Quote Of The Year

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

or

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

Monday, September 19, 2011

AusHealthIT Poll Number 88 – Results – 19th September, 2011.

The question was:
Have NEHTA / DoHA Responded Adequately And Fully To The PCEHR Submissions With the New PCEHR ConOps?
No Way
- 14 (56%)
Some Minor Progress
- 9 (36%)
Major Progress
-  2 (8%)
Full And Adequate Response
- 0 (0%)
Votes 25
A stunningly clear cut vote. DoHA and NEHTA are just not listening!
Again, many thanks to those that voted!
David.

Weekly Australian Health IT Links – 19th September, 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

No doubt the big news of the week has been the release of the ‘Final’ Concept of Operations for the PCEHR.
Two other bits of news - the announcement of the Draft Telehealth Standards and the DoHA data warehouse have rather slipped between the cracks!
Setting up these warehouses to be data-mined for quality, performance and cost information may indeed turn out the be a much larger step than most are recognising right now!
The Draft Telehealth Standards are found here:
There is a lot of information - but it is not clear to me exactly what is being standardised at a technical level. Comments welcome on this one!
Certainly the control and governance of this information needs to be very closely watched.
Lots of other interesting stuff - including the rather sad note that one of our medical technology companies has hit a rather nasty bump on the road. This country produces only so many major successes of a technical kind and it is to be hoped this ship can be quickly righted.
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DoHA gets data warehouse in order

Enterprise data warehouse project will help facilitate the National Health Reform initiative
  • Tim Lohman (Computerworld)
  • 16 September, 2011 09:36
Australia’s National Health Reform (NHR) initiative has taken a step forward with the announcement that it will shortly begin the enterprise data warehouse (EDW) overhaul component of the initiative.
The NHR initiative seeks to unify the Commonwealth, states and territories in a nationwide health and hospital system overhaul.
The EDW program, one of many elements, will ensure the data collection and storage facilities for a range of key health-related data sets are in place to support the NHR.
The EDW will also provide access to key common and agency specific data collections; provide the tools for a range of data analysis, modelling and forecasting activities; and ensure activity based funding-related data transfer between the relevant national, state and territory agencies. The data sets involved in the data warehousing program are sizable.
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Ceasefire over e-health standards

NEHTA standards head made redundant.

The Department of Health and Ageing has agreed to resume the funding required to develop the technical standards that underpin its $466.7 million personally controlled electronic health record initiative.
The department had reportedly cut funding to an e-health standards development program by Standards Australia over the current financial year.
Negotiations around funding for Standards Australia's work continued well into August. A spokesman for the national body said an agreement had since been reached.
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Gillard government's health records rollout 'lacking in standards'

THE Medical Software Industry Association has warned that the Gillard government's $500 million e-health records rollout is a "standards-free zone" that will lead to massive costs and risks sinking local e-health providers.
The revised concept of operations for the personally controlled e-health record system, currently under implementation at 12 lead sites, was released by Health Minister Nicola Roxon in Canberra yesterday.
But the document reveals that a swag of technical standards needed for the build are yet to be decided. Instead, private contractors will have to rely on "specifications" developed by the National E-Health Transition Authority, which will ultimately progress these for acceptance by Standards Australia.
An MSIA spokeswoman said there was little point in having a dozen projects and a national repository for patient records if the work was being done without reference to appropriate standards.
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6minutes Online Video - the PCEHR

  • 15 September 2011
The final plans for the personally-controlled e-health record (PCEHR) have been released by health minister Nicola Roxon. However, medical groups such as the AMA say the government has not listened to the practical suggestions put forward by doctors for the scheme, which is due to start in July 2012. Michael Woodhead reports on what the scheme will look like.
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E-health push to give stars false IDs

  • Natasha Bita, Consumer editor
  • From: The Australian
  • September 16, 2011 12:00AM
CELEBRITIES, politicians and victims of domestic violence will be given fake identities to prevent hacking into their medical records stored in the federal government's new electronic health database.
The government has decided to let patients who "fear exposure due to the public nature of their work" use pseudonyms when they sign up for the $467 million e-health system, which will begin storing medical records in a central database from July next year.
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AMA pours cold water on PCEHR, again

The Australian Medical Association (AMA) has renewed its concerns about the structure of the PCEHR following the federal government’s launch of the final version of the Concept of Operations today.
In particular, the AMA has raised concerns about the ability for patients to excise aspects of their medical records from the record as something that could have serious consequences in an emergency situation. The AMA has repeatedly questioned aspects of the PCEHR’s operation in public and private forums.
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PCEHR needs fine-tuning: RACGP

The Royal Australian College of General Practitioners (RACGP) has welcomed the final Concept of Operations document for the personally controlled electronic healthcare record (PCEHR), with a caveat.
The peak organisation for GPs stated not all of its concerns had not been addressed, the plan did provide the clarity needed to get the record underway.
“The RACGP is pleased that the final plan for the PCEHR has been released and whilst not all our previously raised issues have been addressed, it is important that Australia gets underway with the implementation of the PCEHR,” said Dr John W. Bennett, chair of the RACGP National Standing Committee – ehealth, in a statement.
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Slow uptake better for e-health: Roxon

By Josh Taylor, ZDNet.com.au on September 13th, 2011
Slow uptake of the government's planned personally controlled e-health records (PCEHR) will be better for the system, according to Health Minister Nicola Roxon, who said that it may not be able to cope with 100 per cent adoption on day one.
At the unveiling of the government's final concept of operations report for the PCEHR system in Canberra yesterday, Roxon refused to be drawn on what level of take-up for the opt-in system she was expecting from the launch on 1 July 2012, instead saying that it will be better if fewer people sign up for the system on day one.
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Roxon defends opt-in system for e-health records

13th Sep 2011 AAP
FEDERAL Health Minister Nicola Roxon has hit back at critics of the opt-in system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number, but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
Doctors say that's a mistake, saying an opt-out system would be better.
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E-health rebates ruled out

  • Karen Dearne
  • From: Australian IT
  • September 13, 2011 9:08AM
HEALTH Minister Nicola Roxon has flatly ruled out paying for doctors to create and maintain electronic health records on behalf of their patients.
In a doorstop interview at the launch of a model e-health display in Parliament House yesterday (MON), Ms Roxon replied "no" when asked if there would be a special Medicare rebate for doctors using a new $500 million nationwide patient electronic record system due to start next July 1.
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No rebate for PCEHR adoption

The government has ignored advice from medical groups on the PCEHR,  with health minister Nicola Roxon ruling out any special rebate to cover the costs of adopting the new system.
In an interview yesterday she said GPs were already using computerised systems and would see the value in switching to a new and better record system.
“The government's commitments are to fund the infrastructure that's required so that the system can talk to each other. It's not to fund each and every bit of a general practice or a health practice of any type which is going to constantly update itself and want to keep up with modern technology,” she said.
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No rebates for setting up e-health records

13-Sep-2011
Paul Smith
There will be no new MBS items to fund the time GPs spend setting up the Federal Government’s $467 million e-health record system.
Yesterday saw the release of the government’s final blueprint, detailing how the records will work, the clinical information they will hold, the extent of a patient’s control over their content and the role of the GP.
GPs will be expected to become the so-called “curators” of patients’ shared health summaries, the part of the e-health record that will list diagnoses, medications, allergies and basic biographical details.
But Federal Health Minister Nicola Roxon, when asked by reporters if there would be special Medicare rebates for setting up the records, said: “No. Look, we are not contemplating that there will be a special rebate. I’m sure that over time there’ll be all sorts of different options and requests and they will be considered as they come.
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Issues still to be resolved on e-health records program

THE revised concept of operations for the Gillard government's $500 million e-health records program fleshes out some details but many of the ticklish issues around funding, governance and medico liability remain "out of scope".
Consultations threw up concerns that as yet, there are no arrangements for long-term management of the personally controlled e-health record (PCEHR) program and related services, that there is no ongoing funding beyond its July 1 startup date, and that there is no money on the table to compensate doctors for the creation and maintenance of uploaded patient information.
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Govt releases e-health plan for July 2012

Australians are a step closer to accessing their medical records from July 2012 after the government issued the blueprint for national electronic health records.
The government released the concept of operations for the personally controlled electronic health record (PCEHR) system on Monday.
Health and Ageing Minister Nicola Roxon said the plan would help build the core parts of the system in the move from paper-based records to secure e-health data.
"Ehealth will help us provide better care, save lives and save money," Ms Roxon said in a statement on Monday.
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Health System To Benefit From After Hours Video Conferencing

By Computer Daily News | Monday | 2011-09-12
The Federal Government has released a new blueprint for the deployment of its e-health project. The blueprint includes a timeline for the rollout of its e-health program, as well as development of personally controlled e-health records (PCEHR in Canberra-speak) and telehealth initiatives.
The Government has set out how it will meet 45 percent of efficient growth funding from July 2014, and 50 percent of efficient growth from July 2017 at an initial cost of $467 million.
It plans to have the national infrastructure for the PCEHR in place in the first quarter of 2012, with further enabling legislation ideally set to pass in March or April.
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Roxon strips final veil from ConOps

Five months to the day after releasing its draft concept of operations (ConOps) document regarding the use of personally controlled electronic health records (PCEHR), the Federal Government has unveiled the final version. The ConOps explains how the nation’s e-health system will be structured, how it will work, and what security and privacy principles will be embraced.
According to the minister for health and ageing Nicola Roxon; “The Concept of Operations will be used by our infrastructure partners to build the system to allow all Australians to sign up from July next year.” Despite multiple concerns raised during the consultation phase the regime remains opt-in, meaning that only those Australians that want a PCEHR will get one.
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Health allows for access to patient records in emergencies

Healthcare providers get unlimited "break-glass" access to patient records.

Healthcare providers will have access to all clinical documents and records in an emergency situation under a revised concept of operations released by the Department of Health and Ageing today.
The "no access" provision was proposed in the draft document in May as one of three document security levels that allowed users to fine-tune access to their personally controlled electronic health record, due to be available from July 1 next year.
It came in addition to the "general access" and "limited access" levels, the latter of which restricted access to some documents for nominated healthcare providers.
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E-health gets last-minute access change

By Michael Lee, ZDNet.com.au on September 12th, 2011
The Australian Government has finalised its plans for its personally-controlled electronic health record (PCEHR) system with the release of a final Concept of Operations report, which contains significant alterations to how the proposed system will work, including a change in how health providers will be able to access medical information.
The final plans (PDF) for the health record system, which is expected to be made available to the general public in July next year, were released by the Minister for Health and Ageing, Nicola Roxon, today.
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E-health uptake will be gradual: Roxon

Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for individual electronic health records
  • AAP (AAP)
  • 13 September, 2011 08:27
Federal health minister, Nicola Roxon, has hit back at critics of the "opt-in" system for setting up individual electronic health records, saying people shouldn't have to make the switch before they are ready.
Every Australian has been assigned a 16-digit identification number but they won't automatically get an e-health record when the system starts in mid-2012.
Instead, they'll have to choose to participate.
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Southern Health rolls out iPads, BYOT, wireless network

Plans to expand wireless in the works
The rollout of iPads, a 'bring your own' technology (BYOT) policy and the trial of an internal wireless network have given Southern Health staff members greater access to patient information while on the move.
Southern Health CIO, Dr Philip Nesci, said that the largest public service provider in Victoria began to trial wireless internet at Casey Hospital earlier this year.
“We decided to go fully wireless in Casey Hospital, basically as a pilot to really understand not just wireless but technologies and the impact they can have on personal care,” he said.
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Online mental health services a step closer

A committee of mental health professionals, social media experts and carers has been appointed to oversee rollout of new services.
Access to online mental health services is a step closer after the federal government appointed a committee to oversee their rollout.
The committee comprises a mix of mental health professionals, social media experts and consumer and carer representatives.
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Electronic register could cut drug abuse

SOFTWARE under trial that warns pharmacists not to dispense addictive medication to drug addicts if they have been given such medication just days before could bring addictions under control if introduced.
West Australian Coroner Alastair Hope earlier this week called for a central register to monitor the sale and use of the addictive medicines after a 40-year-old mother of seven died from an overdose of methadone while being treated for an addiction to prescription drugs.
The Pharmacy Guild of Australia says it is working with the government on a real-time recording system that captures data on the dispensing of controlled Schedule 8 drugs such as codeine, methadone, oxycodone and pethidine.
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Doctors back push for drugs register

COLLEEN EGAN and ANDREW TILLETT, The West Australian September 14, 2011, 5:14 am
Doctors need a live computer database system if they are to keep up with trends in the black market prescription drug trade, according to the Australian Medical Association.
AMA WA president Dave Mountain said yesterday there was "a significant number" of people who made a living from visiting GPs and pharmacists for pills which they then sold for $30 to $50 each.
Dr Mountain said painkiller oxycodone and sedative Stilnox were "flavour of the month" in Perth because they had a reputation as party drugs, often when mixed with alcohol and other substances.
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Cochlear facing six-year low in earnings

COCHLEAR'S voluntary global recall of its unimplanted Nucleus 5 hearing device could see the company post its weakest full-year earnings in six years as sales decline.
The world's largest hearing implant maker began the recall on Monday after an increase in the number of failures, and has ceased manufacturing the unit while it investigates the cause of the "shut down", which it says does not injure users.
While Cochlear plans to increase production of the device's predecessor, the Nucleus Freedom, the company could not forecast the financial impact of its first major product recall or how long it would take for the device to re-enter the market.
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Kevin Rudd guru Joshua Gans slams NBN monopoly as deal 'will harm consumers'

KEY planks of the National Broadband Network business case are anti-competitive and will send Australia backwards, one of Kevin Rudd's "best and brightest" economic brains has warned.
In a blistering critique, economist Joshua Gans, who in 2008 was hand-picked to attend the then prime minister's 2020 summit to discuss productivity, has criticised plans to subsidise the rural NBN rollout through the prices that urban consumers pay.
The promise to put a cross-subsidy in place so that regional areas pay the same access prices for the NBN as people in the city was a key promise to the regional independents Tony Windsor and Rob Oakeshott that helped Labor form a second-term government.
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Aging population could benefit most from NBN

Digital business partner says technology can improve quality of life for aged care residents
The opportunity to help Australia's aging population with relevant technology must be taken account for in the rollout of the National Broadband Network (NBN), a KPMG digital business national managing partner has argued.
Speaking at an Enterprise Ireland trade mission in Sydney, Malcolm Alder, said that aged healthcare was a "burning issue" and the infrastructure provided by the NBN would deliver technological advances that could help aged care.
Alder shared the findings of an e-health pilot that he was involved with at a rest home in Foster, NSW, this year.
"The staff had been there 15 to 20 years and were not overly computer illiterate," he said "The thought that a whole bunch of [e-health] technology was going to descend on them was scary."
However, when the staff discovered that the technology was going to make their life easier and the quality of the residents that they were caring for better, their attitude changed, he said.
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Uncertain future for AGPN and SBOs

AGPN board members are to become the founder members of a new Medicare Local National Body, but a question mark remains over the future role  - if any - of the AGPN and GP division state-based organisations (SBOs).
A communiqué (link) from the AGPN Board says health minister Nicola Roxon has made it clear that SBOs will not continue in their current form when the Medicare Local National Body is formed
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Diagnosis? Elementary, with help from ‘Watson’

15th Sep 2011 Mark O’Brien
THE IBM supercomputer most famous for beating two former champions of American game show Jeopardy! earlier this year will soon be helping US physicians identify treatment options, under an agreement announced last week.
US healthcare company WellPoint has signed a deal for the first commercial applications for the IBM ‘Watson’ technology, which was designed to rival a human’s ability to answer questions posed in natural language.
The system can sift through an equivalent of about one million books or roughly 200 million pages of data, analyse the information and provide precise responses in less than three seconds.
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Objective-C, C#, D language: Winners in programming popularity

Java remains the longtime top-ranked language in the Tiobe Programming Community index
Objective-C, used for developing Apple iOS applications, climbs to No. 6 in the monthly Tiobe Programming Community index for most popular programming languages, after being ranked at number 8 a year ago. Also posting gains, C# rose to No. 4, a jump of two spots a year ago, while PHP dropped from No. 4 at this time last year to No. 5.
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Why be a pirate? Use open source software instead

Business decision-makers who get their proprietary software illegally need to wake up and check out the free alternatives.
Close to half of all computer users around the world tend to get their software illegally, and business decision-makers are no exception.
That's one finding from a recent survey commissioned by the Business Software Alliance (BSA) lobby group, which reported the results in a blog post last week.
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Enjoy!
David.

Minister Roxon Talks About the PCEHR on The Health Report This Morning.


You will be able to hear the conversation which is mostly about the PCEHR from this link later today.
The Minister for Health and Ageing, Nicola Roxon, talks about Australia's position at the United Nation's meeting on non-communicable diseases, which starts today.
The conversation is 1 minute about the advertised topic and 3-4 minutes about the PCEHR.
David.

Sunday, September 18, 2011

The Health Minister is Playing A Very Risky Game With the PCEHR. She Needs To Change Tack or She Will Fail!


On Friday we had an intervention in the PCEHR conversation by the Health Minister.

Pulling E-Health Together, Not Tearing it Apart

Article by Minister for Health and Ageing Nicola Roxon and published on 6 Minutes.
16 September 2011
The following article by Minister for Health and Ageing Nicola Roxon was published on 6 Minutes.
This week we took eHealth to the Federal Parliament, demonstrating to politicians how records will make a real difference to patient care in the hospitals, GP surgeries and pharmacies in their electorates.
The same demonstration will soon travel to different parts of the country, helping clinicians, consumers and others in the health system understand how connecting the patient journey will make a real difference.
What we were able to show to politicians is that this is not a technology system – it is a health system. It will improve care for patients, reduce medication errors and avoid unnecessary tests.
The display also demonstrates how eHealth is real, and no longer a vague plan for the future. We now have over a million healthcare identifiers downloaded to be used, lead implementation sites underway, secure messaging being used and patient consultations being undertaken through videoconferencing.
And from next July, Australians will be able to register for an eHealth record.
Yesterday we released the finalised plans for the service which will be built by our infrastructure partners. These were released following long and detailed consultation with clinicians, health consumers and ICT industry professionals across the country.
Now that we’re getting on with the job, it is important that people who want eHealth to be delivered get behind the program. I am buoyed by the enthusiasm that there is for eHealth across the spectrum of professional groups and the community.
Over the past decade of inaction it was easy for everyone to agree – because since nothing was being done, no decisions had to be made.
But now that the Gillard Government is actually getting on with the job – it creates the environment in which differing interest groups want to get their hands on the steering wheel. That’s obviously impossible.
For instance, we’ve seen the AMA saying we’re not listening to doctors. This couldn’t be further from the truth. They should try telling that to the College of GPs that has endorsed the plan, the leaders of the program include former Presidents of the AMA and RACGP, and the over 50 clinical leads that are closely engaged in the program.
The truth is that while the AMA haven’t won every single discussion about how the records will work, we agree on most of the design of the system. We’ll never be able to agree on every single detail because the Government has to take all the right advice and make decisions that are in the overall interest of the community and patients, not one professional group.
What the AMA needs to consider is whether they will be a partner to deliver eHealth, or whether they will act in opposition and miss this once in a generation opportunity.
By working for the collective good, everyone can help us deliver a solution to benefit patients and clinicians. The alternative option is to try and tear apart consensus on this program and leave a legacy of mountains of paper in hospitals and GP surgeries – unconnected and stuck in a luddite time warp.
It would be a waste to miss this opportunity to transform our health system.
For our part, we will continue to push ahead with this program in a way that engages our hard working clinicians, but unapologetically also making sure that this is a system that has patients at its heart.
The press release is found here:
The original publication in 6minutes.com.au is found here:
There was a report of the intervention here:

Minister urges AMA not to reject PCEHR

Health minister Nicola Roxon has rejected AMA claims that the government has failed to listen to doctors in the design and implementation of the PCEHR.
In an opinion article in today’s 6minutes, the minister says compromise is essential in a project that involves so many different groups, and she urges the AMA to come on board as a partner rather than “tear apart consensus” and leave medical records in a Luddite time warp.
.....
The Rural Doctors Association of Australia also said it supported the PCEHR program but was disappointed that no special rebate will be paid to doctors.
“Many rural doctors are already working long hours and struggle to keep their practices economically viable. Given this, they may be reluctant to participate in the PCEHR system without appropriate incentives for the time they will have to spend creating and updating the electronic records,” said RDAA president Dr Nola Maxfield.
This article is found here:
Miss Roxon was presumably reacting to this release from the AMA.

Medical advice missing from e-health records plan

AMA President, Dr Steve Hambleton, said today that the AMA was disappointed that the Government has failed to heed medical advice in finalising its Concept of Operations for the personally controlled electronic health record (PCEHR).
Dr Hambleton said the proposals could ‘de-medicalise’ electronic patient health information.
“Little has changed from the draft plan despite the sound advice provided by many medical groups, including the AMA, about what should be included on a patient’s health record.
“The Government has caved in to minority consumer groups.
“Under the proposed arrangements, people will be able to alter their health record without consultation with their doctor.
“Patients could entirely remove from their record clinical documents that they had previously considered worth sharing with healthcare providers.
“This is a very dangerous precedent that could undermine all the potential benefits of an electronic health record.”
Dr Hambleton said that the AMA would prefer the system to be opt-out, not opt-in.
“The opt-in system has resulted in incredibly complex rules for patients to give their doctors access to their PCEHR,” Dr Hambleton said.
“And there are still concerns around medico-legal liability associated with the electronic health record.
“The AMA is a huge supporter of e-health and the benefits it can bring to the health system, but we cannot support aspects of the system that do not improve on what we have now and which potentially create risks to patient health.
“We will have a system that doctors and other health practitioners are keen to embrace but won’t be able to because their patients haven't yet given them access to their records.
“Australia has the opportunity to be a world leader in electronic health but it won’t happen with the very complex health record announced today,” Dr Hambleton said.
The release is here:
We have also had the Rural Doctors Association of Australia react.

Patient controlled e-health records: Better support needed to ensure rural uptake

The Rural Doctors Association of Australia (RDAA) has warned that rural practices will need adequate support to ensure the success of a Patient Controlled Electronic Health Records (PCEHR) system in the bush.
RDAA was responding to comments made this week by the Federal Health Minister, Nicola Roxon, that at this stage no special rebate will be paid to doctors to cover their time in creating health summaries for PCEHRs.
RDAA wrote to the Minister earlier this month advising that, without such a rebate, many rural practices will find it difficult to meet the challenges associated with implementing a PCEHR system.
“RDAA supports the PCEHR as a means of making important patient information available to doctors working in different locations and with different systems” acting RDAA President, Dr Nola Maxfield, said.
“This is particularly relevant for rural patients who are most likely to be transferred away from their local community in the event of a medical emergency or serious illness.
“However, we have a number of concerns about the likely uptake of the PCEHR system in rural and remote areas.
“Many rural doctors are already working long hours and struggle to keep their practices economically viable. Given this, they may be reluctant to participate in the PCEHR system without appropriate incentives for the time they will have to spend creating and updating the electronic records.
Full release is here:
In the presence of this response I find two sections from the Minister very worrying:
First:
“For instance, we’ve seen the AMA saying we’re not listening to doctors. This couldn’t be further from the truth. They should try telling that to the College of GPs that has endorsed the plan, the leaders of the program include former Presidents of the AMA and RACGP, and the over 50 clinical leads that are closely engaged in the program.
The truth is that while the AMA haven’t won every single discussion about how the records will work, we agree on most of the design of the system. We’ll never be able to agree on every single detail because the Government has to take all the right advice and make decisions that are in the overall interest of the community and patients, not one professional group.”
The Minister is assuming here she can undertake the implementation of the PCEHR without at least tacit support from the AMA and the RDAA. She clearly does not have that support at present and she surely can’t imagine she is on a winner without such support. What is happening here is she is trying to ‘verbal’ the AMA etc. to support a plan they know is flawed. That is a looser of an approach if I have ever seen one!
“What the AMA needs to consider is whether they will be a partner to deliver eHealth, or whether they will act in opposition and miss this once in a generation opportunity.
By working for the collective good, everyone can help us deliver a solution to benefit patients and clinicians. The alternative option is to try and tear apart consensus on this program and leave a legacy of mountains of paper in hospitals and GP surgeries – unconnected and stuck in a luddite time warp.
It would be a waste to miss this opportunity to transform our health system.
For our part, we will continue to push ahead with this program in a way that engages our hard working clinicians, but unapologetically also making sure that this is a system that has patients at its heart.”
What the Minister should be considering here is that the PCEHR she has been advised to try and implement is by no means the best approach to this mythical ‘e-health’ she is conceptualising at a remarkably simplistic level.
I am perfectly sure both the AMA and the RDAA would be thrilled to work with Government in implementing a practical workable e-Health Strategy and but sadly the present ConOps is just not it!
The bottom line is that the RACGP thinks the PCEHR needs some work according to their most recent release:
See here:
 “Dr Bennett pointed out however, that some aspects of the plan still needed to be worked out.
“As highlighted in previous College submissions, we would have preferred to have a default option of the patient’s usual GP being the nominated healthcare provider. However, the College acknowledges that in some very remote areas without full-time general practice services, this role is best filled by a healthcare provider other than a GP.
The RACGP is also concerned that the current plan doesn’t offer any incentives for GPs and urges the Government to consider how this additional effort will be acknowledged.
“We would like to see amendments to the Medicare Benefits Schedule to recognise the additional workload GPs will undertake in consultations initiating and maintaining the patient’s shared health summary and other elements of the PCEHR,” Dr Bennett said.”
Full release here:
- and the AMA and the RDAA are pretty convinced it is not a goer in its present form.
Sorry Minister you have a lemon here of the same sort as a number of other Labor plans.
I hope your advisers are brave enough to tell you that without medical profession support this will be a huge unused white elephant!
David.

Saturday, September 17, 2011

Weekly Overseas Health IT Links - 17 September, 2011.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Data breaches cost organizations a staggering $156.7 billion over six years

06 September 2011

Data breaches cost organizations $156.7 billion over a six-year period, according to new data breach study by Digital Forensics Association.

The study presents data breach information collected from 2005 through 2010, including the disclosure of more than 800 million records over that period. The association said the overall data breach dollar figure did not include the costs that the organizations downstream or upstream incurred, or the losses sustained by the data breach victims. Further, the report, The Leaking Vault 2011, said the data breach cost estimate was low because 35% of the incidents did not name a figure for records lost.
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S.F. experiment in improving patient health care

Monday, September 5, 2011
Researchers long ago established that certain medical procedures are performed at dramatically different rates from place to place, and that these disparities affect the quality and cost of health care.
Now, health insurers, hospitals and government agencies from the Bay Area to Washington, D.C., are getting more aggressive about tackling variation in medical care.
The issue will surface in San Francisco with a collaboration that started this summer among Blue Shield of California and some local hospitals and physicians, aimed at better coordination of patient care for about 26,000 public employees.
The partnership is modeled after a similar one in the Sacramento region whose early efforts to rein in variation resulted in training doctors in newer medical techniques and offering patients less-invasive treatment options.
In the case of weight-loss surgeries, procedures fell in one year by 13 percent.
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Spurring the market for high-tech home health care

A daunting array of financial and operational barriers is holding back growth. What can be done?

September 2011 • Basel Kayyali, Zeb Kimmel, and Steve van Kuiken
On the surface, technology-enabled home health care should be thriving in the United States. The country’s aging population and the transformation of acute illnesses such as heart failure into chronic diseases mean that the number of patients is growing. In addition, new medical-technology devices could help keep patients at home rather than in costly institutions, such as assisted-living facilities or nursing homes—leading to potentially big savings for the health care system.
Instead, the full potential of the technology-enabled home health care market remains to be tapped. In the United States, home care accounts for about 3 percent ($68 billion a year) of national health spending. The market is increasing by about 9 percent annually,1 solid but hardly booming growth, especially since labor (mainly nurses and aides) accounts for about two-thirds2 of the expenditure and home-monitoring technology represents a small fraction of it. What’s holding the market back? We observe a daunting array of financial and operational barriers, including the misalignment of incentives between payers and providers, the need to demonstrate a strong clinical value proposition, and the problem of designing attractive, easy-to-use products that facilitate adoption by patients.
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Telemonitoring Pilot Attacks Diabetes

Health information exchange's project aims to keep diabetic patients out of the ER; if it works, the technology could pay for itself.
By Ken Terry,  InformationWeek
September 08, 2011
As part of a larger project to reduce the burden of diabetes on patients in western New York, Buffalo-based health information exchange HealtheLink has launched a pilot to test the effect of telemonitoring on diabetics' health. A premise of the 18-month pilot is that telemonitoring will pay for itself by reducing the enrolled patients' emergency room and doctor visits.
While the evidence for that remains uncertain, the pilot is set up to measure clinical and claims data for the study group and compare it to data from a control group of similar patients, Todd Norris, western New York Beacon Project director for HealtheLink, told InformationWeek Healthcare. HealtheLink will make quarterly reports to the Office of the National Coordinator of Health IT (ONC), which is funding the study through its Beacon Communities program. The study will end March 31, 2013.
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Virtual Lifetime Electronic Record pilot expands to include more veterans

September 08, 2011 | Molly Merrill, Associate Editor
WASHINGTON – The pilot for the Virtual Lifetime Electronic Record (VLER), which enables sharing of Veterans' health records will be expanded, the Department of Veterans Affairs announced Thursday.
"The expansion of the VLER pilot program will allow more Veterans and facilities to participate in this exciting new technology," said Secretary of Veterans Affairs Eric K. Shinseki. "I invite Veterans to sign up for the program. It will keep health care providers informed, improve continuity and timeliness of care, and eliminate gaps in healthcare information."
VLER is a multi-faceted business and technology initiative that includes a portfolio of health, benefits, personnel and administrative information sharing capabilities. 
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HIE Vendor Market Poised For Shakeup

Among dozens of vendors selling technology products and services to health information exchanges, no clear player dominates, study says.
By Marianne Kolbasuk McGee,  InformationWeek
September 07, 2011
The health information exchange (HIE) vendor market is still very fragmented, with more than three dozen companies identified as providing IT products and services to these data sharing initiatives, according to a new report.
Of the 35 vendors HIEs named as product and services providers, no vendor has a majority foothold yet, according to a new report released by the eHealth Initiative, which recently surveyed 196 of the 255 HIEs currently operating in the United States. The HIEs surveyed ranged from state-run initiatives to community-based organizations, including for-profit and non-profit efforts.
Leading the pack is Axolotl, which provides products and services to 22 of the 196 (about 11%) surveyed HIEs. Axolotl was recently renamed OptumInsight, and is part of UnitedHealth Group's health IT services business. The next most prevalent HIE vendor is Medicity, being used in 14 initiatives, followed by a tie between Cerner and Mirth, with each providing products and services to nine HIEs.
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Making the Most of Meaningful Use

Health Data Management Magazine, 09/01/2011
On one level, the meaningful use electronic record incentive program is all about the money. Many providers, especially small practices, jumped head first into the program because the financial incentives made it possible to automate at little or no cost-if they got those incentive checks.
Take Springfield (Ohio) Center for Family Medicine, where all six physicians have attested to meaningful use, with four by mid-July having received $18,000 first-year checks from the Medicare incentive program, and the other two awaiting payment.
That money is already flowing downstream at the practice, which purchased a document management and imaging system along with workstations, all integrated with the electronic records and practice management systems of Horsham, Pa.-based NextGen Healthcare Information Systems, says Cindy Brewer, office manager. The EHR and the purchase of ancillary technology would not have been done without the incentive payments, she adds. "We've wanted to do it but didn't know when the finances were going to be there."
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ONC debuts new HealthIT.gov

Posted: September 8, 2011 - 12:00 pm ET
The Office of the National Coordinator for Health Information Technology on Thursday announced the launch of its new HealthIT.gov website targeting consumers as well as healthcare providers.
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SE Essex develops EPR for COPD patients

8 September 2011   Shanna Crispin
NHS South East Essex has created a shared electronic patient record across primary, secondary and community care for patients with COPD.
The primary care trust decided some years ago to develop an integrated primary care system strategy.
This involved moving the majority of its GP practices onto the hosted SystmOne GP, and deploying SystmOne systems into its community services and prison.  
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EMRs go mobile: Not to be ignored

September 6, 2011 — 5:38pm ET | By Dan Bowman
Although accessibility of electronic medical records (EMR) on tablet devices is nothing new (we've been reporting on such capabilities as far back as April 2010), that doesn't make recent announcements from drchrono, Epocrates, GE, Greenway Medical Technologies and SAP about their mobile EMR offerings any less important. Rather, it reaffirms the notion that mobility in healthcare is king, something all current and future EMR vendors would be wise to take note of.
The users, doctors and other medical professionals, are flocking to the iPad and devices like it in droves. In May, Manhattan Research concluded that 75 percent of U.S. physicians owned an Apple mobile device in one form or another.
More recently, the medical schools at Ivy League heavyweights Harvard and Yale each announced its own mobility news. Harvard is creating a set of apps specifically for med students, and Yale has handed out 520 iPads to its students.
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Cloud-based EMRs offer improved data security

September 6, 2011 — 5:33pm ET | By Marla Durben Hirsch - Contributing Editor
Cloud-based electronic medical record systems may not be as vulnerable to security breaches as once thought, as more vendors begin to offer these systems as an option and information is made available about how they operate.
There has been some industry concern, if a Physicians Practice blog post is any indication, that cloud-based EMR systems, which operate on the web rather than on site at a provider, were more vulnerable to cyber attacks and other security risks. But that's not necessarily true, according to Sheldon Needle, president of CTSGuides, a software screening and referral service. Needle recently posted on his own blog, comparing the two types of systems.
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Thursday, September 8, 2011

Internet VCs Circle Health Care

Silicon Valley investors helped reinvent everything from sharing photos to buying books online. Now can they fix health care?
Some prominent venture capitalists are betting that the Internet strategies that created giants such as eBay and PayPal could reshape the ailing U.S. health-care system. That system currently devours 18 percent of the world's largest GDP while delivering mediocre health results.
In August, the online health marketplace ZocDoc, which lets patients look up doctors by specialty and zip code and make appointments over the Internet, raised $50 million from the investment fund of Russian billionaire Yuri Milner, who in the past has backed companies like Facebook, Twitter, and Groupon.
The idea behind ZocDoc and other startups getting funding is that our costly, paper-based health-care system is ripe for the same technological fixes—such as data visualization, cloud computing, and mass-market self-service concepts—that have transformed industries such as consumer banking and travel.
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NYC Program Shows EHRs Can Boost Preventive Care

Program led by Farzad Mostashari, before he became national health IT coordinator, supports entering structured data into an EHR to monitor a population's health.
By Ken Terry,  InformationWeek
September 06, 2011
In a New York City program that subsidized doctors' electronic health records (EHRs) in return for sharing quality data with the city, physicians showed significant improvements on eight of 10 preventive care indicators, according to a new study in the Journal of the American Medical Informatics Association (JAMIA).
The findings provide some perspectives on the federal government's Meaningful Use program, which requires attestation-of-quality data this year and electronic reporting in 2012. Not coincidently, the national coordinator of health IT, Farzad Mostashari, MD, who has responsibility for implementing the federal incentive program, led the team that created the New York EHR program when he was assistant commissioner of the city's department of health and mental hygiene.
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Hurricane Irene Sparks Talk Of HIT Disaster Strategy

Health IT managers are looking at the damage done and reassessing their disaster planning strategies.
By Nicole Lewis,  InformationWeek
September 06, 2011
Like other natural disasters before it, Hurricane Irene disrupted hospital services in the Northeast, causing hospital IT officials to once again mull their disaster preparedness strategies.
Several recent reports in the aftermath of Irene show how damaging hurricanes can be to hospital systems. At Johnson Memorial Medical Center in Stafford Springs, Conn., 43 patients were relocated to other medical facilities when the hospital lost power and utility workers were prevented from fixing the problem because of the approaching storm.
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More than 30,000 health-records breaches since 2009: HHS

Posted: September 7, 2011 - 12:01 am ET
The medical records of about 7.9 million people have been exposed in more than 30,750 healthcare-related security breaches since breach notification requirements took effect two years ago, according to a report by the HHS secretary and the Office for Civil Rights at HHS.
The vast majority of the breaches—more than 30,500 of them—were relatively small-scale mishaps that involved fewer than 500 records each and collectively accounted for the unauthorized disclosure of the records of roughly 62,000 individuals, according to the report to Congress (PDF).
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ONC Tackling Population Data Query Issues

HDM Breaking News, September 7, 2011
The Office of the National Coordinator for Health Information Technology has launched Query Health, an initiative to establish standards for querying widely distributed data sources such as electronic health records.
Three workgroups, with membership being solicited, will cover business, clinical, and technical implementation issues. The business work group will handle privacy, security, consent, sustainability, data use arrangements and best practices. The clinical work group will develop use cases, functional requirements, and standards for an information model, query syntax and results expression. The technical workgroup is responsible for implementation of Query Health and support of pilot projects.
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ONC launches Query Health data-sharing program

Posted: September 8, 2011 - 12:00 pm ET
The Office of the National Coordinator for Health Information Technology formally introduced its Query Health data-sharing program. The program is part of its standards and interoperability framework—an initiative to promote health information exchange.
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CONNECT issues latest iteration of open source HIE software

September 06, 2011 | Tom Sullivan, Editor
Health information exchanges running the CONNECT platform take note: The CONNECT team has issued a new version, 3.2.1, which fixes a number of bugs and known issues.
The open source software taps National Health Information Exchange (NwHIN) standards and protocols to enable the creation of an HIE and the exchanging of healthcare information, both regionally and on a national level.
Connect 3.2.1 corrects known problems, and the latest iteration can correlate multiple responses for patient discovery, defer patient discover requests and make policy checks inside the gateway and refactor deferred services implementation.
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Health Care IT Departments Must Adopt Mobile Strategies: CSC

2011-09-02
As physicians use mobile devices in large numbers, IT departments at health care organizations need a strategy to support them, according to a new CSC report.
CSC, an IT integrator and cloud-service provider, has released a new report suggesting that health care IT departments should act fast to support the mobile devices that physicians are using.
Doctors are adopting smartphones at more than twice the rate of the general population, according to CSC's report, called "Harnessing the Value of mHealth for Your Organization." More than 17,000 health care apps are available for smartphones, the company said.
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KLAS Finds Enterprise Players Making Oncology Inroads

Posted by Anthony Guerra on September 6th, 2011
Looking for greater integration with other core clinical applications, providers have invited enterprise HIT vendors to enter the Oncology arena, according to a new KLAS report Oncology IS 2011: Integrating the Island.
The specialty is one fraught with information silos, due to physicians moving between hospitals and clinics, and patients moving between infusion suites and radiation oncology facilities.
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Wednesday, September 7, 2011

E-Medicine's Perfect Storm

A look, in numbers, at the forces shaping electronic medicine.
A recent video that appeared on YouTube.com asked:  What if air travel worked like health care?
The hilarious answer (here) shows an imaginary traveler attempting to book a flight to Eugene, Oregon on Air Health Care.  Frustration mounts as he's instead offered a flight to Chicago for $17,885, but only if he first faxes in his "complete flight history."
There are plenty of reasons that health care isn't as automated as airline reservations or check processing. Each person's health situation is, if not unique, immensely personal. Would anyone want to book radiation treatment on a medical Orbitz?
Even so, automating the collection and processing of medical information is an huge opportunity for hospitals and software companies. The U.S. medical establishment has yet to universalize even simple look-ups, such as what drugs a patient is taking, and has only begun to harness such phenomena as cell-phone apps and Web 2.0 trends like crowd sourcing to improve health care.
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Healthcare is IT's new frontier in Asia

o AvantiKumar
07.09.2011 kl 00:14 | MIS Asia
The adoption of information technology (IT) in the healthcare industry is speeding up, driven in part by cloud computing, according to Asia-based healthcare IT solutions provider iSOFT Health Asia.
The adoption of information technology (IT) in the healthcare industry is speeding up, driven in part by cloud computing, according to Asia-based healthcare IT solutions provider iSOFT Health Asia.
iSOFT Health Asia general manager Dr Timothy Nam said the healthcare industry has been slower than other sectors in adopting IT solutions. "Having to manage, as well as maintain, healthcare's legacy systems and upkeep its traditional best practices, many called the health sector extremely backward. In fact, quite a number of observers have declared it as being 20 years behind the banking sector."
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Q&A: Between the lines of NEJM EHR report - 'Trust trumps technology' for EHR success, authors say

September 01, 2011 | Tom Sullivan, Editor
Distinguishing itself from previous efforts to prove the viability of EHRs and meaningful use, a study published Wednesday in the New England Journal of Medicine shed light on just what can be accomplished by using electronic medical records rather than paper records.
The finding: A survey of 27,000 adult diabetics spanning 500 primary care physicians across 46 practices in the Cleveland area found that those practices employing EHRs earned “annual improvements in healthcare that were 10 percent greater than their paper-based counterparts,” and their patients were “significantly more likely to have healthcare and outcomes that align with accepted standards than those where doctors rely on paper records.”
Government Health IT Editor Tom Sullivan interviewed two of the study’s authors – Randall Cebul, director of the Center for Healthcare Research and Policy at MetroHealth Medical Center and a professor of medicine, epidemiology and biostatistics at Case Western Reserve University; and Anil Jain, senior executive IT director at the Cleveland Clinic while the study was being conducted, and now CMIO at Cleveland Clinic spin-off Explorys – about the gap in care quality between patients attending practices using EHRs and those still in the paper- and filing-cabinet era, the competitive nature of providers sharing patient data, and bridging the chasm between EHRs and PHRs.
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Mayo: Social media useful to recruit patients for clinical research

August 30, 2011 — 4:09pm ET | By Ken Terry
The use of social media and online networking promises to be important both in clinical trial recruitment and in clinical discovery. Down the line, it might even prove valuable in comparative effectiveness research.
A new Mayo Clinic study shows that social media can help researchers find patients with rare diseases who are candidates for clinical trials more quickly than conventional methods of recruitment. 
Using patient-run websites dedicated to heart conditions and women's heart health, a team of cardiologists led by Sharonne Hayes, MD, is reaching out to survivors of spontaneous coronary artery dissection (SCAD), a condition that affects only a few thousand people a year, but can be fatal if it leads to a heart attack. 
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Cloud-based service streamlines quicker image sharing for hospital

September 1, 2011 — 7:48pm ET | By Ken Terry
Montefiore Medical Center in the Bronx, N.Y., has begun using a cloud-based service to share medical images among multiple physicians without entering them into the healthcare system's picture archiving and communication system (PACS), according to an article in InformationWeek.
These are images that the Montefiore specialists use in their review of referrals before they accept patients for treatment. The images, which may arrive on disc or film, have not been entered into the PACS. In case more than one physician has to view the images, the other doctors can pull them down from the cloud rather than waiting for the physical media to be delivered.
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Verizon health ID management expands to cover EHRs, HIEs

September 1, 2011 — 5:54pm ET | By Ken Terry
Verizon is expanding its cloud-based identity-management services for healthcare providers. Verizon Universal Identify Services-Healthcare, founded in November 2010, now supports new identity standards for accessing electronic health records and health information exchanges. In addition, it offers new features for electronic prescribing, including the prescribing of controlled substances.
Verizon now provides legally binding digital signature capabilities for authenticating signatures on clinical documents. The company's new ID Message Center allows users to monitor their digital signature activities through a mobile application or optional Web-based portal. Providers can use their smartphones or other mobile devices to gain access to Verizon's identity management features.
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Why Halamka's health IT predictions might overestimate the future

September 5, 2011 — 4:46pm ET | By Ken Terry
John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston and a professor of medicine at Harvard Medical School, is one of the most respected opinion leaders in health IT. He's also one of the smartest people I know. Yet his new piece in the MIT Technology Review, predicting where health IT will take us in the next five years, is too optimistic by half.
I don't dispute Halamka's contention that the pace of electronic health record adoption will accelerate dramatically, partly because of the federal government's incentive program. Nor do I disagree with his argument that health IT will be essential to transforming the provider payment system in ways that can control cost growth.
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EMIS: 'lessons learned' from crash

1 September 2011   Fiona Barr
The outage at the EMIS data centre was “a very rare occurrence” caused by a number of complex, interacting factors that are unlikely to be repeated, the company has said.
In a statement issued first to EHI Primary Care, Sean Riddell, the chief executive of EMIS, said the investigation into the outage on 18 August - which affected almost 800 GP practices - has now been concluded.
He added: “This shows that the outage was the result of a number of complex, interacting factors- it was, in effect, a very rare occurrence that could not have been predicted.
“At its core was a series of multiple, consecutive component failures in one of our storage devices – combined with a previously unknown bug in the hard disk firmware – that culminated in an unexpected shutdown of the entire device.”
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Tech That Powers Quality Standards

Gienna Shaw, for HealthLeaders Media , September 6, 2011

A study published in the New England Journal of Medicine is among the first to put hard numbers on the benefits of electronic health records.
Researchers looked at four national quality standards, including:
  1. eye exams,
  2. pneumonia vaccinations,
  3. outcome measures such as blood sugar, blood pressure, and cholesterol control,
  4. patient-driven issues such as obesity and smoking
Nearly 51% of patients in EHR practices received care that met all four quality standards, compared to just 7% of patients at paper-based practices. Nearly 44% of patients in EHR practices met at least four of five outcome standards, compared to about 16% of patients at paper-based practices.
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Tuesday, September 06, 2011

Jury Still Out on Health IT Workforce Training Programs

With health care providers working to implement electronic health records to qualify for meaningful use incentive payments and vendors seeing big spikes in business, it is not surprising that there is a huge demand for health IT professionals. What is surprising, though, are reports from recent graduates of federal health IT training programs who say they can't find a job.
It's been estimated that the country will need up to 50,000 health IT professionals to help doctors and hospitals meet meaningful use criteria.
With the U.S. unemployment rate hovering around 9%, health IT is seen as an area ripe for job creation. The federal government has invested millions of dollars in developing a skilled health IT workforce, and interest in federal health IT training programs has been high.
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Tuesday, September 6, 2011

A Federal Jump-start for Health IT

White House aide leads push to improve health-care IT with billions in stimulus funds.
In a landmark government effort to drive American health care into the information age, the February 2009 stimulus bill earmarked about $30 billion in incentives for doctors and hospitals who install electronic medical records—paying up to $63,750 to individual physician and millions to hospitals.
Now comes the tough part: implementing "EMRs" and proving they really can reduce medical errors or get doctors to keep better track of chronically ill people. As National Coordinator for Health IT, Farzad Mostashari coordinates federal efforts to promote adoption of EMRs and to prod reluctant hospitals to share patient data.
Mostashari was recruited to take over the federal effort in February, after leading a patient-records initiative as an assistant health commissioner in New York City. He spoke with Technology Review's chief correspondent, David Talbot, about when we'll start seeing evidence that the technology is working.
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Mobile staff 'save £3k each per year'

1 September 2011   Fiona Barr
Mobile working by community staff could save £3,000 per clinician per year, the Department of Health’s National Mobile Health Worker project has concluded.
A 254-page report says clinicians working across the 11 sites in the project estimated that mobile devices loaded with office and clinical software allowed them to make nearly 9% fewer referrals and avoid 21% of admissions.
Using standardised costs developed by Kent University, the project estimated this would equate to a saving of £3,002 per clinician per year.
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  • Martin Regg Cohn
  • Fri Sep 02 2011

eHealth fiasco has a deep and wasteful history

The provincial election is about to begin, but the campaign against eHealth Ontario is already two years old — and still going strong.
EHealth is the gift that keeps on giving, the kiss of death in a field that is supposed to save lives. Brace yourself, in the weeks leading up to the Oct. 6 vote, for yet more reruns of the “billion-dollar-boondoggle” attack line.
Toronto Mayor Rob Ford used that catchphrase to devastating effect against his opponent in the city’s mayoral election — former provincial health minister George Smitherman, who carried much of the baggage for the eHealth fiasco. But like that other Ford slogan — “ending the gravy train at city hall” — the billion-dollar-boondoggle allegation doesn’t quite add up.

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Enjoy!
David.