Another Approach To Patient Information Control Begins Testing. Concerns In US and OZ Are Similar.

There is some interesting work going on in the US on patient control of personal health information.

The US debate does need to be put into context however. Because of the absolutely labyrinthine system of healthcare financing and re-imbursement all sorts of information flows from providers to insurers and this information flow is neither control by or consented for by the patient.

There is now considerable enthusiasm on the part of a good section of the American populace to find out just who had their identifiable health information and what they are doing with it!

Now read on.

Announcing Metadata Pilots to Realize PCAST Vision

August 17, 2011, 1:55 pm

Dr. Farzad Mostashari / National Coordinator for Health Information Technology

Those of you keeping a close eye on the Office of the National Coordinator for Health Information Technology (ONC) and its activities might have noticed the advance notice of proposed rulemaking (ANPRM) that was published on Tuesday, August 9, 2011, requesting public input on a set of proposed metadata standards recommended to ONC by the HIT Standards Committee.

The immediate focus of the ANPRM is the association of metadata with summary care records, but we also welcome input on the use of metadata relative to other electronic health information contexts. To better inform future proposals, we expressed our interest in learning about stakeholders’ relevant metadata implementation experience and requested public comment on the results of any real-life testing or use of the metadata standards discussed the ANPRM. The ANPRM builds upon the recommendations of the Health IT Policy and Standards Committees, which put forth analysis on how ONC could accelerate health information exchange consistent with the vision laid out by the President’s Council of Advisors on Science and Technology (PCAST) in the report it issued in December 2010. The PCAST report envisions a robust health information exchange ecosystem in which patients and providers are able to privately and securely exchange health information across organizational boundaries.

ONC is considering a series of prototypes and pilots to put some of our recommendations to the test. Two of these initiatives – the Query Health initiative and the Data Segmentation initiative – are slated to launch through the Standards and Interoperability (S&I) framework this fall. These initiatives have the potential to improve the quality, safety and coordination of health and health care. Information can be found on the S&I Framework wiki and will be updated frequently so check back often!

• Query Health initiative: The Query Health initiative aims to define and deliver the standards and services for distributed population health queries from certified electronic health records (EHRs) and community records originating in the routine course of patient care. As a result, requesters will be able to create and securely distribute queries to network data partners who subscribe to the published queries. Network data partners will execute the query against a standard clinical information model and securely return the results of the query to the requester. Standards will also include sustainability and extensibility for the clinical information model, as well as the terminology that enable the queries and results expression. Ultimately, this initiative will enable population analyses to inform both clinical and payment strategies for their health systems and practices, in alignment with the HITECH and Affordable Care Acts. Providers will be able to calculate quality measures for populations. From a HITECH perspective, Query Health will leverage the standards and policies that enable the Meaningful Use of patient care and health information exchange.

• Data Segmentation initiative: The ONC Offices of the Chief Privacy Officer and Standards and Interoperability are currently planning an initiative on data segmentation of sensitive information. This project aims to make progress on the persistent privacy issues raised in the PCAST report. The goal of this project is to enable the implementation and management of health information disclosure policies originating from a patient’s request, statutory and regulatory authority or organizational disclosure requirements. The project aims to examine and evaluate the standards needed for sharing individually identifiable health information (including standards recommended by the Health IT Standards Committee through the use of metadata tagging of privacy attributes in standard clinical and policy records and record segments). The initiative will develop use cases that define the current need for data protection services, such as a patient’s directive not to disclose substance abuse records in accordance with 42 CFR Part 2, and will then extend current standards-based software models to demonstrate interoperability. Testing will be based on a reference model aligned with a set of use cases and functional requirements developed by the S&I community.

Read more here:

http://www.healthit.gov/buzz-blog/from-the-onc-desk/announcing-metadata-pilots-realize-pcast-vision/#axzz1VWmud3UV

Here is a press announcement of the plan.

ONC: Metadata Pilots Start This Fall

Joseph Goedert

HDM Breaking News, August 18, 2011

The Office of the National Coordinator for Health Information Technology this fall will launch two pilot projects covering the use of metadata to support the electronic exchange of health information.

The pilots follow ONC's publication of an advance notice of rulemaking on August 9 to lay out its initial thoughts and seek public comment prior to development of a proposed rule.

More here:

http://www.healthdatamanagement.com/news/onc-metadata-ehr-meaningful-use-43021-1.html

I have to say I do so much like the approach of actually getting out and funding proper pilot studies to prove up concepts and make sure they really work .

There is also some discussion of the topic here:

http://www.modernhealthcare.com/article/20110815/BLOGS02/308159999/

By Joseph Conn

Patient control of data seen as within reach

The Office of the National Coordinator for Health Information Technology is asking as many questions as it is giving directives in its unusual “advance notice” of proposed rule making (PDF) regarding some of the recommendations for health information exchange issued late last year by a White House advisory panel.

The President's Council of Advisors on Science and Technology, or PCAST, told HHS to come up with a scheme to attach metadata tags to clinical information to facilitate search, research and privacy protection.

Regarding privacy, the ONC rule makers noted that some industry commenters “supported the concept of giving patients granular consent as envisioned in the PCAST report.” What the presidential advisers had in mind was attaching a patient's privacy preferences for individual data elements, say a positive lab result for HIV, or entire encounter records, such as treatment for drug or alcohol dependency. But the ONC also noted there has been industry pushback as well.

Another federal advisory panel created by the ONC to review the PCAST recommendations “concluded that it was not feasible to include the privacy policy with each tagged data element because policy can change over time, and that a pointer to an external registry (where the privacy directive would be located) would be most appropriate.

Along with this we also have the following issue being raised in the US.

Privacy advocates want stricter rules for online, patient-controlled health records

For 15 years, the Health Insurance Portability and Accountability Act (HIPAA) has given patients a variety of privacy protections for personal health information obtained by medical providers. Unbeknownst to many, though, the same protections do not apply to records controlled by consumers. Privacy advocates say it’s time that stricter standards apply to those records — but efforts to do just that have gone nowhere in Washington, and Congressionally mandated recommendations on how to make it happen are already 18 months late.

The regulatory void amplifies the dangers that exist when people post their health information online — to social networking sites, discussion boards, mobile technologies and personal health record-keeping systems, privacy experts say.

HIPAA, the law that outlines how doctors, hospitals and insurance companies are supposed to handle patient health information, dates to 1996, but was amended most recently in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act portion of the president’s economic stimulus legislation. HITECH set aside $27 billion to encourage doctors and hospitals to convert paper records to digital form, and Congress amended HIPAA to provide additional protections, since so much more data was likely to be exchanged electronically.

But HIPAA doesn’t cover so-called personal health records, which are patient-managed medical records, and other related technologies, including mobile applications and social media, where people sometimes store or publish details about their health. Personal health records are typically provided for free online — by firms like Google Health, Microsoft HealthVault and Dossia — and include services that allow patients to record their health information, set health goals, list medications, communicate with doctors and track their progress. They also often provide access to medical search engines and discussion groups.

“There is a strange perception in the public that all health information is under HIPAA, but it’s not,” said Pam Dixon, executive director of the World Privacy Forum [3], a nonprofit public research interest group. “People are taken by surprise that there is no legal regulation.”

Depending on company privacy policies, health records outside of HIPAA’s purview can be bought and sold, shared with merchants and even disclosed to employers, according to the World Privacy Forum [4]. Privacy policies and consent forms have become so complex and ubiquitous that privacy advocates fear consumers are not adequately reviewing them.

“If consents are made too complex, many will click ‘Yes.’ They've simply become so overwhelmed by lengthy online notices. Yet the risks of medical data disclosures exceed those of financial breaches, and the damage may simply be irreparable,” said William Pewen, former senior health policy adviser to Sen. Olympia J. Snowe, R-Maine, who helped draft the HIPAA legislation.

“Too few realize that social networking sites can utilize such information for commercial purposes, or that some disease-related sites have ties to drug manufacturers who might exploit the medical data one shares.”

There is a lot more here:

http://www.iwatchnews.org/2011/08/12/5732/privacy-advocates-want-stricter-rules-online-patient-controlled-health-records

And for good measure we also had this appear.

Patient health care records ready to go viral

By Misty Williams

The Atlanta Journal-Constitution

4:56 a.m. Tuesday, August 16, 2011

Taking control of your health -- from organizing medical records and lab results following doctor visits to logging efforts for dropping those few extra pounds -- one day might be as easy and intuitive as online banking.

A groundbreaking project in northwest Georgia soon will encourage consumers to play a bigger role in their health care by creating electronic personal health records, uploading medical information and images into one easy-to-access location a button click away.

Earlier this year, the Georgia Cancer Coalition and state Department of Community Health received a $1.7 million federal grant – one of 10 awarded nationwide – to create a patient-focused health information exchange in the Rome area.

While states have developed ways for hospitals, doctors and other providers to electronically share information, the Georgia effort to create a more consumer-focused system could result in a national trend, said Farzad Mostashari, National Coordinator for Health Information Technology.

“Implementing technology can be difficult,” Mostashari said. “It’s changing not only the tools you use but more fundamentally the way we take care of patients.”

Still in the beginning stages, Georgia organizers are exploring technology options but haven't established yet exactly how the electronic system will work or what features it will include. The possibilities, however, are abundant.

Patients could send secure emails with questions to doctors or nurses. Mothers could use their personal health records to store their children’s immunization records. Diabetics could record daily blood sugar readings for doctors to examine.

People would be able to choose who gets access to the information, from family members to emergency room doctors. Privacy protections will be of the utmost concern.

The exchange initially will be available to cancer patients with complex diagnoses and treatments, people who now must navigate a dizzying array of specialist visits , lab tests, chemotherapy sessions and medications. The coalition will work with three medical providers, Harbin Clinic, Floyd Medical Center and Redmond Regional Medical Center.

More here:

http://www.ajc.com/news/patient-health-care-records-1112756.html

The big picture here to me is that we are still learning just how we can address patient privacy concerns with respect to ‘hidden’ information flows while at the same time also not really being sure just what model of Personal Health Record (PHR) will most assist patients best involve themselves in their care.

The issues are linked as choosing to have a PHR will be in part modified by how confident a patient is that their privacy will be properly protected and that, where reasonable, they will have control as to who has access to their information.

There is also a need to balance the importance of clinical information flows against the need for patient control of their own information. I have to say that ‘common sense’ and application of professional ethics should ensure things work reasonably.

Difficult stuff, and I am not sure it will ever be possible to make everybody happy!

David.

Just How The PCEHR Might Be Used In Law Suits Is An Interesting Question. It Seem To Me To Be A Minefield!

The following appeared a few days ago.

When EHRs Meet Malpractice Suits: New Concerns

Electronic health record data stores bring legal liability fears, logistical headaches for healthcare organizations, attorneys say.

By Neil Versel, InformationWeek

August 17, 2011

An electronic health record (EHR) is more than just an electronic representation of a paper chart. It is a legal representation of a patient's medical condition and treatment at a given point in time, one that could be admissible in court. And that could present a whole new set of challenges for healthcare organizations.

"There is no guide out there to walk people through all that changes with an EHR," Adam Greene, a Washington, D.C.-based partner in the law firm of Davis Wright Tremaine, said this week at the American Health Information Management Association (AHIMA) Legal EHR Summit in Chicago.

EHRs make patient information more readily accessible to far more people than any paper chart stashed away in a filing room. They also change how and to what extent medical professionals document patient encounters and add in safety-related features such as clinical decision support.

"There are all sorts of liability fears with all these improvements," Greene told InformationWeek Healthcare. The Health Insurance Portability and Accountability Act privacy and security rules require anyone that handles electronic healthcare data to keep an audit log of access to any personally identifiable information, and records have helped organizations catch employees taking unauthorized looks at patient records--sometimes also landing the organizations themselves in hot water.

Indeed, some worry that audit logs can reveal too much. "There are concerns by providers that access reports could be used in malpractice suits," Greene said.

In fact, such reports already are, according to Stacey Cischke, an attorney with Chicago firm Cassiday Schade who teaches a course in legal issues in e-health at Loyola University Chicago. "The scope of traditional discovery is expanded," Cischke said. "More and more courts are finding that metadata and access to the inner workings of the EHR system is relevant and discoverable."

The general public and even plaintiffs' attorneys do not always comprehend how EHRs work, Cischke added. Because there is so much to chart, physicians and nurses are rushed and things get missed. From the patient's perspective, all the doctor should have to do is click and check off boxes in a list, but, according to Cischke, physicians often are "overwhelmed" by time and economic pressures, and skip steps or simply forget to check some boxes. "The metadata will show this," Cischke said.

Much more here:

URL: http://www.informationweek.com/news/healthcare/EMR/231500140

This report prompted me to think about few aspects of the PCEHR.

As I understand it in legal cases both written and electronic information are ‘discoverable’ within the legal process.

With this being the case, once proceedings are commenced it will be vital for both sides that the electronic information is reliable and trustworthy - and can be correctly interpreted.

From the point of view of the proposed PCEHR this means that the audit trail is able to correctly identify the user who made the entry in the record and to ensure the information has not been tampered with in any way.

This means that the only acceptable model for the PCEHR is one that uniquely and positively identifies the user (provider or consumer) - i.e. organisation and shared logons are not good enough - and that the system is not used until that can be achieved.

I do not think we have arrangements in place to handle this from feeding systems - maybe when NASH is actually delivered and fully implemented the situation will be fixed.

The only other possibility I can see is that the Government declare the PCEHR records to be privileged and not discoverable through legislation.

Note that this is important for both sides as getting a reliable view of all the facts is the first step to achieving justice - witness the effect of CSI etc.

So information provenance in the PCEHR must be assured and additionally once the Government takes on operating a PCEHR system it has a responsibility to maintain all the information over time and for quite extended periods. Failure to do could cause all sorts of problems.

It is also not clear how information sourced from primary systems will be treated vis a vis the secondary information held in the PCEHR - recognising, of course, the patient contributed information will be primarily sourced from the PCEHR. What to do when interpretations differ I will leave to legal experts.

There is also the issue of what is the ‘source of truth’ clinical document as compared to the document that was reviewed in the PCEHR and possibly acted upon.

We also need to understand what would be ‘reasonable care’ in assessing and judging the validity of some contents in a PCEHR. How entitled is a practitioner to rely on the contents and how do they confirm that view?

Second last there was a recent medico-legal submission on the PCEHR pointed out that there were situation where medico-legally the PCEHR might be forced to turn over information to the courts or lawyers against the wish of the patient. I wonder will there be a disclaimer when you sign up that this might happen?

Lastly there are sure to be issues around the quality and reliability of software that is operationalized and implemented in considerable haste. Who is responsible for errors and how does a complainant obtain access to system internals to check etc. etc.

The harder you think about this - the harder this becomes both for current systems and for the proposed PCEHR.

Does anyone know of any good legal writings on this topic? My brain starts to hurt just thinking about it!

David.

Now I Think This Is A Biggie From The Health IT Standards Perspective! Not Quite As Good In OZ!

The following popped up a few days ago.

Single vocab standard for each EHR reporting domain seen as 'momentous'

August 18, 2011 | Mary Mosquera

The Health IT Standards Committee has endorsed a single set of vocabulary standards and a single guide for putting them in place for each area of quality reporting measures, an accomplishment that some individuals and groups have been working on for 10 years. The domains include medications, labs and allergies.

The committee will recommend to the Office of the National Coordinator for Health IT to incorporate the vocabulary standards and implementation guides in certification criteria for electronic health records (EHRs) for stage 2 of meaningful use.

Standards provide the common technical methods that can be installed in EHRs to support functions that improve care and help physicians and hospitals meet meaningful use.

ONC has offered choices of vocabulary standards associated with some quality measures in stage one, according to Dr. John Halamka, committee co-chair and CIO of Beth Israel Deaconess Medical Center.

“Today we have achieved something that some of us have been working on for a decade. For the first time in history, we will be declaring a single set of standards for each domain with one set of implementation guides,” Halamka said at the Aug. 17 committee meeting. “This is truly a momentous event.”

In categories where more work is needed, the committee will suggest that pilots be the next step.

One criticism of stage one where vocabulary standards are involved is the availability of choice. “Every time we say ‘or,’ we really mean ‘and.’ It creates a dizzying amount of mapping because vendors must support every variation,” Halamka said.

Over the past month, the committee has fine-tuned the proposals of two of its work groups to require a minimal number of vocabulary standards, primarily SNOMED-CT, LOINC or RxNorm.

“For every category of vocabulary, they have chosen one standard,” Halamka said.

The Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) is a standard medical vocabulary for use in electronic health records for sharing information across specialties and sites of care. The Logical Observation Identifiers Names and Codes (LOINC) is used for lab and clinical identifiers. And RxNorm is a standard for the names for clinical drugs and drug delivery devices produced by the National Library of Medicine.

More here:

http://govhealthit.com/news/panel-endorses-single-vocab-standard-each-ehr-reporting-domain

A few days earlier we had a closed loop lab ordering approach moving forward at a good clip.

ELINCS lab order specification completed

By Joseph Conn

Posted: August 12, 2011 - 12:01 am ET

A key communications specification for laboratory orders between office-based physicians and community health centers and hospital and commercial clinical laboratories has been completed, the Califorinia Healthcare Foundation has announced.

The release closes the loop on the Electronic Health Record-Lab Interoperability and Connectivity Specification, or ELINCS, a project of the foundation that dates back to 2005 to standardize communications out of an electronic cacophony of standards and channels between providers and the labs they routinely use in patient care.

ELINCS Orders, as its name implies, aims to facilitate standardized orders between providers and labs and is the product of about a year of work, according to Glen Moy, the Oakland, Calif.-based senior program officer for the foundation.

“Now that Version 1.0 has been developed, we’re going to start doing pilot implementations both here in California, and we’re going to select some partner sites across the country as well,” Moy said. “We haven’t finalized that list yet. We’re probably kick off the pilots in early fall or this winter, with the plan of taking the feedback from those pilots and producing a Version 1.1, if you will. We’re also looking at taking the specification and having it balloted through HL7 (Health Level Seven, a healthcare-oriented standards development organization) as a draft standard for trial use. That’s going to take a while, so we’re going to try to do the two in a slightly staggered approach.”

More here:

http://www.modernhealthcare.com/article/20110812/NEWS/308089988/

All one can conclude from this is that there is a good deal of activity leading to clear outcomes on what will be used in the US for the foreseeable future. It is also clear that the choices being made have been carefully considered and that each has been selected to cover its areas of strength.

In Australia, for a reason that is not clear, the NEHTA Standards Catalogue and we are told that “The PCEHR Standards Catalogue currently being updated and will be available soon.” (As of 24/08/2011)

See here:

http://www.nehta.gov.au/standards-catalogue

I know a report was prepared on PCEHR Standards but for reasons that are not clear it has also not been made public. Its status is pretty murky at present I have to say.

An indication of what might be included can be browsed her from a recent presentation - albeit a lot of it is still draft.

www.ihe-australia.wikispaces.com/file/view/GRain_+standards+for+PCEHR.pdf

Of course, at last report, there is still a stand-off on the DoHA / Standards Australia funding agreement as far as has been heard.

There are also some issues with Standards choice identified here:

http://blog.healthbase.info/?p=253

A problem that can’t be sugar coated

All in all, one gets the sense that, right now, Australian E-Health Standards Delivery does not have the management and governance that is needed. It really is feeling like a bit of a mess, despite all this architecture effort!

David.

Here Is The Reason That NEHTA is an Utterly Dysfunctional Organisation. They Are Off On A Total Frolic!

The following organisational chart dropped across my desk yesterday.

It covers the organisation of NEHTA’s Enterprise Architecture Office (EAO).

Click on image to enlarge and have the awful detail revealed!

As a respected management academic said to me regarding this chart - “the only way you get something like this is when you have no idea how to manage!”

To me this just shows an utterly out of control, overreaching and utterly absurd organisation that really needs to get back to doing what was expected - not build empires of this bizarre and irrelevant sort.

Just what is the justification for all this when the Health IT industry in this country is the provider of systems and services and not NEHTA?

This is just a travesty and a farce.

David.

The Following Amazing Report Appeared Today. I Am Just Staggered!

This came up just a few hours ago.

DoHA confirms next round of PCEHR funding in negotiations

The third round of funding for the project will be allocated to the National e-Health Transition Authority (NeHTA) by November 2011

• Chloe Herrick (Computerworld)
• 23 August, 2011 11:24

The Federal Department of Health has confirmed it is in negotiations for the third tranche of funding to be allocated to the National e-Health Transition Authority (NeHTA) for the $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.

Speaking to Computerworld Australia, a spokeswoman for the Department of Health and Ageing (DoHA) said negotiations were progressing in line with the end of the previous stage with a new allocation to be made by November this year.

The spokeswoman could not comment on the exact amount of funds to be allocated to NeHTA, but said it would be dependent on contract deliverables and used to build upon the work completed so far.

The second round of funding received by NeHTA, $50.5 million for the period from May to October 2011, covered a number of areas including system architecture, detailed business requirements, security design, standard requirements and technical specifications. This followed the allocation of the initial $38.5 million to support the PCEHR project from November 2010 to April 2011.

“NeHTA is also acting as the Department’s managing agent in relation to the recently announced National Infrastructure, National Change and Adoption and Benefits Partners and the 12 lead implementation sites,” the spokeswoman said.

Lots more here:

http://www.cio.com.au/article/398098/doha_confirms_next_round_pcehr_funding_negotiations/

Here is the earlier report for reference.

NEHTA receives next instalment of $466.7m e-health project

The funding of $38.5 million will assist the organisation in the next stage of its personally-controlled electronic health record (PCEHR) project

• Chloe Herrick (Computerworld)
• 03 February, 2011 12:45

The National e-health Transition Authority (NEHTA) has confirmed it has received the latest tranche of a total of $466.7 million in funding from the Federal Department of Health for the next stage of its personally-controlled electronic health record (PCEHR) project.

According to a NEHTA spokesperson, funding of $38.5 million will be provided for a six month period to 30 June this year under which the organisation will provide management support services as private-sector partners are hired for four key roles: a national infrastructure partner; a change and adoption partner; a benefits realisation partner and an external assurance adviser.

Much more here

http://www.computerworld.com.au/article/375382/nehta_receives_next_installment_466_7m_e-health_project/

So what we have here is about $89M paid to NEHTA for their contribution to the PCEHR for the year to October, 2011.

All this seems just utterly over the top to me. That some of money could, for example, pay for 1 year for about 590 staff each being paid $150,000 p.a. What on earth were even ½ of this number of people actually doing?

We are also told above the funds were for “a number of areas including system architecture, detailed business requirements, security design, standard requirements and technical specifications”. Well the flash on this is that DoHA has bought a system, for the sake of speed of implementation, and so a good deal of this work will be out the window as it is just irrelevant to what Accenture is actually delivering.

An audit of just how this money has been spent is urgently required as,- on any reasonable look - the spend seems just profligate in the extreme.

What is even more amazing is that without any public accountability as to what has been delivered even more is to be spent!

I am happy to be shown it is and was all utterly reasonable, but really I find my credulability just a trifle stretched!

I look forward to someone explaining how a spend of this sort can be justified - given that the various Wave sites and provisioning contracts are all apparently funded directly from DoHA.

David.

Weekly Australian Health IT Links – 22 August, 2011.

Here are a few I have come across this week.

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

General Comment

It seems to me that the most important news this week are covered in the first two articles. IBM is a formidable innovator and announcements like this have the prospect of creating significant change over the next couple of decades.

The second is this survey in the Australian

http://www.theaustralian.com.au/national-affairs/health-of-the-nation

Health of the Nation.

The report on attitudes to e-Health records I see as pretty important and they need to be carefully considered by the PCEHR program.

Of course the announcement of the PCEHR Infrastructure Partner is important but I suspect what we have heard from IBM will have a bigger impact a decade from now!

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http://www.news.com.au/breaking-news/ibm-unveils-chips-that-mimic-human-brain/story-e6frfku0-1226117824208

IBM unveils chips that mimic human brain

• From correspondents in Washington
• From: AFP
• August 19, 2011 4:53AM

US computer giant IBM has announced that it has developed prototypes of computer chips that mimic the way the human brain works.

The Armonk, New York-based company known as Big Blue said overnight the experimental "cognitive computing chips" could eventually lead to machines that "emulate the brain's abilities for perception, action and cognition".

"These chips are another significant step in the evolution of computers from calculators to learning systems, signalling the beginning of a new generation of computers," said Dharmendra Modha, project leader for IBM Research.

"Future applications of computing will increasingly demand functionality that is not efficiently delivered by the traditional architecture," Ms Modha said.

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http://www.theaustralian.com.au/national-affairs/e-records-in-doubt/story-fn59niix-1226117945857

E-records in doubt

• Adam Cresswell
• From: The Australian

SCEPTICISM about the security of the federal government's proposed system of electronic health records is running so high experts warn it threatens to render the $500 million system a white elephant.

In the 2010-11 budget the Labor government allocated $466m over two years to set up a national system of electronic medical records, which it said would cut waste such as duplicated tests, and improve care by allowing doctors faster access to patient histories.

But Newspoll research for Inquirer suggests nearly half of Australians may consider boycotting the voluntary system when it launches in July next year amid concerns the government may find it impossible to guarantee private medical details remain private.

Forty-one per cent of respondents say they are not confident their details will remain confidential under the new system.

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http://www.mja.com.au/public/issues/195_04_150811/lia10586_letter_fm.html

Can we trust the PCEHR not to leak?

Siaw-Teng Liaw and Terry Hannan

MJA 2011; 195 (4): 222

In April this year, the Federal Minister for Health and Ageing, Nicola Roxon, stated that by July 2012 all Australians will be able to “sign up for a personally controlled e-health record . . . [that] will enable better access to important health information currently held in dispersed records around the country”.1 Laudable aims, but can patients and clinicians trust the reliability and confidentiality of this personally controlled e-health record (PCEHR)?

The National eHealth Transition Authority’s draft concept of operations document proposes that individuals will be able to access a data repository (“My PCEHR”) and tools (“My Access Controls”) to make this dispersed information available to their chosen health care providers.1 The authors failed to give essential details on how the PCEHR will work, but showed insight in their assessment that the scope and extent of information to be shared in the PCEHR is dependent on the readiness of the health care sector to participate.

The concept of democratisation of personal health information is central to the PCEHR, reflecting the populist philosophy of the present Web 2.0 and social networking environment where information is freely published and shared.2 This increases the potential for leakage of information, albeit often unintended, from clinician-held electronic health records (EHRs) via the disparate members of the PCEHR network (Box). Information that, if leaked, might have potential adverse impacts includes family history of disease, and information that may reflect negatively on other health professionals, friends or family members.2 Information leakage, along with complex access and provenance arrangements and individuals “hiding” rather than “denying access” to PCEHR information, will discourage clinicians from participating in a system where they are uncertain about the completeness of the information.

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http://www.theage.com.au/national/technology-vaccine-for-mental-health-help-20110818-1j060.html

Technology 'vaccine' for mental health help

Dan Harrison

August 19, 2011

TECHNOLOGY could be the 21st century vaccine for suicide, depression, eating disorders and substance abuse, according to the head of a new research centre that will investigate how internet and smartphone applications can be used to improve the mental health of young people.

Speaking at the National Press Club yesterday, Jane Burns, the chief executive of the Co-operative Research Centre for Young People, Technology and Wellbeing, said the internet could provide support to the large numbers of young people who do not seek help for their mental health issues. Dr Burns said 70 per cent of young people who experienced mental health difficulties did not seek care.

''For a generation that has grown up with the internet and web-enabled devices, accessing support online feels comfortable, safe and easy. Its anonymity and 24-hour availability are added advantages for a young person that is not yet ready to speak to someone face-to-face or by phone,'' Dr Burns said.

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http://www.zdnet.com.au/accenture-nabs-key-e-health-deal-339320395.htm

Accenture nabs key e-health deal

By Suzanne Tindal, ZDNet.com.au on August 15th, 2011

A consortium headed by Accenture has reportedly snagged the largest deal going under the government's migration to personally-controlled electronic health records.

The group has taken out the contract to develop and implement the physical systems, product and interfaces necessary for the personally-controlled electronic health record system, according to reports, with the contract expected to be formally announced shortly by Health Minister Nicola Roxon's office. The government has pledged that the $467 million electronic health record system will be ready for July 2012.

The contract would include the integration of the system with existing e-health infrastructure nationally.

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http://www.itnews.com.au/News/267036,telstra-cerner-named-in-e-health-record-rollout.aspx

Telstra, Cerner named in e-health record rollout

By James Hutchinson on Aug 16, 2011 4:00 PM

Health finds silver lining as sub-contractors revealed.

A total of eight parties have been chosen to participate in the infrastructure build for the Federal Government's $466.7 million personally controlled electronic health record (PCEHR), with Telstra and e-health partner Cerner among those joining the Accenture-led effort.

iTnews can reveal that consortium winners Accenture, Oracle and Orion Health are to be joined by sub-contractors Telstra, Cerner, ThinkPlace, Extensia and Ocean Informatics in the infrastructure build.

The Department of Health and Ageing had agreed to pay out the $77 million budget for the build, with Accenture receiving the lion's share at $47.8 million. Oracle and Orion Health had also picked up $17.8 million and $11 million, respectively, for the license fees required to use the software underpinning electronic health records.

A further $137.5 million had been allocated to 12 implementation sites around the country, tasked with trialling individual elements of the technology to be used in the record with specific demographics.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=29139

Australia to build personal e-health system

Written by Editorial Staff

August 18, 2011

Australia’s Department of Health and Aging will get assistance in the design and implementation of the country’s Personally Controlled Electronic Health Record (PCEHR) system from Accenture. The e-health system will span all Australia-based health systems and give patients a single record for managing their care.

The PCEHR, which was announced by Australia’s Department of Health and Aging last year, invested $466.7 million over two years to establish the system, which is available by registration.

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http://www.theaustralian.com.au/australian-it/health-industry-preparing-to-mine-patient-data-from-monitoring-systems/story-e6frgakx-1226115516522

Health industry preparing to mine patient data from monitoring systems

• Karen Dearne
• From: The Australian
• August 16, 2011 12:00AM

ADVANCED analytics are set to transform healthcare, as the industry prepares to mine patient data streamed from monitoring systems and held in electronic medical records.

Jim Davis, senior vice-president of analytics leader SAS, says "tremendous amounts of data" are being generated by remote monitoring systems and new digital imaging and diagnostic tools.

"Doctors have live data coming out of these devices and equipment, but to date it really hasn't been analysed," he says.

But that will rapidly change, as health organisations begin adopting mature analytics tools.

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http://www.theaustralian.com.au/australian-it/business-management-system-to-aid-hospital-workflow/story-e6frgakx-1226115508107

Business management system to aid hospital workflow

• Jennifer Foreshew
• From: The Australian
• August 16, 2011 12:00AM

A NEW IT system designed to improve workflow in surgical theatres has the potential to save time and boost patient numbers through the door.

The customised IT business management system, developed by Queensland University of Technology, has been successfully demonstrated in a hospital in Germany.

The project, involving QUT's Business Process Management group, is being done in partnership with German software company Gecko.

BPM group researcher Chun Ouyang said the system was more accurate, efficient and quicker than a human-run scheduling system.

"Scheduling of operating theatres has been one of the open issues in the health domain," Dr Ouyang said.

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http://www.zdnet.com.au/analysis-the-key-to-better-healthcare-ibm-339320491.htm

Analysis the key to better healthcare: IBM

By Michael Lee, ZDNet.com.au on August 16th, 2011

The lack of ICT in healthcare has led to lower productivity and more labour-intensive processes, and has exposed more patients to more errors, according to IBM Australia managing director Andrew Stevens. Stevens said that more money needs to be spent on healthcare IT, putting special emphasis on data analysis.

Addressing the American Chamber of Commerce in Australia today, Stevens said that at the current rate of healthcare spending, and coupled with the ageing population, healthcare would account for almost half of government expenses if nothing was done to fix the health system.

"Australia's healthcare sector already costs taxpayers approximately $100 billion per year, equivalent to 10 per cent of GDP, and health expenditure is growing faster than GDP," he said.

"Within 20 years, Treasury expects Australia's healthcare bill to top $250 billion as the population ages and as serious and chronic disease levels increase."

He said that this was further exacerbated by the lack of investment in ICT, which would raise productivity. According to Stevens, only 1.5 per cent of revenue per annum is spent in ICT in the healthcare industry, compared to 2.5 per cent in other industries.

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http://www.crikey.com.au/2011/08/18/roxons-health-records-system-a-massive-waste-of-467-million/

Thursday, 18 August 2011 /

Roxon’s health records system a ‘massive waste of $467 million’

by Andrew Crook

The headline announcement this week that health minister Nicola Roxon had hatched a $77 million deal with global services behemoth Accenture to deliver its controversial e-health records system has failed to quell the rage of vocal detractors who say taxpayers are being taken for a ride.

The chosen consortium, also including Oracle, Orion Health and a suite of smaller IT minnows, is charged with rolling out the $467 million “personally controlled electronic healthcare record system”, or PCEHR. It will allow patients to register for an e-health record that could be accessed by GPs and specialists around the country. The winning trio triumphed in the Singapore government’s bid to deliver a similar system last year.

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http://www.theaustralian.com.au/australian-it/csc-australia-aims-to-woo-sap-public-sector-with-cloud-push/story-e6frgakx-1226116586390

CSC Australia aims to woo SAP, public sector with cloud push

• Fran Foo
• From: Australian IT
• August 17, 2011 11:12AM

CSC has unveiled a three-pronged strategy to push its cloud computing wares in Australia, with executives hopeful it can lure nascent player SAP.

Aimed at enterprise and government, CSC will be able to tap into its existing base of clients such as Defence, Immigration, AMP and Westpac Group.

Customers have the option of utilising CSC's local data centres for either a public or private cloud, or host a private cloud at the premises of their choice.

CSC's private, on-premises offering, dubbed BizCloud, includes an infrastructure as a service component that relies on virtualisation software from VMware, security and networking from Cisco and EMC storage.

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http://www.computerworld.com.au/article/397357/perth_fiona_stanley_hospital_signs_bt_communications_it_services/

Perth's Fiona Stanley Hospital signs on with BT for communications and IT services

Serco partners with BT for the project

• Georgina Swan (CIO)
• 16 August, 2011 12:22

The new Fiona Stanley Hospital in Perth, Western Australia, will put communications and sustainability at the forefront of its IT agenda, thanks to an agreement with international services firm, Serco, for facilities management and support services.

Serco will partner with BT for the project. Under the contract, BT will install and manage the hospital’s communications infrastructure and run a range of IT services.

The WA Department of Health announced Serco as the preferred bidder for the contract in October 2010, following a nine-month evaluation process. According to BT, Serco will work with the Western Australian Government as the lead service integrator to provision non-clinical services, with BT as the key IT partner.

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http://www.itwire.com/it-industry-news/deals/49186-bt-wins-wa-hospital-it-contract-promises-90-jobs

BT wins WA hospital IT contract, promises 90 jobs

By Stuart Corner

Tuesday, 16 August 2011 12:40

BT has been selected by international services company, Serco, to be its IT partner on the new Fiona Stanley Hospital in Perth. The deal represents a first of BT, which has been trying for some time to export its expertise in the sector into the Australian market.

Under the contract, BT will install and manage the hospital's communications infrastructure and run a range of IT services "aimed at helping the hospital become one of the most technologically advanced and environmentally friendly hospitals in the country."

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http://www.6minutes.com.au/news/dvt-risk-calculator-for-gps

VTE risk calculator for GPs

• By Michael Woodhead on 17 August 2011

A new algorithm has been developed to predict the absolute risk of venous thromboembolism in primary care patients.

Published in the BMJ this week, the ‘QThrombosis’ calculator (link) may be used “to identify patients at highest risk of venous thromboembolism and those most likely to benefit from intervention, such as change in medication, mechanical prophylaxis, or thromboprophylactic medication,” say its UK developers.

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http://www.news.com.au/breaking-news/data-matchmaker-finds-new-uses-for-drugs/story-e6frfku0-1226117131450

Data 'matchmaker' finds new uses for drugs

• From correspondents in Washington
• From: AFP
• August 18, 2011 7:35AM

US scientists have devised a drug-disease matchmaking program that mines databases for potentially useful new treatment combinations and has turned up two so far, says a study.

For instance, a drug commonly used to alleviate ulcers has shown promise against lung cancer and an epilepsy medicine for halting seizures could also work against inflammatory bowel disease, the study released today said.

The research, led by Stanford University scientists and funded by the National Institutes of Health, is published in the journal Science Translational Medicine.

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http://www.theage.com.au/victoria/kids-medical-records-abandoned-in-office-20110815-1itgd.html

Kids’ medical records abandoned in office

August 15, 2011 - 6:58AM

Thousands of children’s medical files from a controversial treatment program for hyperactivity and dyslexia were left strewn throughout an abandoned clinic in Melbourne.

The files including the names, dates of birth, home addresses and medical details were left inside the Dore clinic at Hawthorn when the British parent company went into voluntary administration in 2008, The Australian reports.

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http://www.theaustralian.com.au/news/nation/abandoned-clinics-medical-records-gathered-up/story-e6frg6nf-1226115529143

Abandoned clinic's medical records gathered up

• Belinda Smith
• From: The Australian
• August 16, 2011 12:00AM

CHILDREN'S medical records left unsecured in an abandoned clinic for three years were yesterday seized by Victoria's Health Services Commissioner, who vowed to investigate the serious breach of privacy.

As Victorian Department of Health officials and members of the police privacy unit looked on, Health Services Commissioner Beth Wilson removed all patient information from a former Dore clinic in the inner Melbourne suburb of Hawthorn. While some files were still in boxes, many had been pulled out and scattered throughout the building, which has been vacant since 2008.

The files will be stored securely while Ms Wilson investigates whether the state's Health Records Act has been breached.

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http://www.computerworld.com.au/article/397538/nbn_answer_disability_disadvantaged_conroy/

NBN the answer to disability and disadvantaged: Conroy

Conroy has claimed the NBN will take down the walls that restrict socially isolated Australians

• Chloe Herrick (Computerworld)
• 17 August, 2011 13:14

Communications minister, Senator Stephen Conroy, has sought to position the National Broadband Network (NBN) as a means to connect those who are digitally isolated as a result of age, illness or disability.

Addressing attendees at the National Digital Inclusion Summit, Conroy said the NBN would enable socially isolated Australians to chat, browse and shop, access services and information and connect with their community outside the walls of their home.

“For many isolated Australians the walls or their home define the world, setting the boundaries of their social contact. The internet has the power to dissolve those walls,” Conroy said.

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http://www.news.com.au/national/glitches-delay-school-computer-program/story-e6frfkvr-1226118766112

Glitches delay school computer program

• From: AAP
• August 20, 2011 7:43PM

EDUCATION Minister Cameron Dick says its unfair to compare glitches in a new computer system used by Queensland schools with last year's Queensland Health payroll debacle.

Half of the state's public schools have been using the OneSchool computer system to control accounts payable and receivable since the June/July holidays.

It was to be introduced across the state next month but the education department backflipped late on Friday after unions labelled the system a disaster.

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http://smarthouse.com.au/Wireless_And_Networking/Industry/L6E7X4A3

Mosman Kidnapper Has Links To IT World

By David Richards | Wednesday | 17/08/2011

The Australian man arrested by an FBI SWAT team yesterday in Louisville, Kentucky, over the collar-bomb hoax at the Sydney home of the Pulver family, appears to have strong links to the IT world.

Paul "Doug" Peters, 50, is said to have been a director of the ill-fated Allco Finance Group which collapsed in 2008. Allco had been deeply involved in financing the $400 million deal by which Australian e-health company IBA Health acquired iSoft of the UK (and later renamed itself iSoft) – only to collapse and be acquired in recent weeks by CSC of the US.

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http://www.computerworld.com.au/article/397568/cloud_computing_101_risks_cloud_computing_part_1_/

Cloud computing 101: The risks of Cloud computing (Part 1)

Awash with cloudy concepts

• Sandra Van Dijk (Computerworld)
• 17 August, 2011 17:02

As the most hyped concept in IT today, Cloud Computing has taken spin to a whole new level. Vendor marketing is awash with the benefits of Cloud computing with little mention of the pitfalls.

In this three part series Computerworld examines some of the very real risks and shortfalls associated with Cloud Computing and also identifies which areas have the most potential to completely transform the enterprise.

Part One deals with the need for greater Cloud transparency and warns users to be wary of vendor certification claims.

It also examines the rise of DevOps, which is starting to generate a lot of interest. But beware: DevOps isn't the right fit for every enterprise and is better suited to an IT organisation with a high level of maturity. Finally, Part One delves into the concept of Cloudbursting.

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Enjoy!

David.