The NSWHEALTH system I witnessed being introduced at Broken Hill GWAHS in 2009 will not fly in an operating theatre suite.

Admittedly my GP does use her terminal well.

In fact, in the Western District of Victoria I set up a Peri Operative Unit and in my office we had a blisteringly fast connection courtesy of a smart CEO.

Utilising that in pre and post anaesthetic consultations, in an office actually did work very well.

{I had a duplicate screen for the patient to watch, and deleted any hospital email}

The privacy hurdle is real.

However, I do assume that the world knows who I am, where I am and what I am about to buy, already.

So .... ???

My concepts of ehealth include:

Blisteringly fast convenient "at the bedside" access to:

Patient's known clinical "Problems" list {"History"}

Significant other "History" data ... such as ...

· Trend data of past numbers

· True "allergies"

· Prescribed Rx Hx.

· and non time critical access to details of Hx events PRN

Inpatient current-admission numbers imaging and other data.

Carers' instant access to academic/journals/other quality data, in the office, at coffee, on the tram, at home, at bedside, and during a boring Keynote.

In the hospital setting ... ALL DATA AVAILABLE, STANDING ON WARD ROUND, AT THE BEDSIDE "ON THE FLY", FOR ALL MEMBERS OF THAT WARD ROUND, on their own iPad.

SCREEN TAP DATA ENTRY/RETRIEVAL AS A FIRST PRIORITY INTERFACE MECHANISM .

One patient One system ....

Same data retrievable at GP, in DEM, in private, in public ...

Dr George Waters

----- E-Mail Ends.

Thanks George. I especially like your emphasis on speed, ease of use and ubiquity of information access.

David.

I Am Not Sure There Is Really A Serious Problem Here.

The following appeared last week

http://www.fiercehealthit.com/story/emr-development-debate-focuses-standards-competition/2010-09-20

EMR development debate focuses on standards, competition

September 20, 2010 — 9:05am ET | By Neil Versel
Lest anyone think the issue has been settled, national health IT coordinator Dr. David Blumenthal says there is a "raging debate" in scientific and policy circles about whether standards or competition should drive EMR development, MassDevice reports.

"There is a raging debate in the computer science world, which I have only lifted the lid on because I'm not a computer scientist, but it goes basically like this: Do we want a world where somebody sets very detailed standards for what computers have to do in order to create interoperability? Or do we want a world that's a little bit more like the Internet, where a minimal set of standards was created and an enormous, vibrant competition and spontaneous growth occurred?" Blumenthal reportedly said at a gala for the Lucian Leape Institute of the National Patient Safety Foundation.

"I hear both sides of that argument, constantly, and even those people who believe in the minimal set of standards aren't really sure what that minimal set is, but we're working on precisely that," Blumenthal added.

He was responding to a question from former U.S. Treasury Secretary Paul O'Neill about EMR standardization.

"Why is it that we're reluctant to declare that we are going to design the best prototype that we can with an idea that we will have [iterative versions] as we learn more and we identify more needs?" wondered O'Neill, himself now a patient-safety advocate. "Why is it that we can't call to question and get on with what's a clear and apparent need for a national standard that's a work in progress?"

…..

To learn more:
- take a look at this MassDevice
story

More here:

http://www.fiercehealthit.com/story/emr-development-debate-focuses-standards-competition/2010-09-20

I have to say I am a little surprised that this has become a hot topic.

It seems to me what you do is Standardise the basic infrastructure and then let innovation flourish in matters of user interface, usability, workflow, functionality etc.

As long as the underlying data models and structures, communications protocols and coding systems being used are properly managed a more than adequate level of interoperability should be possible.

I am told that, at the very least, openEHR, has a very good place to start on all this actually developed. If it can be properly proven up at scale - or alternatives with the appropriate clinical richness and integrity developed then there seems to me to be a line that can be drawn between what is standardised and what is level to developer / vendor choice.

Working out just where the line should be might be a trifle exciting - but I reckon it is doable.

Comments welcome.

David.

Tuesday, September 28, 2010

Sometimes Politicians Really Comes Out With Rubbish. This Is One of the Worst.

The following appeared today.

Roxon demands Coalition admits it was wrong on e-health

HEALTH Minister Nicola Roxon will seek an admission from the Coalition that it was wrong on e-health.

She will also seek Coalition support for health IT measures in the new parliament.

"The Coalition does not believe in e-health," she told The Australian.

"Despite all the experts uniting to support the Gillard government's $467 million e-health investment, the Coalition wanted to cut the funding.

"A key question during this parliament will be whether the Coalition is prepared to accept they were wrong, and support our work."

Ms Roxon said the introduction of a patient controlled e-health system had the potential to save lives and money.

"It is one part of the government's plan to build a health system for the future, through investing and building up services," she said.

Opposition response follows:

http://www.theaustralian.com.au/australian-it/roxon-demands-coalition-admits-it-was-wrong-on-e-health/story-e6frgakx-1225930202906

In summary they say because of previous examples of “waste and mismanagement” they are sceptical.

Can I say I just despair about the quality of this debate. We have Labor pushing a totally ill-defined plan that is supported by virtually no evidence base I have seen (if Anon knows where this evidence is hiding I would love a link!) and we have the Opposition coming up with oppositionistic platitudes!

How can the Opposition admit they were wrong when they have not been provided with any real information about just what is being proposed in any credible detail.

As we have this drivel emitting from our politicians we have this from Canada:

Canada invests $500 million in electronic health record (EHR) systems with a focus on physicians and nurse practitioners across Canada

September 27, 2010 (Toronto, ON) - Canadian physicians and nurse practitioners will benefit from a $500 million investment made by the Government of Canada in Budget 2010, announced Richard Alvarez, President and CEO of Canada Health Infoway (Infoway).

Of the total amount allocated to Infoway, $380 million of the new money will be directed to speed up the implementation of electronic medical record systems.

EMR systems are the gateway that will enable physicians and nurse practitioners to securely access vital patient information including diagnostic images, blood test results, drug histories and clinical reports.

"A number of provinces and territories are making solid progress developing systems to electronically store the patient information that is far too often unavailable when health providers need it," said Alvarez. "The time has come to shift our attention to the front-lines, where the lion's share of care is delivered, so more physicians and nurse practitioners can access and retrieve the information stored in these systems."

EMRs will provide physicians and nurse practitioners with a better picture of their patients' overall health so better informed care decisions can be made. They also allow health care professionals to record their clinical notes electronically, eliminating the need for inefficient paper-based systems.

"Electronic medical records will allow health professionals to access the vital patient information that is too often lacking in a paper-based environment," added Alvarez. "Currently, 37 per cent of community-based physicians have adopted EMR systems across Canada. The new funding is intended to significantly increase their use in clinics, clinician offices and ambulatory care clinics."

In addition, funding from the $500 million invested by the Government of Canada will be used to support consumer health, diagnostic imaging and telehealth solutions.

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government. Infoway jointly invests with every province and territory to accelerate the development and adoption of electronic health record projects in Canada.

The release is found here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/637

At least Canada is smart enough to direct resources where the focus is needed in my view. And before everyone comments I do know most GPs are using some form of EHR but that is by no means the case in other forms of practice.

We would do much better to get all clinicians properly supported by quality EMR systems (with integrated clinical decision support) and get those systems properly networked and sharing information appropriately before heading down what I suspect will be a wasteful ‘wild goose chase’ of the PCEHR.

I believe we have taken a very bad strategic step to plan to move down this path. Time will doubtless tell!

David.

Monday, September 27, 2010

Weekly Australian Health IT Links – 27 September, 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:

A very interesting week. I think what we are now seeing, after the formation of a new government, is positioning of each of the actors with respect to what is going to happen in the e-health domain - and Health Reform in general - over the next year or two - or until the government collapses.

I made clear what I think is needed at the strategic level in the Australian on Sept 25, 2010.

See here:

http://aushealthit.blogspot.com/2010/09/my-prescription-for-australian-e-health.html

Note I accept the thrust of some of the comments that there is also some detailed work needed - but I don’t think that can happen until we can get a concerted direction determined.

I think we can expect some interesting developments leading up to Christmas.

-----

http://www.computerworld.com.au/article/361911/change_management_key_e-health/

Change management key to e-health

Industry leaders key change management among clinicians, patients and politicians

The ultimate success of e-health programs in Australia will come down to how change management and adoption processes are put in place for clinicians, patients and politicians alike, a key industry leader told attendees of the World Computer Congress 2010 in Brisbane.

Adam Powick, a consultant with Deloitte and lead author of the 2008 Australian National eHealth Strategy report approved by health ministers, said that political programs had to be geared towards financials and other motivations that would create incentives for clinicians to adopt programs such as the individual e-health identifier released by Medicare in July, and the personally-controlled voluntary e-health record the Government plans to roll out by 2012.

“To get e-health to work, you have to answer ‘what’s in it for me?’ for every single part of the sector, and I think we don’t do that well enough,” he said.

Powick noted that such programs were already happening, pointing to the $392.3 million telehealth program announced by the Labor party during the Federal election campaign. The program, to begin in 2012, will see doctors paid to conduct about 495,000 online consultation services over four years to rural, remote and outer metropolitan areas — an initiative Powick said was a vital piece of the e-health puzzle.

-----

http://www.news.com.au/technology/doctors-caught-revealing-secret-information-on-facebook/story-e6frfrnr-1225929424789

Doctors caught revealing secret patient information in Facebook posts

  • Patients mocked on Facebook posts
  • Doctors warned over flippant comments
  • Patient confidentiality is "at risk"

DOCTORS have been disclosing sensitive medical information - and even mocking patients - on Facebook.

The NSW Medical Board has cautioned one doctor for making "flippant and derogatory" comments, and warned others to "think twice" before disclosing patient details on social networking sites.

Doctors are being warned the online conversations they think are private "may come back to haunt you".

"The usual rules about confidentiality apply. But even when patients are not identified, members of the public may be upset by the content of such postings," the board said.

"Facebook users are reminded that, despite their privacy settings, no security measures are perfect or impenetrable."

-----

http://www.lexology.com/library/detail.aspx?g=b8ae20d3-f231-4df6-b17f-2023657e3f3c

Are health records protected by copyright?

In brief - Health records and copyright

On 4 May 2010 the Federal Court of Australia held that copyright did not subsist in a number of health records created and maintained by a health care provider. Therefore, they were not an asset of the business.

The health records were health summary sheets, consultation notes, referral letters and other letters written in respect of patients.

Importance of copyright status of health records

The question was important because, if copyright subsisted, the owner of the health records would have been able to claim a more favourable tax position. The decision also has ramifications for apportionment of the price on the sale of any medical or allied health practice.

-----

http://ehealthspace.org/news/nt-reins-walkabout-ehealth-records

NT reins in walkabout ehealth records

The Northern Territory has over 100 small communities scattered across its landmass. Add to that a highly mobile populace and you have a recipe for poor healthcare records.

To combat this problem, the NT government has developed a personal, portable electronic healthcare record for its citizens.

NTHealth chief information officer Stephen Moo told CHIK Services’ Health-E-Nation conference last week the territory’s electronic healthcare record currently has 35,000 citizens enrolled across 104 healthcare centres. Three primary healthcare systems are integrated into the package, plus the major hospitals.

-----

http://www.australiandoctor.com.au/articles/d0/0c06cad0.asp

Audit prompts Medicare investigation

24-Sep-2010

By Paul Smith

MEDICARE Australia says its investigators are targeting 300 practices, especially those that may be abusing incentive payments for e-health and Indigenous health care.

The warning follows last month's Australian National Audit Office report, which said Medicare had only recently been targeting "high-risk" practices that could be abusing the $280 million Practice Incentive Program.

The audit report found that almost 10% of practices claiming practice nurses PIP payments between 2006 and 2009 were not entitled to the money paid out, amid suspicions that practices have not been employing qualified nurses for sufficient hours to be eligible for the payments.

-----

http://www.australiandoctor.com.au/articles/e1/0c06c7e1.asp

PIP fails aim of rewarding longer consults: auditors

24-Sep-2010

By Paul Smith

The Practice Incentives Program is failing to reduce red tape and the rise of six-minute medicine, according to a major review of the system.

The report by the Australian National Audit Office said more practices had become accredited in order to access the payments — now worth around $280 million a year.

But the audit office warned the administrative burden on general practices had not decreased, with 80% of survey respondents saying there had been increases over the past five years in the cost and work required to receive PIP incentives.

-----

http://www.medicalobserver.com.au/news/medicare-ramps-up-pip-audits

Medicare ramps up PIP audits

24th Sep 2010

Andrew Bracey

MEDICARE has defended its record on administering the Practice Incentives Program (PIP), indicating “high-risk” practices will be targeted for PIP audits in the coming year.

The recent Australian National Audit Office report on the scheme revealed Medi­care had relied on 10-year-old data to determine some PIP payments, and that in some cases payments were made to practices that may not have met PIP requirements.

“Furthermore, until rec­ently, Medicare Australia’s PIP compliance audits have been based on factors such as the type of incentive payment and geographic considerations, rather than practices with higher risk of non-compliance,” the report warns.

-----

http://www.theaustralian.com.au/australian-it/government/e-health-record-tenders-out-soon/story-fn4htb9o-1225928533259

E-health record tenders out soon

  • Karen Dearne
  • From: Australian IT
  • September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

-----

http://www.cnet.com.au/aussie-app-a-shot-to-e-health-339306119.htm

Aussie app a shot to e-health

By Darren Pauli on 21 September 2010

A mobile application is set to ease the burden of rehabilitation on the health system by allowing patients to report their conditions to doctors through their phone handsets.

The application can report a patient's exercise routine, diet, weight and other health conditions to health carers using smartphone functionality such as an accelerometer, which measures propulsion, and an on-board camera.

Clinicians can log into a web portal to check the patient's distance travelled when jogging, review photos of their food, and monitor consumption of cigarettes and alcohol. They also issue motivational SMSes and conduct weekly tele- and video-conferences with patients.

The Australian e-Health Research Centre, which developed the application, is also creating mobile tools to capture and analyse a patient's heart rate using wearable sensors.

-----

http://www.theaustralian.com.au/australian-it/government/medicare-e-health-contract-in-limbo/story-fn4htb9o-1225927995135

Medicare e-health contract in limbo

  • Karen Dearne
  • From: Australian IT
  • September 22, 2010 5:40PM

THREE months after the start of the $90 million mandatory Healthcare Identifier system, Medicare is yet to sign a contract for service delivery.

Medicare is operating the HI service without a formal agreement, as negotiations continue with the National E-Health Transition Authority.

The original $57m, two-year contract for Medicare to design and build the system on behalf of NEHTA expired in January.

-----

http://abnnewswire.net/press/en/63796/iSOFT_Group_Limited_%28ASX:ISF%29_Appoints_Ron_Series_As_New_Director_.html

iSOFT Group Limited (ASX:ISF) Appoints Ron Series As New Director

Sydney, Sep 24, 2010 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the appointment of Ron Series as a new director of the company. This is consistent with the company's commitment to Board renewal.

Ron will join the company as an executive director and will be responsible for overseeing the operational restructure of the company's business as previously announced. Ron will be based in the United Kingdom and will work closely with the executive management team to ensure a well planned and efficiently executed restructure plan.

-----

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

New generation of health informaticians

Approximately 40 students from La Trobe University in Melbourne visited the Model Healthcare Community (MHC) on Tuesday 14 September.

As part of their studies the Bachelor of Health Science and Master of Health Information students toured the MHC and will be assessed on what they learnt.

The MHC shows how the Healthcare Identifiers Service (HI Service) works. The HI Service, which commenced operation on 1 July 2010, has been developed as a foundation service for e-health initiatives in Australia recognising that a requirement for a safe and secure e-health system is the ability to uniquely identify everyone involved in a single healthcare transaction.

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http://www.nehta.gov.au/media-centre/nehta-news/708-wa

WA e-Procurement system a national first for health

Western Australia has become the first State to implement an electronic trading system for medical goods and services that complies with new national e-procurement specifications developed by the National E-Health Transition Authority (NEHTA). The new system, linked to the National Product Catalogue for medical goods and services, will significantly streamline supply chain operations in WA’s public health sector enabling multiple suppliers to offer products and manage ordering, payment and dispatch processes electronically.

The system has been developed by Health Corporate Network, which is the WA Department of Health’s Shared Corporate Services arm responsible for coordinating supply, financial services and human resources to WA Government health agencies.

-----

http://www.theaustralian.com.au/news/world/system-to-wash-away-bugs/story-e6frg6so-1225926963376

System to wash away bugs

  • From: The Times
  • September 21, 2010 12:00AM

GENERAL Electric is working on how to minimise the spread of hospital superbugs by ensuring doctors and nurses wash their hands when they are supposed to.

Medical errors, including hospital-acquired infection, cost US healthcare $US30 billion ($31.7bn) and cause up to 100,000 preventable deaths a year, according to the US Institute of Medicine of the National Academy of Sciences.

The failure to follow hand-washing rules is regarded as a leading cause of the problem. Estimates of compliance levels run at only 35 to 40 per cent and little improvement has been made during the past 10 years, according to Jeff Terry of GE Healthcare.

-----

http://www.proactiveinvestors.com.au/companies/news/10061/stirling-products-to-acquire-pathology-business--10061.html

Thursday, September 16, 2010

Stirling Products to acquire pathology business

by Proactive Investors

Healthcare group Stirling Products (ASX:STI) will acquire the business and assets of Halcion Pty Ltd, a national pathology business with laboratory services generating revenues of approximately $7.5 million per annum.

Halcion manages over 40 employees and 20 contractors nationally and operates profitably with the pathology sector. Total consideration is $3,305,000.

The acquisition is effective today but is conditional on due diligence to be completed within 30 days and also the issue of the consideration shares which is subject to approval by the Stirling’s shareholders.

If these two conditions are not satisfied, then the acquisition is subject to reversion to the Halcion interests.

-----

http://www.ferret.com.au/c/Bizcaps/Parker-Healthcare-goes-to-the-National-Product-Catalogue-NPC-with-Bizcaps-Enterprise-n896861

Parker Healthcare goes to the National Product Catalogue (NPC) with Bizcaps Enterprise

By Bizcaps Pty Ltd

Bizcaps Pty Ltd has assisted Parker Healthcare to load its catalogue of 400 products to the National Product Catalogue (NPC) and quickly become NPC-ready using Bizcaps Enterprise.

Drew Hayes of Bizcaps said that the project demonstrated how a supplier who understood the benefits of data synchronisation could ensure a swift and reasonably painless deployment of their product data to the National Product Catalogue.

He said Parker Healthcare’s absolute determination to do what was needed to have its product data quickly available on the NPC in a complete and correct format was the key element in the success of the project in such a short time.

Bizcaps Enterprise is part of a range of product lifecycle management, product data management and business process management software solutions available from Bizcaps.

-----

http://www.smh.com.au/national/miracle-market-unpoliced-20100925-15rkx.html

'Miracle' market unpoliced

Mark Russell

September 26, 2010

WIDESPREAD criticism of the Therapeutic Goods Administration has forced the Gillard government to look at overhauling Australia's drugs regulator because it is failing to adequately police the $2 billion industry in ''miracle'' cures and other quasi-health devices.

Claims that ''therapeutic'' products can cure everything from AIDS to cancer, guarantee weight loss or improve strength, balance and flexibility are misleading and deceptive and can sometimes lead to lethal results, health experts say.

The federal Department of Health and Ageing released a consultation paper on the advertising of therapeutic goods in June, saying it was important the public received accurate information about the risks as well as the purported benefits of these goods on the market.

''Concerns have been raised by some opponents of the current advertising framework that the system is not working to protect consumers as well as it might,'' the paper said. ''There is a perception that the complaints handling process is not as transparent as it could be, and that the sanctions available to the [TGA's] complaints resolution panel … do not provide sufficient deterrence.''

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http://www.theage.com.au/victoria/ultranet-access-an-issue-principals-20100922-15mz0.html

Ultranet access an issue: principals

Jewel Topsfield

September 23, 2010

THE ultranet, Victoria's new online portal in schools, has little use unless every student from years 3 to 12 has a computer, according to the state's principals.

A virtual classroom that will enable parents to view their child's timetables, school work and attendance, the ultranet is due to be rolled out in all schools by the end of September. But principals have warned that to be effective, the ultranet requires every student to have access to a computer, increased technician support and training for teachers.

-----

http://www.theaustralian.com.au/national-affairs/telstra-to-test-services-on-trial-fibre-network/story-fn59niix-1225927596396

Telstra to test services on trial fibre network

TELSTRA announced yesterday it would soon begin testing its broadband services on the trial Tasmanian fibre network.

From next month, 100 Telstra customers in the NBN trial sites of Tasmania's Midway Point, Scottsdale and Smithton will be offered free internet services and products so the telco can test the compatibility of the $43 billion network's infrastructure with its own products and systems.

The select customers will receive super-fast broadband connections capable of 1000 megabits a second download speeds over the fibre network. They will retain and pay for services that currently use Telstra's copper-based network, such as the telephone.

http://www.smh.com.au/business/senate-must-move-on-nbn-20100921-15lh0.html

Senate 'must move' on NBN

Andrew Darby and Lucy Battersby

September 22, 2010

TELSTRA boss David Thodey says the telecommunications company is becoming impatient with delays in finalising its deal with the national broadband network.

Mr Thodey said 18 months after the NBN project was unveiled, it was important for the country, and for Telstra, to finish the regulatory work and pass implementing legislation.

''We need to move on,'' he told reporters in Hobart yesterday.

Under the $9 billion deal to combine forces, reached in June, Telstra agreed to give NBN Co access to infrastructure, in exchange for compensation for closing its copper wire network.

-----

http://www.theaustralian.com.au/business/accc-proposal-threatens-telstra-revenue-nbn-deal/story-e6frg8zx-1225927015291

ACCC proposal 'threatens Telstra revenue, NBN deal'

THE recent ACCC proposal to lower the price Telstra charges its rivals to access its copper network will hurt the telco's revenues.

It will also put its dividend at risk and raise questions over the telco's $11 billion NBN deal, a leading analyst has warned.

The competition regulator last week released a draft report proposing to drop the price of Telstra's basic wholesale telephony service by $6 to $20. The 23 per cent price reduction came as the ACCC decided to do away with its traditional pricing regime of recalculating the total cost of rebuilding Telstra's network with a new system that calculates prices based on the assets and costs associated with providing services.

The draft pricing system has led to a dramatic change in the ACCC's valuation of Telstra's customer access network (CAN), which has now been written down from about $23bn to $7.5bn.

-----

http://www.theaustralian.com.au/national-affairs/greens-put-labors-nbn-sale-plan-in-doubt/story-fn59niix-1225926437224

Greens put Labor's NBN sale plan in doubt

  • Mitchell Bingemann and David Uren
  • From: The Australian
  • September 20, 2010 12:00AM

LABOR'S plan to privatise its $43 billion National Broadband Network is in jeopardy.

The problem has arisen after Greens senator Scott Ludlam pledged to fight for the project to remain in public hands.

The government wants to eventually sell down its stake in the NBN once the ambitious project is completed, but Senator Ludlam believes the network should not be sold to private investors lest another monopoly-empowered telco emerges from the sale.

-----

http://www.computerworld.com.au/article/361294/australian_chamber_commerce_industry_backs_national_broadband_network/?eid=-255

Australian Chamber of Commerce and Industry backs National Broadband Network

However Labor must supply hard numbers on the cost and benefits of the NBN, ACCI says

  • Tim Lohman (Computerworld)
  • 19 September, 2010 09:21

The National Broadband Network (NBN) has been given strong endorsement by the Australian Chamber of Commerce and Industry (ACCI) which at the same time has called for hard data from Labor on the economic benefits of the infrastructure project.

Speaking on Network Ten on Sunday, ACCI chief executive, Peter Anderson, said the Australian business community realised the benefits to the economy which national broadband infrastructure initiatives could bring.

"The instinct in the business community is that there can be a real productivity kick and benefit," Anderson said appearing on Meet The Press.

-----

http://www.ft.com/cms/s/0/8c0a68b0-c1bc-11df-9d90-00144feab49a.html

Computers set for quantum leap

By Clive Cookson in Birmingham

Published: September 16 2010 19:18 | Last updated: September 16 2010 19:18

A new photonic chip that works on light rather than electricity has been built by an international research team, paving the way for the production of ultra-fast quantum computers with capabilities far beyond today’s devices.

Future quantum computers will, for example, be able to pull important information out of the biggest databases almost instantaneously. As the amount of electronic data stored worldwide grows exponentially, the technology will make it easier for people to search with precision for what they want.

An early application will be to investigate and design complex molecules, such as new drugs and other materials, that cannot be simulated with ordinary computers. More general consumer applications should follow.

Comment - This looks like another serious game changer coming!

-----

Enjoy!

David.

Sunday, September 26, 2010

This is Not the Way to Go About Things but Despite That There Are Some Hopeful Comments.

This appeared a few days ago.

E-health record tenders out soon

  • Karen Dearne
  • From: Australian IT
  • September 24, 2010 12:00AM

ELEMENTS of the planned personally controlled e-health record system will go to an open tender, with an industry briefing due before the end of the year.

Some details of the $467 million project to deliver electronic patient records "to every Australian who wants one" by mid-2012 have emerged in response to questions on notice since the Senate estimates sessions in May.

It's understood answers from the federal Health Department were on hold during the extended election caretaker period.

"The (Gillard) government's investment over two years will fund the core infrastructure, standards and tools to provide (everyone) with access to a secure PCEHR from 2012-13, if they chose to register for one," the department said.

"The priority projects for initiating the national system (commenced from) July 2010 with the initial focus on working with key stakeholders including consumer representatives, healthcare organisations, providers and states and territories to identify the design requirements.

"These early planning and development projects will build on the work already undertaken through organisations including the National E-Health Transition Authority and will include ongoing consultation.

"Elements of the national PCEHR will be procured via an open tender process and an industry briefing is expected to be held in the first six months of the program."

The Australian Health Ministers' Conference will oversee the development - rather than the Council of Australian Governments - with the AHMC due to consider a specific workplan and resourcing later this year.

With the federal government funding the first two years of the national rollout, "the states and territories are expected to make complementary investments to upgrade their health and hospital systems in readiness for connecting" to the new system.

"This will allow for a carefully planned and staged introduction of a complex operation, and allow governments, industry, healthcare professionals and patients to make the necessary investments and operational changes needed to participate in the national e-health records system," the department said.

"The first two years of funding will allow lessons to be learned and inform further stages of the roll-out. The government will evaluate progress and make future investments post these two years, as necessary, to expand on the range of functions delivered."

The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.

…..

An initial report on long-term governance arrangements is currently being developed in collaboration with the states, for consideration by the AHMC, which will manage the whole process.

More here:

http://www.theaustralian.com.au/australian-it/government/e-health-record-tenders-out-soon/story-fn4htb9o-1225928533259

What is right here is the recognition that some long term governance arrangements are being worked on.

What is wrong here is that The governance arrangements are being developed with the states and presumably the State Hospital Focussed CIO cabal rather than with all the important other stakeholders in the health sector. If that is actually happening, and the track record is not good, so far there has not been much apparent in the public domain.

Also it seems to me that having the AHMC (The Australian Health Minister’s Council) at the apex of governance of e-Health is going to lead - as it has always before - to very diffused accountability. The way you avoid this is to do what is done in the US and UK where a powerful executive is given a brief to get something done, the resources and authority to do it and simply gets on with it. Without leadership and accountability of that sort we won’t get far again.

It also needs to be pointed out that this quote is having the Government play fast and loose with the truth.

“The government says the introduction of individual patient records is "a core element of the National e-Health Strategy" adopted by COAG in December 2008.”

The National e-Health Strategy said there was a great deal to do in all sorts of areas before shared records / IEHR was to be developed - and that it should be done incrementally at a regional level. It was the much later National Health and Hospital Reform Commission (NHHRC) that came up with the PCEHR as the priority.

This paragraph points out just what needs to be done first.

“As a result, national action will focus on four key areas: infrastructure and rules for access and sharing of patient information; stimulating investment in high priority computer systems and tools; encouraging healthcare providers to adopt and use advanced tools, and establishing a governance regime for effective coordination and oversight of e-health activities.”

It seems to me that what should be happening is that we get governance and leadership in place and then ask of them to develop plans for progress and procurements - going out and procuring until all the wrinkles are sorted is yet another recipe for disaster. We have waited for over a decade - a few more months at this stage to ‘get it right’ won’t be a disaster.

I also have to say this nonsense of funding for 2 years and then trying to work out where next? is just a prescription for a disaster. If you are going to do it, do it once, do it properly and so it with fibre, oh I mean commitment!

I really wish some strategic sanity could prevail here rather than the ‘fire, ready, aim’ approach this seems to betoken.

The most recent poll would seem to confirm a lack of confidence about how this is being handled.

See here:

http://aushealthit.blogspot.com/2010/09/aushealthit-poll-number-37-results-26.html

David.

AusHealthIT Poll Number 37 – Results – 26 September, 2010.

The question was:

What Do You Think is the Chance of NEHTA / DoHA Delivering a Working Functional PCEHR For All Who Want It By July 2012?

100%

- 6 (12%)

75%

- 1 (2%)

50%

- 8 (16%)

25%

- 7 (14%)

0%

- 28 (56%)

Votes : 50

Very clear cut view here with 86% being only 50% confident or less of delivery.

I know the readers are a pretty sceptical bunch on occasions but that is a pretty definite result!

Again, many thanks to the record number that voted!

David.

Dr Andrew McIntyre Tell It As It is Again! Great Read But Pretty Sad.

The following was posted late yesterday.

NASH, Lies and Ideologically Driven Architecture

September 25th, 2010 andrew

Like many people, the idea of e-Health excited me in the mid 1990’s and I got the bug, and wanted to contribute to it. After 15 years, countless standards meetings and international plane trips to attend meetings I would expect us to be further ahead than we are. In fact most people would expect that.

The traditional answer from bodies such as “Health Connect” is that the problem is “change management”. This is pretty unhelpful overall. While change management is required, we first need working solutions and the lack of specifying those is the real problem. There will never be a final solution as Medicine will always change, but what we need for national programs to work is real solutions to build on. In typical public service fashion, no one has been brave enough, or pragmatic enough to actually select one. I guess if it’s a work in progress it can never fail, except many of us believe that the governance has failed in a big way and mainly because of a lack of pragmatism and no deep understanding of the domain.

The glaring example of this is “NASH” – the national authentication service for Health. This is Nehta’s baby and they have failed dismally. For about 10 years we have had HESA Medicare PKI which after a woeful start actually delivers a PKI service for health that is real. Its initial architects could not see much past Email, and it was aimed at that, but it supplies Encryption and Authentication certificates that are actually in existence for the vast majority of general practices in this country. It is not however restricted to email and there is a freely available library available from Medicare that does PKCS-7 encryption and digital signature in a cross platform way. Despite the howls of protest, it does work cross platform and we have been using it in this fashion for many years. It’s not a speed daemon, but it works and it’s free. It even has a SQLite database for the key ring management which shows remarkable foresight as this is a binary cross platform file format as well! It’s this technology that powers the online billing in this country. Despite some suggestions that it was “never designed” for clinical content, it was, and this was enshrined in the electronic Transactions act from 1999 to 2009.

However when we (the industry and Nehta) came to debate the SMD – “Secure Message Delivery” standard Nehta would have none of this, They told us they had NASH which would solve all the” issues” with the Medicare PKI and this would allow us to use the latest and greatest xml encryption and despite having message level security they wanted to add TLS as a requirement. This is a function that requires certificate usage outside of the Medicare Certificate usage and means that the Medicare Certificates are not sufficient. Newer versions of some IDEs’ also require extended certificate usage to perform xml encryption which also invalidates the certificates for this supposed advance.

As someone who protested that the practices already had Medicare certificates and the PIP incentive was to use them, I was suggesting a more pragmatic solution using PKCS-7 which could be used with REST or a more simple SOAP specification. The response was that the PIP requirement was to “apply” for the certificates and did not require “using” them! We were told NASH was “close” to being available and would solve all the issues. Thus the pragmatic solution was not going to be considered.

It’s now apparent that Nehta’s attempts to implement NASH have failed! They are going out to tender not just for implementation, but for design! It is hard to believe that it was “close” when this issue was debated. So now we are left with a PKI infrastructure that can’t be used without a lot of workarounds and a specification that is now missing all the components that it needs to make it work. We have no NASH, no Provider directory, no endpoint location service and to make things worse no compliance program to ensure that the content meets any standards.

The primary reason for this situation appears to be some sort of idealistic view that WS-Security will solve all the issues when in fact it depends on a stack of other services that do not yet exist. In addition to this naive ideology driven utopian view we have seen no effort to standardise content to actually make sure the payloads work. From what I hear Nehta have a similar outlook to content. On top of this stack of unimplemented services they are going to define all the business rules for health as web services and move to a pure document content. This may well work in one enterprise with a tight talented team and one implementation talking to itself but it will never work in the world that I inhabit of greater than 50 vendors of systems with wide variation in quality and ability.

Over the last 15 years Medical-Objects has implemented a HL7 V2 based SOA stack with HL7 based Provider Directory and Endpoint location service along with Medicare PKI support with automated discovery and connection setup to new practices We have push based real time delivery to clients located behind firewalls (SOAP and REST). We have implemented all the services required and have an in depth knowledge of what is required to achieve this. Any system like this will not scale without a working NASH equivalent and an Endpoint location service linked to a provider directory. The HL7 V2 content can easily support CDA based documents and any other data requirements that people may want. The Nehta plans could have worked if they had been busy implementing and testing services that scale for the last 5 years, but it is clear that is not the case. We are still many years away from that point. We could implement SMD, but configuring it manually would make such a service impossible to scale as it lacks all the required services to automate it.

Despite their own failures they appear the think that the barrier to inter-operability is the messaging providers! The messaging providers that deliver clinical documents know that the major barrier to interoperability and the lack of content standards compliance and the resulting lack of reliability of endpoint interoperability. We all try and compensate for that in different proprietary ways which means that the interconnection of messaging providers ultimately depends on the standards compliance of the content, which is a subject that has been totally ignored, presumably out of ignorance. I suspect that the ignorance reflects the idea that “enterprise solutions” by enterprise focused architects will scale to the internet level, which is simply not the case. The best hope we have to achieve results in Australia is to use the existing Medicare PKI to deliver PKCS-7 secured HL7 V2 messages (which could support CDA documents), where the semantics are in the messages and not the SOAP and content compliance is given its rightful place. That path is the pragmatic solution that could work, and does work now at a basic level. Surely 10 years of ideology driven failures is enough? The recommendation to use HL7 V2 to move forward has been made several times but has been blocked by ideologues who knew better. It appears they were wrong. I guess when you are spending $160,000/day of someone else’s money there is no urgency to produce a working solution! At some point someone needs to accept that our current path is off in the weeds.

----- End Post.

The post is found here:

http://blog.medical-objects.com.au/?p=73

For those who have even a basic understanding of the issues raised it is clear that NEHTA’s intransigence has become a major barrier to progress. Again, as I said in a blog yesterday, sorting this out will require a fundamental change to the way e-Health in Australia is governed, led, planned and delivered!

Thanks Andrew!

David.