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, October 14, 2010

This Is All Just A Symptom of a Larger Problem with NEHTA. Rampant Arrogant Unaccoutability!

The following appeared earlier today.

Health rejects Opposition calls to reveal NEHTA spending

  • Karen Dearne
  • From: Australian IT
  • October 14, 2010 10:21AM

THE Health Department has refused to reveal how much the National E-Health Transition Authority has spent on travel in the past financial year, saying the taxpayer-funded body is not required to report such information under its funding agreement.

"Provision of this information to the department is not required, and is not provided in NEHTA’s annual reports," the department said in response to questions on notice from Senate estimates hearings in June but only published this week.

Liberal Senators Sue Boyce and Concetta Fierravanti-Wells have been pursuing details of NEHTA’s spending and accountability to parliament over the past year.

Senator Boyce sought details of the amount spent on domestic and overseas travel, the number of officers going on overseas trips and the purpose of the trips.

Last month, it was revealed that taxpayers have forked out more than $1.4 billion on specific e-health initiatives over the past 16 years, with around half of that sum spent since NEHTA was established in 2005.

Senator Boyce has previously expressed frustration NEHTA representatives cannot be compelled to appear before Senate estimate hearings and inquiries, citing immunity as a private, jointly federal and state-owned corporation.

NEHTA has been allocated almost $350 million in total funding up to July 2012, including $206m spent during 2006 and 2010. Half of the funds comes directly from the federal government, and the rest from the state and territory governments.

Lots more here:

http://www.theaustralian.com.au/australian-it/government/nehta-escapes-scrutiny/story-fn4htb9o-1225938540282

To be honest, while I know politicians love to ask these sort of questions, I really don’t much care about the sum involved as long as when considered against what they are doing it is reasonable and not grossly excessive.

What I do care about is having a publicly funded organisation like NEHTA using a legal fiction (of being a limited company) to prevent it being accountable to the Senate and our other elected representatives. This just reflects a culture that is much of what is wrong with NEHTA overall.

Until the Auditor General gets into NEHTA and does a serious value for money audit of just what we have received - as the public for the $350 million - I will not be convinced there is not just a huge funding through here and a large number of snouts having a bit of a funding ‘pig out’ in a rather unaccountable way.

If all is kosher what has NEHTA to loose in asking the Auditor General in?

Of course the culture of secrecy and spin is also needing to be addressed and getting the truth on the value for money being delivered would go a good way towards having an effective ‘sunlight’ cure for that too!

It is time the Senate bit back and referred to matter to the Auditor!

David.

Wednesday, October 13, 2010

Common Sense Prevails With the UK Shared Electronic Health Record - A Good Thing!

The following appeared a few days ago.

Summary Care Record given go-ahead

11 Oct 2010

The Summary Care Record is to go ahead, but its content will be limited to core information and an opt-out form will be included in patient information packs.

The Department of Health has published the results of two simultaneous reviews of the SCR, covering the content of the record and the information patients receive before their record is uploaded.

The reviews were set up by the coalition government this summer, following concerns about patients’ awareness of the SCR and the kind of information added to it. This had led to the suspension of further patient information programmes.

The review of the content of the record, led by NHS medical director Sir Bruce Keogh, concluded that the core record should only contain a patient’s demographic details, medications, allergies and adverse reactions, and that these should continue to be copied from the GP’s medical record.

The review group said the DH should only consider expanding the content of the record “when we have built trust in the system and when patients request that we should do so.”

Lots more detail here:

http://www.ehiprimarycare.com/news/6308/summary_care_record_given_go-ahead

All I can say is that this is a remarkably sensible set of decisions.

The keys are:

1. The simplest possible record - populated largely with information that does not change all that often or much.

2. Source the information direct from a system that is used by the caring clinician who has an interest in making sure the information is correct.

3. Make sure that anyone who wants to can simply ‘opt out’. (Avoid all privacy concerns at the ground level)

4. Have the information accessible to responsible clinicians for use in what would typically be more emergent situations.

By taking this simple first step you are then in a position to gradually, over time, as public and clinician confidence grows expand what is done, who can access the information and so on.

If NEHTA and the RACGP were working to get something of this ilk going as a first step to their much more risky and expansive objectives I for one would be keen to support the program. Of course I would like to see careful evaluation of a substantially scaled pilot to ensure a national effort was actually going to work and deliver the benefits that appear to be intuitively obvious but for some reason seem hard to actually demonstrate.

Surely we all now know that trying to do too much on a grand scale simply doesn’t seem to work well.

As I have said endlessly success will only flow if we bite of chunks we can actually chew!

As I said yesterday we also have to make sure we consider the impact of all the various different demands on the system providers, and integrate this simple sharing with a secure messaging framework and so on to minimise the change required at the ‘pointy’ clinician end.

If this simple shared record and secure message transfer can be made to work over the next few years then is the time to start considering how a PCEHR might be then added.

To not move slowly and incrementally in a carefully planned and resourced way will be a prescription for failure I believe.

David.

A Bit of A Rarity - A New Course in Health Informatics In Australia.

I became aware of this today.

Information Session

The University of Sydney,

2011 Master of Health Informatics

The Master of Health Informatics

Designed to Equip You with the Knowledge and Skills needed as an Aspiring Future e-Health Leader

Information session:

6-7pm, Thursday 14th October, Seminar Room 100, New Law School Building, Eastern Avenue, Camperdown Campus, University of Sydney:

http://www.usyd.edu.au/news/fhs/628.html?eventcategoryid=49&eventid=6644

You are encouraged to pre-register at the above URL.

6:00- 6:20pm Overview of Graduate Entry Master programs

6:20- 7:00pm Individual Discussion and Information about Master of Health Informatics

The closing date for applications is 30th Oct 2010.

Please contact

Professor Robert Steele,

robert.steele@sydney.edu.au,

(02) 9036 7368,

if you have further enquiries about the program.

Program information:

http://www.usyd.edu.au/courses/index.php?detail=1&course_sef_id=Master_of_Health_Informatics_870

Sounds like a worthwhile session to attend for those who are interested!

David.

Tuesday, October 12, 2010

This Multiple Bites of the Cherry Approach Will Be an End of Us!

The following very illuminating report appeared in The Australian today.

Three-month testbed delay for health project

A THREE-month-old draft Healthcare Identifiers Service implementation plan has been reissued almost unchanged by NEHTA.

But a project plan is still some way off.

National E-health Transition Authority public affairs chief Heather Hunt says the material and timelines provided in the HI implementation approach and communication strategy were "only designed to show the public that the service will be adopted incrementally, rather than overnight in all locations".

The first deadline nominated has already been missed, with the final technical specifications due to be provided to IT developers by October 1 -- three months after the start of HI operations on July 1 -- still not available.

A Medical Software Industry Association spokesman told The Australian yesterday: "No, we do not have the specs, nor have we been given a draft, which we were expecting for review prior to the final specifications being published.

"We haven't seen a draft which includes the latest changes that were contained in the HI legislation and regulations". Changes included a new category of identifiers for third-party IT service providers.

Ms Hunt said the 45 pages of material released last week was "not a project plan, but a high-level document developed to give information to sector stakeholders who are going to be impacted by the HI service".

"While it contains approximate timeframes, that is for context only," she said. "Actual project plans will be managed by jurisdictions, the private sector, aged care, primary care and many other participants in the rollout. More detailed sector plans are being prepared."

More gruesome reporting (with the associated spin from NEHTA) is found here:

http://www.theaustralian.com.au/australian-it/three-month-testbed-delay-for-health-project/story-e6frgakx-1225937337510

The first point to be made is that, of course, what NEHTA has provided here is not actually anything that could in your wildest dreams be described as a full implementation plan.

I made this point, among others, a day or so ago here:

http://aushealthit.blogspot.com/2010/10/we-can-all-watch-in-bemused-amazement.html

However as I read the comments from NEHTA I realised that not only don’t they have properly formed plans for the so called ‘early adopter’ implementations, but even more worrying there is no real plan as to how, in any level of detail, the full e-Health picture is going to emerge.

This is more than a fussy academic concern. If you accept that the strategic direction being pursued by NEHTA - at the very top level - is to use various styles of secure messaging to deliver discharge summaries, pathology and radiology results and requests, electronic transmission of prescriptions and other clinical summaries then surely we need a coherent plan about how all this is going to be brought together.

I also suspect that if we are to reach the desired outcome of having vendors provide a client to be used by clinicians that integrate all these functions with the other expected functionality the GP systems, then having NEHTA just tossing out specifications at random times over the next few years and hoping the vendor community will just seamlessly respond then we are all dreaming.

What NEHTA, or someone else, if you are concerned at their apparent lack of capacity in delivery in this area, must deliver is a coherent implementable plan as to how this is to be done together.

Integration with the HI Service seems to me to be just one of a series of steps and projects NEHTA is expecting the vendors to just undertake over the next few years, for the good of all at a real cost to them. This really has no chance of working I believe unless we stop the sort of silliness we have seen here where old documents are just expectantly re-issued and none of the underpinning technical work and planning - to say nothing of funding and staffing - has been done.

Going at this in a piece meal fashion is really just not good enough - but it seems it is just this we are faced with. Additionally, of course, NEHTA is not offering any actual funds or staff to help.

I have to say if I was a software provider in this market I would be seriously considering selling out rather than being just randomly put upon as NEHTA takes its own time to decide what it wants next.

What should happen is that RACGP / NEHTA vision for the future which is described here:

http://www.racgp.org.au/ehealth/ehealthfutures

should be analysed for the components that need to be brought together and a plan developed to have this achieved in a series of planned, co-ordinated steps where there is a logical flow and progression of capabilities.

Clearly right now this has not been done and ‘ad-hoccery’ is the order of the day. (Of course it could just be secret and we have not been told - but from achieving an outcome point of view that is just as bad!)

It seems to me to be doing one part of an overall vision in some sites and another part in other sites - without getting a single full capability site up, working and proven - is a recipe for long term problems.

Given we know where we are aiming to be, actually undertaking this is a properly planned and led fashion should not be too hard - but we shall see.

Demanding that we have an implementation organisation and plan - as advocated here:

http://aushealthit.blogspot.com/2010/10/nehtas-clinical-leads-recognise-nehta.html

To address this issue makes really good sense to me!

David.

Monday, October 11, 2010

Weekly Australian Health IT Links – 10 October, 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:

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The first item below is really getting to be quite a concern and it seems that yet again a newly founded government entity is having more than a reasonable amount of difficulty implementing what really should be a pretty simple project - i.e. creating a register of licenced health care professionals.

One really wonders how such a project can be messed up and comprehensively as this one seems to be at present.

Of course there is a spill over to e-Health as it is this entity that is meant to be the source of information on all clinical professionals that is to be used with the National Authentication System for Health (NASH). It may be that NASH finds itself with external as well as internal problems going forward. We shall see but AHPRA really needs to get its act together and soon!

Elsewhere the week has provided an eclectic collection of news snippits.

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http://www.theage.com.au/national/irate-doctors-miss-national-plan-deadline-20101004-164bg.html

Irate doctors miss national plan deadline

Julia Medew

October 5, 2010

DOCTORS say the transition to a national registration and accreditation scheme for health professionals has been disastrous, with the new authority failing to register thousands of practitioners before last week's deadline for the changeover.

The Australian Health Practitioner Registration Authority (AHPRA) asked about 39,000 doctors with state-based registrations to register with its new national database by the end of September. By yesterday, about one-quarter, or 10,000, doctors had not done so.

The unregistered doctors, including about 4000 in Victoria, have been told they have until the end of October to register or they will not be able to practise from November 1.

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http://www.medicalobserver.com.au/news/payforperformance-schemes-lack-it-support

Pay-for-performance schemes lack IT support

6th Oct 2010

Andrew Bracey

PAY-FOR-PERFORMANCE schemes should not be viewed as a panacea for health system funding, experts warn, and health policy makers must give serious consideration to Australia’s health IT systems before starting on this path.

Writing in this week’s MJA, researchers from the Australian National University and the University of Melbourne said Australia needed to take particular note of lessons learned from the failures of the Quality and Outcomes Framework (QOF) scheme used in the UK.

Co-author Professor Anthony Scott, from Melbourne University’s Institute of Applied Economic and Social Research, said the UK pay-for-performance system had largely failed due to payments focusing on outcome targets alone.

A system that encouraged and rewarded quality improvement as well as maintenance of peak quality care levels could work, he said.

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http://www.theaustralian.com.au/national-affairs/database-to-raise-alarm-on-vaccines/story-fn59niix-1225933551227

Database to raise alarm on vaccines

  • Natasha Bita, Consumer editor
  • From: The Australian
  • October 04, 2010 12:00AM

HEALTH authorities are to be alerted instantly to any severe side effects from vaccination in the first "real-time" immunisation database.

The Australian Health Ministers Conference will debate Western Australia's plan to set up an online monitoring system for immunisation, to avoid a repeat of this year's flu-shot scare.

The proposed database would require doctors and immunisation clinics to enter the details of all vaccinations given to children, as well as any side-effects.

More than 100 Australian children suffered febrile convulsions after being injected with a new flu vaccine in March and April, and the Queensland coroner was unable to rule it out as the cause of death of a Brisbane toddler.

The Chief Medical Officer has suspended the Fluvax vaccine -- a world-first combination of seasonal and swine-flu strains -- for the under-fives.

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http://www.pharmacynews.com.au/article/e-health-initiative-to-cut-costs/524263.aspx

E-health initiative to cut costs

8 October 2010 | by Nick O'Donoghue

Health care workers are being urged to take advantage of a new e-health system to help reduce administrative costs and save time.

Specialist Link managing director and Former Young Australian of the Year, Alison Hardacre said web based software system had the potential to alleviate the unmet needs of patients and help health professionals.

A finalist in the University of Queensland (UQ) business school’s enterprize business planning competition, she said the software was designed to connect practitioners and patients with GPs and other health providers including Medicare.

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http://www.misaustralia.com/viewer.aspx?EDP://1286316855134&section=news&xmlSource=/news/feed.xml&title=Support+builds+for+electronic+drug+alerts

Support builds for electronic drug alerts

Wednesday, 06 October 2010 | Rachael Bolton

Listed pharmaceuticals giant CSL has joined mounting calls for a centralised, electronic drug alert system to more quickly identify adverse reactions to medicines before widespread community health problems arise.

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http://www.pharmacynews.com.au/article/alert-system-may-not-work-guild/524165.aspx

Alert system may not work: Guild

6 October 2010 | by Nick O'Donoghue

Doctors need to start recording vaccines they administer and starter-packs they give patients if an electronic adverse reaction system is to work, the Pharmacy Guild of Australia said.

Responding to a call from the Community Health Forum, Guild president Kos Sclavos told Pharmacy eNews an electronic warning system may not have raised the alarm earlier this year when children in Western Australia were experiencing adverse reactions to CSL’s Fluvax.

He said many doctors do not write prescriptions when they administer vaccines and therefore do not record them through prescribing software, which he noted could be used to highlight any suspected adverse reactions, with pop-ups warning doctors of adverse events associated with medications.

“It’s not like you’re writing a script for a medicine with a vaccine, they’re not recorded via the prescribing software, so there is absolutely no certainty that even if that [alert] was in place today that technology would’ve picked up this vaccine issue,” he said.

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http://www.medicalobserver.com.au/news/tga-sets-its-sights-on-iphone-medical-apps

TGA sets its sights on iPhone medical apps

5th Oct 2010

David Brill

THE days of iMedicine could be numbered, as the Federal Government turns its attention to the unregulated world of health-related iPhone applications.

Amid growing public pressure, the TGA has announced it will closely scrutinise new apps to see whether any are making unsubstantiated health claims.

The move follows calls from consumers for greater regulation of smart phone applications, some of which claim to monitor heart rate or blood glucose, and even diagnose disorders.

There are more than 1500 smart phone applications believed to available for health professionals and many more for the public.

-----

Press Release:

Take Control of Your Health Records

October 9th, 2010 (Sydney, Australia)

People often lose track of their medical records, especially information relating to vaccinations and allergies. A new application, MyMediStats.com was launched during the weekend which allows people to track their immunisations and allergy information in one place, anytime, anywhere.

The website can track past vaccinations and notify users of future vaccinations. Users can print out a card which will have a unique URL which doctors can access to check the patient’s vaccination and allergy information.

http://MyMediStats.com

Temporarily located at: http://mymedistats.heroku.com/

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http://www.nehta.gov.au/media-centre/nehta-news/711-torres-strait

Can e-health improve Aboriginal and Torres Strait Islander health outcomes?

5 October 2010. E-health has the capacity to enhance the health outcomes of Aboriginal and Torres Strait Islander people, according to Dr Brad Murphy, an Aboriginal man from the Kamilaroi people of northwest New South Wales and a solo GP in Eidsvold (central Queensland). Dr Murphy is also the Inaugural Chair of the Royal Australian College of General Practitioners (RACGP) National Faculty of Aboriginal and Torres Strait Islander Health.

Dr Murphy can see enormous potential of having individual healthcare identifiers for each patient, which will then enable the exchange of vital health information between remote GPs, such as himself, and city based specialists.

“An issue that we face is that many Aboriginal people use multiple services and they often see many different doctors who each then have to try and build up a patient history. If we can have one electronic record that can be accessed each time that would also help to build a medical history for the patient that will improve treatment outcomes.

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http://www.nehta.gov.au/media-centre/nehta-news/712-imp-and-comms

Finalised Healthcare Identifiers Implementation Approach and Communications plan

7 October 2010. NEHTA is pleased to announce the release of the finalised Healthcare Identifiers Implementation Approach and Communications plan.

This Healthcare Identifiers Implementation Approach will guide development of implementation plans for adoption of identifiers by healthcare providers over the next two years.

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http://www.theaustralian.com.au/australian-it/government/more-integration-needed-to-reap-benefits-of-nehta/story-fn4htb9o-1225934046664

E-health needs implementation body: Haikerwal

NEHTA'S Mukesh Haikerwal has called for a new entity to co-ordinate activities across the states and with the private sector.

Dr Haikerwal, head of the National E-Health Transition Authority's clinical leads program, says a more integrated approach is needed if the community is to gain improved patient care and cost savings from e-health programs.

"To reap the benefits, the role of NEHTA must be matched with a national implementation arm with the ability to co-ordinate across the states, and across the myriad private providers that administer the bulk of healthcare to Australians," Dr Haikerwal said. "With the rubber now set to hit the health superhighway, health professionals urgently need technical capacity and expert guidance to ensure clinical relevance, utility, safety and acceptability of e-health systems."

NEHTA was established in January 2004 as a joint federal-state not-for-profit entity intended to deliver a nationwide health IT infrastructure.
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http://www.bjhcim.co.uk/news/2010/n1010002.htm

iSOFT achieves ISO security standard at Bangalore centre

6 October 2010

iSOFT has announced that its Bangalore centre has achieved the ISO 27001 information security certification.

The move follows ISO 27001 re-certification of the company's UK operations at Banbury and Prestwich earlier this year. Certification at the company’s development centre at Chennai is underway.

“The certification confirms that iSOFT properly manages and protects valuable information and demonstrates to our customers that security of their information is paramount,” said Andrea Fiumicelli, iSOFT’s acting Chief Executive Officer. “It also gives customers the surety that we have embraced and provide best-practice, world-class security standards.”

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http://www.news-medical.net/news/20101006/iMDsoft-to-install-MetaVision-clinical-information-system-across-Queenslands-network-of-public-hospitals.aspx

iMDsoft to install MetaVision clinical information system across Queensland's network of public hospitals

6. October 2010 06:08

iMDsoft® announced today that the Government of Queensland has signed an agreement to install MetaVision® in selected ICUs across the state's network of public hospitals. MetaVision will be installed in 14 hospitals and will be implemented in a diverse range of ICU settings including pediatric, neurology and cardiac units. The university-affiliated Gold Coast Hospital will be the first to implement MetaVision under this agreement.

“As governments all over the world pursue e-health reforms to standardize care and reduce costs, they require a truly scalable, unified system to advance their goals.”

Queensland, Australia's second largest state by area, sought an enterprise solution to facilitate care standardization and enforcement of clinical best practices throughout its complex hospital network. MetaVision was selected as the single electronic patient record for the network's ICUs, replacing paper records and competing software systems. With centralized configuration management, MetaVision will enable hospitals to enhance operational efficiency through access to common data with consistent terminology.

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http://www.crn.com.au/News/234325,polycom-targets-nbn-with-melbourne-office.aspx

Polycom targets NBN with Melbourne office

Oct 6, 2010 9:28 AM

First to demo OTX 300 in APAC.

Victoria's Parliamentary Secretary for Regional and Rural Development Jaala Pulford joined Polycom chief executive Andy Miller on Monday to launch the vendor's first Melbourne office and demonstration centre.

The office added to Polycom's presence in Sydney, Canberra and Perth, and became the first to deploy the Polycom Open Telepresence Experience High Definition 300 in the Asia Pacific.

Michael Chetner, managing director for Polycom Australia and New Zealand gave an example of how the products were used in the health sector.

"The Loddon Mallee Health Alliance in central Victoria is connecting city based medical specialists with trauma patients in rural areas using high-definition visual communications technology from Polycom," he said.

Parliamentary Secretary Pulford said Polycom was positioning itself in "regional e-learning and e-health telepresence initiatives for a high speed National Broadband Network".

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http://www.smh.com.au/technology/technology-news/turnbull-says-65-a-month-will-keep-most-off-broadband-20101004-164ek.html

Turnbull says $65 a month will keep most off broadband

Clancy Yeates

October 5, 2010

The ''extraordinary'' cost of accessing the national broadband network will limit the number of people who choose to use it, the opposition spokesman on communications, Malcolm Turnbull, has warned.

Mr Turnbull, who has yet to finalise the opposition's policy on broadband, signalled the Coalition was unlikely to make any dramatic change to its approach to rural broadband in response to the federal election result. Yesterday he challenged the government's central argument that the broadband network would benefit consumers and competition.

The government-owned NBN Co is likely to charge retailers about $35 a month. He predicted this would result in customers paying an average of $65 to $70 a month.

''That is higher than most people are paying now. So there is no reason to believe that the NBN will deliver cheaper broadband. It certainly will deliver faster broadband than many people are getting at the moment, but at an extraordinary cost,'' he said.

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http://www.smh.com.au/technology/technology-news/tasmanians-to-be-forced-to-connect-to-nbn-under-new-laws-20101006-167vi.html

Tasmanians to be forced to connect to NBN under new laws

Ben Grubb

October 7, 2010 - 9:18AM

Tasmanians will be forced into connecting to the national broadband network (NBN) unless they "opt-out" of being connected under new laws being proposed by its Premier.

It's unclear whether the plan will be extended nationally, but federal communications minister Stephen Conroy said in July that he supported the idea and that it was "the right way to go".

In June, Mr Conroy said that only 45 per cent of homes in the first three Tasmanian suburbs to be connected had signed a consent form opting into connecting to the NBN. Even so, it was unclear how many would in turn sign up to an internet provider.

"The government welcomes this initiative by the Tasmanian government," Mr Conroy's spokesperson said in a statement to this website. "It will enable faster and more efficient roll-out of the network and minimise inconvenience to landowners, who will not have to confirm in writing that they want to be connected.

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http://www.theaustralian.com.au/national-affairs/nbn-switches-to-opt-out-model-to-boost-take-up/story-fn59niix-1225935147644

NBN switches to 'opt-out' model to boost take-up

  • Matthew Denholm and Mitchell Bingemann
  • From: The Australian
  • October 07, 2010 12:00AM

TASMANIAN homes and businesses will automatically be connected to the National Broadband Network unless they actively refuse.

The shift from an opt-in system for the NBN in Tasmania to an opt-out model, which could be adopted nationally, was announced by Premier David Bartlett late yesterday.

The move to shore up the viability of Australia's first fibre-optic cable rollout follows official estimates that only 16 to 25 per cent of premises passed by the rollout would take up subscriptions to access the high-speed internet it offers.

Industry experts suggest a take-up of 80 to 90 per cent is necessary if the NBN is to become a focus of service and information delivery.

The shift to an opt-out model came as some of Australia's leading businessmen called for the federal government's $43 billion NBN project to be subjected to a thorough business case.

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http://www.theaustralian.com.au/business/chairmen-table-concerns-over-nbn-analysis/story-e6frg8zx-1225935126877

Chairmen table concerns over NBN analysis

SOME of the nation's most influential chairmen are urging the government to obtain a cost-benefit analysis into the National Broadband Network.

"You'd be crazy if you didn't assume that we could increase productivity via faster access to the internet. However, I think the lack of a business case and full publicity of that business case is throwing a lot of doubt in people's minds about the level of expenditure," ANZ chairman John Morschel said. "Whether the right thing to do is to cable everyone's house or use alternative technologies as most people do at the moment, we're yet to see."

Mr Morschel's comments were made at The Australian and Deutsche Bank Business Leaders Forum where other high-profile captains of industry, including NAB and Woodside chairman Michael Chaney and Boral and Wesfarmers chairman Bob Every, voiced similar concerns about the lack of transparency surrounding the contentious NBN project.

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http://www.smh.com.au/technology/technology-news/legal-changes-needed-to-ensure-nbn-connections-go-ahead-20101007-169w7.html

Legal changes needed to ensure NBN connections go ahead

Lucy Battersby

October 8, 2010

MORE state governments will have to change trespass or property laws to ensure households are not left without fixed-telephone connections, following the Tasmanian government's move to introduce legislation for property owners to opt out of the government's fibre network.

''All state governments are now turning their minds to the practical issues that will go along with migration and the roll-out of the network,'' said the chief executive of Communications Alliance, John Stanton.

''In the future, when copper networks have been decommissioned, consumers will have a choice of [retail service providers] to connect to the NBN, and in many cases they will also have the choice to opt for a wireless-based service that is independent of the NBN.''

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http://www.theaustralian.com.au/national-affairs/states-baulk-at-opt-out-on-nbn-link/story-fn59niix-1225935670164

States baulk at opt-out on NBN link

  • Mitchell Bingemann and Lauren Wilson
  • From: The Australian
  • October 08, 2010 12:00AM

NSW and Victoria have ruled out following Tasmania's lead and legislating for all homes to be connected to the National Broadband Network.

The states' reluctance to legislate, coupled with take-up rates mirroring Tasmania's sluggish appetite to connect to the broadband network, could result in the federal government conducting a review into the NBN's roll-out schedule.

Failure to achieve good take-up rates in the test phases of the NBN -- which include the Tasmanian roll-out and 19 sites on the mainland -- would trigger a review to correct the connection deficiencies and pare back the NBN's mandate to connect 93 per cent of the nation to the fibre network, according to the government's $25 million implementation study into the viability of the NBN.

"If the results of the first phase of roll-out suggest the . . . coverage target will not be reached, government should use its performance management mechanisms to correct the course of the roll-out and/or revise its target," the study recommends.

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Enjoy!

David.

Sunday, October 10, 2010

AusHealthIT Poll Number 39 – Results – 10 October, 2010.

The question was:

Do You Believe The Personally Controlled EHR is the Top Priority In Australian E-Health?

For Certain

- 8 (25%)

Possibly

- 3 (9%)

Probably Not

- 3 (9%)

No Way

- 18 (56%)

Votes : 32

It would be fair to say 50% reckon that this is not the main game and 2/3 have some level of uncertainty about its rank.

Again, many thanks to those that voted!

David.

We Can All Watch in Bemused Amazement as NEHTA Stuffs This Up. Sadly They Are Just Clueless at Implementation.

The following popped up a day or so ago.

NEHTA publishes health identifier plan

By Renai LeMay, ZDNet.com.au on October 8th, 2010

The nation's peak e-health group has released a comprehensive set of documents that outline how the Federal Government's $466.7 million electronic health identifier project will be implemented over the coming years, and how it will work in practice.

The project is slated to see all Australians allocated a unique identification number enabling medical records to be transferred — with their consent — between medical providers such as hospitals and general practitioner doctors electronically, rather than through paper records, as is often the case today.

However, so far details on how it will be implemented have been scant.

In the documents, the National E-Health Transition Authority (NEHTA) said there would need to be three complementary programs of work to be undertaken for the project to move forward.

Firstly, a change management program would need to be carried out that would depend on what NEHTA said was the "nature of the healthcare business" and the current state of its IT systems. In this program, industry peak bodies will be involved as well as other organisations.

Secondly, NEHTA said medical software vendors would need to be provided with assistance so that their products could communicate with the healthcare identifier service. Well-designed specifications would need to be provided to assist with their implementation of standards.

Lastly, NEHTA said it would be necessary to identify and establish early adopter sites that could demonstrate the use of the technology in supporting outcomes. The organisation is planning to collaborate with key organisations that would be prepared to get involved early, which will produce lessons learned, research and toolkits from the process.

More here:

http://www.zdnet.com.au/nehta-publishes-health-identifier-plan-339306475.htm

When I saw this I thought maybe we have a new era of openness and implementation competence emerging from NEHTA. Sadly it is just not the case in my view.

Actually far from being comprehensive what we are given in two documents (an HI Service Implementation Approach (39 pages) and a Communications Plan (15 pages) that are as high level and vague as is possible to be. They also are often rather naïve and uninformed about the world of Health IT outside Australia.

The guts of all this is found on page 14.

2. How will the HI Service be implemented?

Healthcare providers in both the private and public sector have made significant investments in technology over the past 20 years. Australian governments have agreed that any national program must recognise this investment and build on existing systems.

The HI Service has been established to:

  • Implement and maintain a national system for uniquely identifying healthcare providers and individuals;
  • Develop and operate a Healthcare Provider Directory to facilitate electronic communication between providers by enabling them to locate and verify the contact details of other providers;
  • Operate in conjunction with a standardised authentication infrastructure and comply with international best practice for information security.

A number of service channels are being established for both individuals and providers to access the HI Service. Healthcare providers (individuals and organisations) will be able to look up or enquire about identifiers from the HI Service via a secure business-to-business (B2B) web service, a secure web portal or telephone. Individuals will also be able to access their own information held by the HI Service through a web portal, by telephone or face-to face at Medicare Australia Offices. Patients will be able to find out which healthcare providers have accessed their IHI by reviewing an audit log held by Medicare Australia.

Identifiers have been automatically assigned by the HI Service Operator to all individuals enrolled in Medicare Australia’s and Department of Veterans’ Affairs (DVA) programs.

Those not enrolled with Medicare Australia or the DVA can be provided with a temporary (unverified) IHI when they seek healthcare, and can choose to validate (verify) this number through the HI Service by providing sufficient demographic information to ensure the IHI is uniquely assigned to that individual.

Individual healthcare providers have been issued with either a HPI-I as part of their professional registration process through the Australian Health Practitioner Regulation Agency or may obtain one directly from the HI Service.

Healthcare organisations will need to apply directly to the HI Service Operator to be issued with a HPI-O.

Healthcare identifiers are designed to improve information management and communication in the delivery of healthcare and related services. While identifiers are designed primarily for these purposes, there will also be benefits for other health-related purposes. For example the timeliness and accuracy of health research and management of health services could be improved through the use of healthcare identifiers. These purposes are specified in the Healthcare Identifiers Act 2010 and will be permitted only in accordance with rules for access.

----- End Extract

Having read this are you any the wiser as to how the HI Service will be implemented? I am not.

The more you read of the document the more you just shake your head in horror. Classics I noticed going through were:

Page 7:

In addition, implementation plans will be developed in consultation with parts of the sector, e.g. primary care, jurisdictions and aged care.

And, on asks, what about the rest of the health system?

Page 8:

The document refers to being guided by the National E-Health Strategy which remains unfunded and ignored except when convenient for DoHA or NEHTA.

Page 12:

The linkage between the HI Service, Identifiers and the claimed benefits is fatuous on any careful analysis.

Page 12:

There is a lot of discussion of the PCEHR but read here:

1.3 Personally controlled electronic health records

While the HI Service does not store any health information, it provides a foundation for future e-health initiatives such as the personally controlled electronic health records (PCEHR) that was outlined in the 2010-11 Federal Budget.

The national system will enable all Australians who choose to participate, to register online for their PCEHR from 1 July 2012. Australians will be able to check their health history online through their own electronic health record.

The PCEHR system will enable improved sharing of critical health information and better integration of patients’ care across multiple healthcare providers and settings. It will help patients experience smoother transitions between healthcare providers, reducing waste and inefficiency and enabling better and safer care that is more responsive to patients’ needs.

With a patient’s consent, the PCEHR system will allow an authorised healthcare professional to view a summary of health information from a range of providers. Summary health information will become richer over time and include key clinical information, such as conditions, treatments, medications, test results, allergies and alerts. The PCEHR system is a key building block in the National Health and Hospitals Network.

A key element of the PCHER system’s implementation will be through lead implementation sites that will test and evaluate key health information exchange between participating healthcare providers. This staged approach will ensure that lessons learnt through these lead implementation sites are responded to and subsequently, inform the future national roll-out of the system. This will enhance sustainability of the system and improve benefits to patients.

The purpose of the lead implementation sites will be to:

· Deploy and test national e-health infrastructure and standards in real world health care settings;

· Demonstrate tangible outcomes and benefits from funded e-health projects;

· Build stakeholder support and momentum behind the national PCEHR system work

· program; and

· Provide a meaningful foundation for further enhancement and roll-out of the national PCEHR system.

The PCEHR system will be underpinned by rigorous governance, national standards and planning, as well as core infrastructure requirements.

----- End Extract.

I find it interesting that this does not say these pilots are implementing the HI Service. If they all were one might have expected they would say so.

Page 15:

2.2 How will the health sector adopt and use identifiers?

The use of HIs will be progressively adopted by the health sector to support strategic initiatives and priorities at the national, state and territory levels including for example in the areas of medications management, discharge summaries, and referrals, as well as a future PCEHR program. Identifiers may be used for internal clinical purposes as well as for information exchange between healthcare providers. There will be different drivers across the healthcare sector for using healthcare identifiers. Most healthcare organisations will ultimately only adopt identifiers when their systems are able to support them and if they see value in making the change.

And lastly on Page 20”

“Based on overseas experience and feedback from Australian healthcare providers and their associations, the characteristics of B2B systems will be most appealing to small-to medium sized healthcare providers such as general practices, allied health professionals and specialists. These providers generally run efficient operations using standard off-the-shelf software. They are amenable to changing their business practices where there is a clinical benefit to be gained and where the change will not affect their efficiency or require significant retraining of staff. Access to the HI Service through a B2B connection meets these requirements.”

And there is the rub, as all providers can see at present in possible future benefit but real difficulties with avoiding major workflow impacts in the present.

I would suggest the big gaps here are as follows:

First there is not actually a real Implementation Plan! What we have here is motherhood and waffle

Second there is not an explicit allocation that leads to a resourced, funded and staffed implementation.

Third there is no clue as to how leadership and governance is to work - just saying Health Ministers will do it is a joke. Who is actually going to lead and deliver this do you imagine?

Fourth there is absolutely no firm rationale offered as to why anyone would go to the bother and expense of adopting the HI Service. The document talks of incentives but offers no concrete proposals.

Fifth there is no Resource Plan covering who, what, when, budgets etc. Without this you can tell this is one of those rather hopeful ‘Build it and They Will Come’ sort of projects. They don’t work often in my experience

Fifth note there are no explicit targets and timelines. Shows you they are not sure how it will go I believe.

Last, although the draft of all this was apparently put out for consultation there is no obvious summary of the consultation and change list from draft. Besides some graphics changes they are pretty similar.

You can read it all from this link:

http://www.nehta.gov.au/connecting-australia/healthcare-identifiers

The alleged comment made by a senior NEHTA official that “implementation is not NEHTA’s problem, and that they are there to design perfection’ sure rings true!

Watch this unravel - from their timelines it already seems to be behind. Without a properly resourced and led implementation, backed by appropriate incentives and undertaken with a solid well considered sector wide implementation plan (developed by project managers who know what they are doing) this is a dead duck!

David.

Saturday, October 09, 2010

Guess What? Another Example Where Big Has Blown Up Badly At Vast Expense!

The following appeared a day or so ago.

DOD's EHR Failure Due to Poor Planning, Says GAO

John Commins, for HealthLeaders Media , October 8, 2010

Shortcomings in the Department of Defense's failed 13-year, $2 billion transition to electronic medical records were largely due to poor planning and execution, and a failure to appreciate the "significant complexity" of the program, the Government Accountability Office said.

DOD's EHR project—the Armed Forces Health Longitudinal Technology Application (AHLTA)—was expected to give the military's healthcare providers realtime access to health information for the 9.6 million active duty service members, their dependents, and other beneficiaries worldwide. However, the system hasn't met expectations.

GAO was asked by DOD to examine AHLTA's shortcomings as the military prepares to acquire a replacement system called EHR Way Ahead, for which the federal government has budgeted $302 million in fiscal 2011.

GAO found that AHLTA had met some benchmarks for outpatient care and dental care documentation, but that DOD had been forced to scale back other capabilities. "In addition, users continued to experience significant problems with the performance (speed, usability, and availability) of the portions of the system that have been deployed," GAO reported.

DOD has begun to improve system performance and enhance functionality and plans to continue to stabilize the AHLTA system through 2015, as a "bridge" to EHR Way Ahead. "However, it has not carried out a planned independent evaluation to ensure it has made these improvements. Until it ensures that these weaknesses are addressed, DOD risks undermining the success of further efforts to acquire EHR capabilities," GAO reported.

Details here:

http://www.healthleadersmedia.com/content/LED-257477/DODs-EHR-Failure-Due-to-Poor-Planning-Says-GAO

Here we have another example of a huge, long project that has failed to deliver on all sorts of major objectives despite lots of time, money and effort.

I hope this is another report that the anonymous people at NEHTA and DoHA who seem to be planning to implement all sorts of large national projects look at very closely.

It is really hard to identify very large scale Health IT projects - with the exception of the clinician led Kaiser Permanente Project which has a second bite after billions had been wasted on the initial effort - that have really gone well.

Let me know if you think there are others that are worth a look!

David.