This Is A Very Interesting Summary of Public Attitudes on EHR Security in The UK and US. I Suspect Australians Would Be Pretty Similar.

The following appeared a few days ago:

U.K. patients demand higher security for medical records

November 03, 2011 | Jamie Thompson, Web Editor

A recent survey, released by FairWarning, Inc., details the overwhelming demand for tighter protections against data theft of medical records. The poll of more than 1,000 individuals reveals that U.K. patients think hospital executives should be held accountable for breaches of protected health information.

Patients concerned that their medical and personal information could be stolen want the NHS to take firm steps to ensure effective monitoring and enforcement of privacy regulations, and that access to their medical records is strictly controlled.

Major findings from the survey include:

• 87.1 percent of respondents think chief executives should be fired or fined if they were aware of threats to protected health information but failed to act and a serious breach occurred
• 73.3 percent think better enforcement of regulations would decrease breaches
• 62.1 percent approve of a national league table that shows the best and worst hospitals for data security
• 86.5 percent think a serious breach of medical information would cause damage to a hospital’s reputation
• 87.2 percent think the NHS should monitor who uses their files

More than 50 percent of respondents said they have or would withhold information about a sensitive personal medical matter from a healthcare provider with a poor record of protecting patient privacy. Nearly half of respondents went even further to say that they have or would put off seeking treatment if a hospital had a poor reputation for security.

More here:

http://www.healthcareitnews.com/news/uk-patients-demand-higher-security-medical-records

This seemed so interesting I thought it was worth going to the source:

Nationwide Survey Reveals Demand by Patients for Medical Record Privacy Guarantees Against Security Breaches

Report details that patients postpone seeking treatment out of confidentiality concerns

London, UK – 13th October 2011 – FairWarning Inc – the inventor and world’s leading supplier of cross-platform healthcare privacy auditing solutions for electronic health records (EHRs) - today released the findings of a major survey which reveals overwhelming demand for patients’ medical records to be guaranteed against data theft and snooping. The independent poll of 1,001 respondents showed that patients believe that hospital chief executives and top managers should be held accountable for healthcare privacy protections and breaches.

The survey also revealed that confidentiality concerns could have a direct impact on people’s health. Nearly four in 10 said they have, or would, put off seeking treatment, and well over half, have or would withhold information from clinicians, if a hospital had a poor reputation for security. Many respondents stated that they would travel substantial distances (37% would go 30 miles or more) to avoid being treated at a hospital they did not trust, in order to keep sensitive information confidential.

Kurt Long, founder and CEO of FairWarning®, said: “Modern patient care is very much information-based. Any obstacle to the free flow of information between care providers and patients, such as those caused by privacy concerns, can prevent patients from receiving the best possible care. Patients across the UK have enormous faith in the NHS, but this survey reveals that more needs to be done for medical information to be shared and exchanged securely, and so to ensure the best patient outcomes.”

The survey showed that patients are worried that sensitive medical and personal information could be stolen and used by criminals for theft or fraud, or disclosed to employers or family – with serious consequences for their careers or relationships.

Most of those taking part in the poll had high demands of what the NHS should deliver in terms of confidentiality, wanting effective monitoring and firm enforcement of regulations. They also revealed that leaks and theft of personal data could do huge damage to the reputation of the health service. A large majority wanted access to their records to be strictly controlled and want to see strong deterrents to prevent further breaches.

The main findings of the survey included that:

·         87.1% agree that chief executives and senior management should be sacked or fined if they were aware of risks but failed to act and there is a serious breach. Only 1.3% disagree.

·         73.3% felt that better enforcement of rules and regulations would cut security breaches.

·         62.1% approve of having national league tables to show the best and worst hospitals for data security – only 9.7% disapprove.

·         86.5% think that a serious breach of personal data would do severe or considerable damage to a hospital’s reputation.

·         87.2% strongly or somewhat agree that the NHS should monitor who looks at their files.

The survey reveals that confidentiality concerns have a direct impact on the outcomes of care, and that patients were concerned about how their records could be misused:

·         Over 61% were very or somewhat worried that their identity could be used to commit fraud or used by criminals to target them, their family or home.

·         53.6% have, or would, withhold information about a sensitive personal medical matter from a healthcare provider with a poor record of protecting patient privacy.

·         38.3% have, or would, put off seeking care for a sensitive medical condition due to privacy concerns.

A total of 41 UK respondents (over 4%) claimed their medical records had already been breached. Some had information used against them in legal actions, had their identities stolen and suffered financially. However, 75.5% of UK patients said they value electronic records as a way for clinicians to share information and keep it up-to-date.

Where FairWarning® has introduced privacy breach detection and auditing solutions to monitor electronic records systems, the levels of staff snooping into patient files with no professional reason to do so, has been reduced by an average of 97%.

For a full copy of the survey results and methodology, please visit

http://www.fairwarningaudit.com/documents/2011-WHITEPAPER-UK-PATIENT-SURVEY.pdf.

The full release is here:

http://www.fairwarningaudit.com/documents/2011-PR-UK-PATIENT-SURVEY.pdf

Now, while Fairwarning has something to sell, this really is just invaluable research. Especially the material on how people who have sensitive clinical conditions behave.

I recommend a download of the full report to all interested in the area!

Usefully there is also a US report covering US attitudes here:

http://www.fairwarningaudit.com/documents/2011-WHITEPAPER-US-PATIENT-SURVEY.pdf

A visit to the web site to see what is offered is fun.

http://www.fairwarningaudit.com/index.asp

I hope NEHTA is having a look! They do need some help in this area I believe!

David.

What Does This Research Mean for the Proposed PCEHR? Sadly Not As Much As You Might Think!

The following paper was published last week. Here is the abstract and the introduction.

AMIA doi:10.1136/amiajnl-2011-000394

The financial impact of health information exchange on emergency department care

OPEN ACCESS

1. Mark E Frisse1,2,
2. Kevin B Johnson1,3,
3. Hui Nian4,
4. Coda L Davison1,
5. Cynthia S Gadd1,
6. Kim M Unertl1,
7. Pat A Turri5,
8. Qingxia Chen4

Correspondence to Dr Mark Frisse, Vanderbilt Center for Better Health, 3401 West End Avenue, Suite 290, Nashville, TN 37203, USA; mark.frisse@vanderbilt.edu

• Received 24 May 2011
• Accepted 5 October 2011
• Published Online First 4 November 2011

Abstract

Objective To examine the financial impact health information exchange (HIE) in emergency departments (EDs).

Materials and Methods We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms. Our estimates employed generalized estimating equations for logistic regression models adjusted for admission type, length of stay, and Charlson co-morbidity index. Marginal probabilities were used to calculate changes in outcome variables and their financial consequences.

Results HIE data were accessed in approximately 6.8% of ED visits across 12 EDs studied. In 11 EDs directly accessing HIE data only through a secure Web browser, access was associated with a decrease in hospital admissions (adjusted odds ratio (OR)=0.27; p<0001). In a 12th ED relying more on print summaries, HIE access was associated with a decrease in hospital admissions (OR=0.48; p<0001) and statistically significant decreases in head CT use, body CT use, and laboratory test ordering.

Discussion Applied only to the study population, HIE access was associated with an annual cost savings of $1.9 million. Net of annual operating costs, HIE access reduced overall costs by $1.07 million. Hospital admission reductions accounted for 97.6% of total cost reductions.

Conclusion Access to additional clinical data through HIE in emergency department settings is associated with net societal saving.

Care delivery is often distributed across multiple settings and is the joint responsibility of many providers who do not have access to the same electronic medical record.1–4 Access to a more comprehensive set of clinical data will be essential to improve care coordination as more care reimbursement shifts from fee-for-service to reimbursement plans exemplified by recent federal accountable care organization initiatives and Department of Health and Human Services meaningful use requirements.5–10 Access to all data required for medical decision-making makes good sense. Such access should reduce medical error, improve healthcare quality, and lower medical costs.11–13 Health information exchange (HIE) allows clinicians access to data originating from other sites of care or service. By our definition, HIE is a set of services that supports access among parties who are motivated by common interest and governed to ensure that the rights of patients and participants are protected. HIE can be achieved through services provided by one or more solitary health information organizations (HIO) and through direct, point-to-point communication among providers.14 15

The national experience with HIE is growing, both in terms of the number of sites exploring this technology16 17 and the business models that rely on it. Unfortunately, because of the economic immaturity of HIE, most HIE benefits are estimates.18–20 Reports of measurable financial benefit are few in number.21 22

Presenting convincing evidence is a challenge because of the relatively small but growing number of HIE efforts, the differences in HIE, the ways in which HIE is enabled and used, and the methodology challenge of measuring value in ‘real world’ settings. Although HIE among institutions usually takes place through a single intermediary HIO, as more organizations share data with one another on a point-to-point basis, measuring the marginal contribution of each external data source and thus the overall value of HIE will become even more problematical.23

As part of our 6-year effort providing access to clinical and administrative data through a single HIO supporting HIE for every consenting patient treated in any of the region's major hospitals and in some ambulatory care clinics, we conducted a 2-year study examining overall use, user perspectives, and a range of other factors.24–26 We report here the direct financial impact study results by determining how HIE data access by emergency department (ED) physicians affected hospital admissions and diagnostic testing.

Continue reading here for the full paper.

http://jamia.bmj.com/content/early/2011/11/03/amiajnl-2011-000394.full

There is a press release on the study here:

Financial Impact of Sharing Electronic Health Information Focus of Study

Released: 11/7/2011 12:15 PM EST

Source: Vanderbilt University Medical Center

Savings of nearly $2 million reported across Memphis EDs

Newswise — Sharing of electronic health information across every major emergency department in the Memphis, Tenn., area resulted in reduced hospital admissions, reduced radiology tests and an annual cost savings of nearly $2 million, according to a Vanderbilt study released today by the Journal of the American Medical Informatics Association.

“The Financial Impact of Health Information Exchange on Emergency Department Care,” led by Mark Frisse, M.D., MBA, professor of Biomedical Informatics, is the nation’s first city-wide study of the impact of widespread health information exchange (HIE) data access in emergency departments (EDs).

“This is the first study to show that, on a city-wide basis, investments in technology can save medical costs by improving care,” Frisse said.

“We took the ‘Tennessee simple’ approach and built a low-cost system that said, ‘Folks, if you do it simply and build it up, doing the right thing can save you money.’”

HIE represents the transformation from provider-centric collection of health care information to a more comprehensive, patient-focused view of this information, allowing electronic health records to be exchanged with other care providers and patient-authorized entities.

Patient privacy protection within the system is “as rigorous and secure as any commercial electronic health record system,” Frisse said.

“It makes available only the information you choose and it can only be used when you are needing care,” he said. “It is far more secure and useful than paper, even if it was all in one place. Health information exchange ensures that we know exactly who has looked at it, when, where and why. So it is accountable to you.”

Vanderbilt researchers studied all ED encounters in which HIE data were accessed in all 12 major emergency departments in Memphis, Tenn., over a 13-month period and matched those encounter records with a similar encounter record in which HIE data were not accessed.

Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT use, body CT use, ankle radiographs, chest radiographs and echocardiograms.

Clinicians used the technology voluntarily and only when they felt it was necessary for the patient -- about seven in every 100 cases. When HIE data was accessed, it was associated with a significant decrease in CT scans and hospitalizations.

“Our people believe that the savings from this study are less than 2 percent of the overall savings these technologies can afford if every physician’s office is connected,” Frisse said. “And we are absolutely convinced and committed to extending this approach to every health care setting.”

Frisse sees the study data as being a national model of how to take the first step.

“Emergency department care is such a very small part of our health care system, but the same value of complete information realized in emergency department settings is even more applicable when an elderly patient goes to multiple doctors without a single, comprehensive medical record,” Frisse said.

“It is the first step in showing that if you give physicians the tools to collaborate, they will voluntarily do the right thing for you, and they will save you money and your quality will improve. These are very busy emergency department physicians. They had to go look it up and they did it because they care.”

The release is found here:

http://www.newswise.com/articles/financial-impact-of-sharing-electronic-health-information-focus-of-vanderbilt-study

The system used in this study was not, in fact, like the PCEHR. It shared Emergency Department encounter records and associated information from 12 substantial hospitals and made it possible to obtain information which was to be used by the attending clinicians - with the permission of the patient. The situation of the patient - being in a hospital emergency department - made it pretty likely consent would be able to be obtained. Interestingly the records seem to have been held a on a separate database from all the hospitals.

Information was only uploaded to the central data-base on an encounter basis and opt-out was very low at between 1% and 3%.

The number of times the system was used was between six and seven per cent of patient encounters.

The information was apparently not able to be added to by the patient nor accessed by the patient. Access was not available outside the hospital system for the trial. No plans for extension of the system into the community was mentioned as far as I can see.

Overall this report provides a very useful report on a model for Health Information Exchange which is fundamentally different from the PCEHR being provider centric, not user interactive and hospital based. The study is still worth a read! It does seem to be working, which is something I fear we will never say about the PCEHR as presently conceived!

David.

The Australian Privacy Foundation Call NEHTA for Just Failing To Consult - So What Is New?

I was sent this today. It is a serious worry I believe.

mail@privacy.org.au

http://www.privacy.org.au

MEDIA RELEASE

14 November 2011

NEHTA Blacklists Privacy Advocate on a Pretext

Embargoed until 23:59 Monday 14 November 2011

The National eHealth Transition Authority (NEHTA) is well-advanced in its design for its Personally- Controlled Electronic Health Record (PCEHR).

It has kept privacy advocates at arm's length, throughout the process, 2008-11.

NEHTA has failed to provide constructive responses to serious and specific expressions of concern about consultation processes, and about deficiencies in the design process.

The Australian Privacy Foundation (APF) is the nation's primary advocate for the privacy interest. It was formed in 1987, and has made many hundreds of submissions on matters of public concern.

APF has provided over 20 detailed submissions to NEHTA in relation to the PCEHR.

NEHTA has previously excluded APF nominees from some events by imposing a lengthy and nonnegotiable non-disclosure agreement (NDA) containing highly-objectionable clauses.

This week, NEHTA found a new way to keep unwelcome advice away from its staff.

Following a meeting in October, APF provided a submission detailing serious problems with the design process. Nine days later, NEHTA delivered comments that showed the organisation had no intention of doing anything about those problems. APF's nominee emailed blunt criticism in return.

NEHTA has branded some unspecified part of an APF email as bullying and/or harassment.

The APF has explained that NEHTA's interpretation is unjustified.

Despite that, NEHTA has excluded APF's nominee from any participation in NEHTA events.

NEHTA has failed in its most important functions – coordinating the application of IT to healthcare, underwriting inter-operability among eHealth systems by means of negotiated standards and protocols, and ensuring that all stakeholders are integrated into the undertaking.

To get safe ehealth records, the design has to be bravely open to patients' concerns while there is still time to fix things. Designs based on political imperatives and timetables from above are doomed to failure. This latest over-reaction provides a further demonstration of how NEHTA invests massive energy in avoiding messages that are inconsistent with its senior executives' song-sheet.

SUPPORTING MATERIALS

For the Sequence of Events, the Email, the Accusations and Demands, and the Responses, see http://www.privacy.org.au/Media/MR-NEHTA-111114-Sp.pdf

BACKGROUND

NEHTA has avoided meaningful engagement with privacy advocates throughout its existence.

After the failure and departure of its first CEO, NEHTA finally drew clinicians inside the fold. But communications with consumer and privacy advocates have remained distant and sporadic.

There is no framework, and no persistent consultation structure or processes.

During 2008-12, NEHTA has been developing an eHealth record scheme, currently called the PCEHR.

APF has made 12 public submissions on substantive matters associated with the PCEHR, and, at NEHTA's request, has left several other submissions unpublished.

In addition, it has made 10 submissions relating to the serious inadequacies in the process.

These are indexed at: http://www.privacy.org.au/Papers/indexPolicies.html#eH

SUMMARY OF THE CONSULTATION PROBLEMS

In November 2010, a letter to NEHTA's CEO summarised the issues:

http://www.privacy.org.au/Papers/PCEHR-Fleming-101108.pdf

The letter drew attention to the indicators of good and bad consultation processes:

http://www.privacy.org.au/Papers/PS-Cons-101106.html

"Over the last five years, your organisation has held various events, but not as part of a coherent process. The contributions have not been cumulative, there has been no carry-through on outcomes from the events, and the previous senior staff-member was side-lined and left in frustration. The lack of a coherent process is all the more surprising in view of frequent statements by NEHTA staff that privacy concerns are a serious impediment to progress in eHealth".

NEHTA's CEO replied, http://www.privacy.org.au/Papers/NEHTA-Consn-Reply-101112.pdf , affirming "NEHTA’s commitment to a methodical and cumulative approach to engagement with privacy advocacy organizations":

The very next meetings failed the test.

A comprehensive list of the problems was sent on 10 Dec 2010, on pp. 2-3:

http://www.privacy.org.au/Papers/NEHTA-PCEHR-101210.pdf

On 25 Feb 2011, APF wrote again:

http://www.privacy.org.au/Papers/PCEHR-Consultn-Ltr-110225.pdf

 "The short sessions on governance matters involved no summary of the points made by participants, no responses to the points made by participants, no propositions, no alternative models, and no options.

There were just a few open-ended questions. The frustration among participants should have been very apparent to NEHTA staff, and if it wasn't then APF draws it to attention herewith. To our further disappointment, the presentation by DoHA at the meeting on 23 February was long on aspiration and devoid of any concrete undertakings in relation to the issues that have been placed on the table".
Prof Roger Clarke - Chair - Australian Privacy Foundation

----- End Extract.

Whatever you think of the Privacy Lobby they need to be heard. Behaviour like this from a publicly funded organisation is just appalling.

An apology and lifting the Game is needed!

David.

Weekly Australian Health IT Links – 14th November, 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

An interesting week with, again, lots of indications that we are going to see a very interesting period leading up to July 1, 2012.

All over the world I would suggest that there is increasing recognition that delivery of e-health is a good deal harder than anyone fully appreciates.

The excellent study cited below from St Vincent’s Hospital shows just how long it takes and how hard it is to make real progress. if it is this hard to implement a single application in one hospital contemplating national implementation of an unproven and untested system in a great rush is clearly nonsense!

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http://www.abc.net.au/news/2011-11-12/ehealth/3662512

Call for e-Health scrutiny

Updated November 12, 2011 15:33:00

West Australian doctors are calling for an independent body to review the Federal Government's planned e-Health system.

The call follows an international report which found while the United States government was spending billions of dollars in incentive payments to encourage doctors to adopt electronic health records, those records could in some instances threaten patient safety.

The Institute of Medicine in the US is now recommending an independent agency be set up to monitor health information technology.

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http://www.theaustralian.com.au/australian-it/government/authority-to-release-e-health-development-plan/story-fn4htb9o-1226192813930

Authority to release e-health development plan

• by: Karen Dearne
• From: The Australian
• November 11, 2011 3:45PM

THE National e-Health Transition Authority will publish a Specifications and Standards development plan for the $500 million personally controlled e-health record system next week.

A NeHTA spokeswoman has told The Australian the plan would be released “within the next seven days”.

The organisation recently announced a series of “tiger teams” to fast-track critical technical specifications needed for the PCEHR build.

There is a November 30 deadline for their work, with the national PCEHR infrastructure project already under way.

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http://www.theaustralian.com.au/australian-it/pcehr-puzzles-aged-care-industry/story-e6frgakx-1226192073941

PCEHR puzzles aged care industry

• by: Karen Dearne
• From: Australian IT
• November 11, 2011 6:24AM

THE Aged Care Industry IT Council says providers cannot establish whether they will be able to participate in the Gillard government’s $500 million personally controlled e-health record system due to lack of information.

The council, which represents the peak Aged and Community Services Australia and the Aged Care Association of Australia, said draft legislation for the PCEHR’s introduction contains very little detail.

“The regulations and rules have not yet been drafted and may vary over time, yet they are to contain significant particulars of the PCEHR system and will be incorporated under the Act,” it said in its submission to the exposure draft PCEHR bill.

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http://www.computerworld.com.au/article/407153/virtual_clinic_offers_anxiety_sufferers_assistance

Virtual clinic offers anxiety sufferers assistance

E-therapy found to significantly improve anxiety management in sufferers

• Diana Nguyen (Computerworld)
• 11 November, 2011 12:25

A new online psychology clinic has been found to help people with anxiety disorders to better manage their symptoms.

The five self-help e-therapy programs, offered via Swinburne University of Technology’s Anxiety Online, showed significant improvements in anxiety management across 21 of 25 measures.

Each program — tailored to people suffering from generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic attacks (PD/A), post-traumatic stress disorder (PSTD) and social anxiety disorder (SAD) — consisted of 12 modules using text-based and multimedia materials such as audio, video and animated graphics and online activities.

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http://www.theaustralian.com.au/australian-it/workcover-confirms-e-health-bullying-investigation/story-e6frgakx-1226188048138

WorkCover confirms e-health bullying investigation

• by: Karen Dearne
• From: The Australian
• November 08, 2011 12:00AM

NSW WorkCover has investigated complaints of bullying at the National e-Health Transition Authority's Sydney headquarters, and is working with the organisation "to ensure bullying does not take place".

The complaints came to light last month at a Senate estimates hearing, when new Victorian Nationals senator Bridget McKenzie asked if Nehta had been investigated following a complaint.

Nehta chief executive Peter Fleming replied: "There was just a very brief investigation.

"I believe a WorkCover officer came and had a talk to our head of personnel and I believe that issue was dealt with to their satisfaction immediately," Mr Fleming said.

WorkCover has confirmed an investigation took place, and "we are continuing to work with the employer to ensure that appropriate measures are in place to limit the workplace bullying and prevent a recurrence", a spokesman said.

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http://www.theaustralian.com.au/australian-it/government/e-health-record-plan-must-be-uniform-says-privacy-commissioner/story-fn4htb9o-1226188093410

E-health record plan must be uniform, says privacy commissioner

• by: Karen Dearne
• From: The Australian
• November 08, 2011 12:00AM

PRIVACY Commissioner Timothy Pilgrim has called for a unified approach to privacy protections in his response to the Gillard government's draft legislation for its $500 million personally controlled e-health record program.

"The legislation should contain clear privacy protections and should clarify how different commonwealth, state and territory privacy laws will apply," he says in a submission detailing 22 needed changes and "clarifications".

"The civil penalty provisions will not apply to health information originally obtained from the PCEHR system where such information 'was stored in such a way that it was capable of being obtained' by other means."

Protection of data held in local systems instead falls under state and territory health and privacy laws, where these exist.

"We are unsure of the policy reasons for this exemption," Mr Pilgrim said.

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http://ehealthspace.org/news/nehta-reports-strong-financial-results

NEHTA reports strong financial results

Posted Mon, 07/11/2011 - 15:59 by Josh Gliddon

The National E-Health Transition Authority (NEHTA) has reported a strong growth in financials for the year ending June 30, 2011.

The federally funded agency is charged with overseeing Australia’s ehealth journey. The organisation’s annual report states it finished its financial year 2011 with a cash surplus of $32.7 million dollars, up from $7.6 million the previous year.

Total gross assets for the year were $77.4 million, while total liabilities were $21.2 million. Total net assets clocked in at $56.16 million.

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http://www.newsmaker.com.au/news/12840

St. Vincent’s Hospital, Sydney - an electronic medication management pioneer

Thursday, November 10, 2011 - iSOFT, a CSC company  

SYDNEY, NSW - Medication error is a frequent, harmful and expensive problem in Australian Hospitals, and yet, most hospitals continue to use paper based systems that rely on the vigilance and skill of staff. More than six years ago, St. Vincent’s Hospital, Sydney, began the journey from paper to electronic medication management. A paper published this week in the Medical Journal of Australia describes how collaboration between the hospital and the software vendor resulted in the successful implementation of the MedChart system from iSOFT, a CSC company, leading to a 50% reduction in prescribing errors.

Clinical systems are some of the most difficult to implement. While technical resources and skills are essential foundations, project leadership must come from clinicians. Change management is typically the most challenging aspect of these projects. With most of the change impacting clinical staff, engagement and extensive consultation with clinical teams are required.
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http://www.mja.com.au/public/issues/195_09_071111/day10451_fm.html

Implementing electronic medication management at an Australian teaching hospital

Richard O Day, David J Roffe, Katrina L Richardson, Melissa T Baysari, Nicholas J Brennan, Sandy Beveridge, Teresa Melocco, John Ainge and Johanna I Westbrook

MJA 2011; 195 (9): 498-502
doi: 10.5694/mja11.10451

Abstract

·         We describe the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital, to inform future similar exercises.

·         The success of eMMS implementation depends on:

o    a positive workplace culture (leadership, teamwork and clinician ownership)

o    acceptance of the major impact on work practices by all staff

o    timely system response to user feedback

o    training and support for clinicians

o    a usable system

o    adequate decision support.

Medication errors are a continuing and seemingly intractable challenge for our health care system. The incidence and annual costs are staggering, and most errors are classed as preventable.2 All steps of the process of medication management (ordering, dispensing and administration) are subject to error, but prescribing is recognised as the greatest source of error.3 Use of an electronic medication management system (eMMS) — including computerised physician order entry, a computerised decision support system, and medication administration and pharmacy review components — has been shown to reduce medication errors, although evidence for this is variable.4,5 It is acknowledged that the health system has been resistant to the promise of, and investment in, electronic information and communication technologies, but that the momentum for uptake is unstoppable.6 We describe our experience of implementing an eMMS in an Australian teaching hospital, in the hope that it will inform similar exercises that are contemplated or in process.

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http://ehealthspace.org/news/dentists-ready-ehealth-surgery-dr-hewson

Dentists ready for ehealth surgery: Dr Hewson

Posted Mon, 07/11/2011 - 16:37 by Josh Gliddon

Dental is one of the health sector’s unheralded areas. Yet according to the Australian Bureau of Statistics, approximately 12,000 dental surgeries are located across Australia.

Because of this widespread role in the community, the oral health profession has much to gain from forthcoming ehealth developments, argues Dr Neil Hewson, who sits on the Australian Dental Association’s special purpose committee on ehealth.

“The ADA has a good understanding of ehealth,” said Dr Hewson. “While there’s a huge focus on the PCEHR, that’s just [one] part of it. Secure messaging is also very important to us, along with e-prescriptions and e-referrals.”

According to ADA figures, 87 percent of dental practices are computerised, a number a few percentage points lower than in the GP sector. And of those computerised practices, 62 percent use digital charting.

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http://www.theaustralian.com.au/news/world/electronic-nose-to-sniff-out-tb-in-india/story-e6frg6so-1226188438193

Electronic nose to sniff out TB in India

• From: AFP
• November 08, 2011 9:38AM

INDIAN researchers have said they were close to developing an "electronic nose" to sniff out tuberculosis on the breath - offering rapid diagnosis that could save hundreds of thousands of lives.

The "E-Nose" is a battery-operated, hand-held unit, similar to a police breathalyser used to catch drunk drivers.

A patient blows into the device and sensors pick up TB biomarkers in the breath droplets, resulting in an almost instantaneous and highly accurate diagnosis.

The "E-Nose" is a collaboration between the International Centre for Genetic Engineering and Biotechnology in New Delhi and Next Dimension Technologies in California.

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http://ehealthspace.org/news/state-snapshot-queensland-s-ehealth-journey

State snapshot: Queensland’s ehealth journey

Posted Thu, 10/11/2011 - 16:24 by Josh Gliddon

The first in a series of state and territory snapshots, Joshua Gliddon examines Queensland’s ehealth investments.

As one of Australia’s fastest growing, yet geographically dispersed and demographically diverse states, Queensland has distinct needs when it comes to ehealth.

In 2007 the Queensland government invested $243 million in its ehealth strategy, leading to the roll-out of the Electronic Medical Viewer application. The Viewer, as it is known, is currently being deployed and due for completion in the middle of 2012.

According to Queensland Health’s chief information officer, Ray Brown, the Viewer is intended to facilitate better informed clinical decisions which in turn will lead to better patient outcomes.

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http://www.theaustralian.com.au/australian-it/government/msia-raises-e-health-safety-issues/story-fn4htb9o-1226190483587

Medical software group raises e-health safety issues

• by: Karen Dearne
• From: Australian IT
• November 10, 2011 12:00AM

The peak medical software group is concerned about the Healthcare Identifiers service.

THE Medical Industry Software Association has warned unresolved patient safety and liability concerns relating to the year-old Healthcare Identifiers service leave members at risk of liability "for any and all adverse outcomes" arising from use of the service.

"Implementers should take legal advice with respect to potential liability, inform their software indemnity insurers and ensure end-users sign comprehensive waivers," the MSIA says in a white paper adopted by members at its annual CEO Forum last month.

The eight-page white paper -- obtained by The Australian -- was provided to all members of the Healthcare Identifiers (HI) stakeholders working group, including the National e-Health Transition Authority, federal Health department and Medicare, for their consideration.
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http://www.smh.com.au/business/privacy-of-millions-at-mercy-of-a-usb-device-20111107-1n3wm.html

Privacy of millions at mercy of a USB device

Leonie Wood

November 8, 2011

Data abuse is part of a 'depressing' trend, writes Leonie Wood.

THE privacy and financial records of millions of shareholders who use Computershare's global share registry system were placed at risk this year when a Boston employee quit the company, allegedly taking with her thousands of pages of highly sensitive and confidential documents.

The employee resigned in September last year but did not return a work laptop for three weeks. When Computershare retrieved the laptop, the company claimed internal documents and emails had been copied without authorisation to a USB flash drive and later to the employee's home computer.

What is most disturbing about the case is that the woman was formerly employed in Computershare's risk management and internal audit department, which is responsible for scrutinising the vulnerabilities of the group's internal systems.

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http://www.theaustralian.com.au/australian-it/unforgiving-aussies-are-willing-to-act-on-privacy-breaches/story-e6frgakx-1226188080061

Unforgiving Aussies are willing to act on privacy breaches

• by: Andrew Colley
• From: The Australian
• November 08, 2011 12:00AM

AUSTRALIAN consumers are among the most unforgiving in the world when it comes to organisations that are careless with their private data, according to a new study.

Nearly nine out of every 10 Australians would stop dealing with a company or another large organisation if they became aware it allowed their private data to be breached, Unisys found in its multi-country biannual security index.

The study found that 85 per cent of the 1025 Australians polled would stop dealing with organisations that allowed their private data to be breached. A further 47 per cent would take legal action.

Unisys Asia Pacific security director John Kendall said the result indicated that, of residents in the 12 countries surveyed, Australians were the most disapproving of privacy breaches.

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http://www.computerworld.com.au/article/406697/australians_would_speak_against_company_data_breach_survey

Australians would speak out against a company data breach: Survey

Unisys Security Index finds 64 per cent would publicly expose companies if their information was compromised

• Hamish Barwick (Computerworld)
• 08 November, 2011 11:15

Legal action, exposure and closing accounts are some of the responses Australians would take if their data was compromised by a company, according to a global survey conducted by Unisys.

The Security Index 2011 which was conducted during September with 1,205 people, found 85 per cent of respondents would take their business elsewhere, while 47 per cent would take legal action and 64 per cent would expose the issue in a public forum.

When asked if they would continue dealing with the same company while not using online services, only 24 per cent of Australians said that they would continue doing so.

In addition, 88 per cent of respondents would change passwords on the affected organisation’s website and any others they had concerns about.

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http://www.smh.com.au/technology/technology-news/police-warn-of-sophisticated-plan-to-steal-identities-20111108-1n5l8.html

Police warn of sophisticated plan to steal identities

Nick Ralston

November 9, 2011

POLICE are concerned about the potential for criminals to steal a child's identity off social networking sites, store the data for years and then use it to obtain fraudulent credit cards and bank loans when their victims become adults.

The Australian Federal Police has evidence that storing stolen personal and financial data for a period before it is exploited - a process known as warehousing - has become a trend among more sophisticated criminals.

Ben McQuillan, the national co-ordinator of the AFP identity security strike team, said a perpetrator warehoused the information for a time, such as six months, to make it harder for a victim or bank to trace where and when the data was stolen.

He said there was now a potential risk that criminals could target users of Facebook and other social networking sites who were unaware of the potential risks of sharing personal information.

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Enjoy!

David.

AusHealthIT Poll Number 96 – Results – 14th November, 2011.

The question was:

With The Presently Declining Federal Budget Situation Will The Funding of the PCEHR Be Extended For 2 More Years?

Yes, For Sure

- 3 (8%)

Probably

- 8 (21%)

It Is At Some Risk

- 7 (18%)

It Is At High Risk

-  14 (37%)

No, Funding Will Cease

-  5 (13%)

Votes: 37

An interesting vote. About 65% think the funding is at some risk while about 35% think it is not. I guess we shall all see!

Again, many thanks to those that voted!

David.

The Recognition Is Dawning Health IT Needs Thought, Smarts and Care. It Is Not Clear The PCEHR Program Gets It!

Last week I reviewed some aspects of the possible impact of Patient Safety issues that may impact on the PCEHR.

This is found here:

http://aushealthit.blogspot.com/2011/11/issue-of-safety-of-deployment-and-use.html

Since that blog last week there have been three developments.

First we have had recognition that the approach to the PCEHR may not be taking into account current developments in the Health IT arena overseas.

Call for e-Health scrutiny

Updated November 12, 2011 15:33:00

West Australian doctors are calling for an independent body to review the Federal Government's planned e-Health system.

The call follows an international report which found while the United States government was spending billions of dollars in incentive payments to encourage doctors to adopt electronic health records, those records could in some instances threaten patient safety.

The Institute of Medicine in the US is now recommending an independent agency be set up to monitor health information technology.

The Australian Medical Association's David Mountain would like to see similar scrutiny of the e-Health system, which is expected to be in place by the middle of next year.

More here:

http://www.abc.net.au/news/2011-11-12/ehealth/3662512

Second we have had the MSIA express some concerns regarding aspects of the safety associated with both the HI Service and some aspects of the proposed PCEHR.

See here:

http://aushealthit.blogspot.com/2011/11/medical-software-industry-association.html

Third we have had a lot of commentary emerge on the Institute of Management report.

The New York Times summarises the recommendations well:

November 8, 2011

Panel Emphasizes Safety in Digitization of Health Records

By STEVE LOHR

Poorly designed, hard-to-use computerized health records are a threat to patient safety, and an independent agency should be set up to investigate injuries and deaths linked to health information technology, according to a federal study released Tuesday.

The report by the Institute of Medicine comes as the government is spending billions of dollars in incentive payments to encourage doctors and hospitals to adopt electronic health records. The Department of Health and Human Services requested the study, in response to concerns from some doctors and public health experts that the drive for digital records might bring a wave of technology-induced medical errors.

The goal of moving from paper to computerized patient records is to improve patient care and curb health care costs. The federal report does not assert that the effort to move to electronic health records is misguided, but that safety considerations must be a crucial ingredient.

The proposed investigative agency, the report said, should be modeled after the National Transportation Safety Board, which examines airline safety and accidents. The Institute of Medicine committee also called for tracking the safety performance of electronic health records in use. Results from studies done so far, the report said, are mixed. Success stories are offset by reports of patients harmed.

The advisory group recommended that electronic health record suppliers drop “hold harmless” clauses from their sales contracts. Such language often limits the freedom of doctors and hospitals to publicly raise questions about software errors or defects.

More here:

http://www.nytimes.com/2011/11/09/technology/federal-panel-emphasizes-safety-in-push-for-digital-health-records.html?_r=1

Usefully the Office of the National Co-ordinator for Health IT in the US has already signalled a keenness to start work addressing the issues raised.

Mostashari assures patient safety plan sooner than 12 months

November 09, 2011 | Mary Mosquera

Dr. Farzad Mostashari, the national health IT coordinator, said that agencies in the Health and Human Services Department will work closely to craft a surveillance and action plan to keep patients safer through health IT, and it will be done sooner than called for by the Institute of Medicine.

An IOM report published this week directed ONC as the office that oversees health IT to complete its plan within 12 months.

“We appreciate the IOM’s recommendations in making sure that we really do have a coherent structure for reporting, analyzing and acting on the information about EHR-related safety incidents,” he said at the Nov. 9 meeting of the advisory Health IT Policy Committee. 

He added that the committee will be an important part of bringing health IT stakeholders together for discussions about patient safety. The IOM calls for the freer flow of safety-related information and action by all stakeholders. 

Mostashari said that the Office of the National Coordinator for Health IT will coordinate with the Food and Drug Administration (FDA), which regulates medical devices, and the Agency for Healthcare Research and Quality (AHRQ), which sponsors patient safety organizations, and the National Institute for Standards and Technology (NIST).

ONC has worked with AHRQ and FDA to promote reporting by EHR vendors on adverse events through patient safety organizations and with NIST to develop standards for EHR testing, measuring and usability.

In its report, IOM reaffirmed its faith in the potential for health IT to improve safety, Mostashari said. But it also made important recommendations to make sure that health IT’s potential is fully realized. The report becomes part of ONC’s long-term strategy for building in safety from the beginning as adoption of health IT moves forward, he said. 

Safety is not just about reliable EHR system software product performance. Mostashari said that the report emphasized that “safety is a system.”

“Successful use of health IT means that we have to understand safety as part of the systematic approach. It means, system usability issues, having the right relationship between design of EHRs and the workflows,” he said.

In response to questions about whether FDA should be regulating EHRs as devices, Mostashari said that it was “clearly one of the most controversial issues that the committee struggled with.”

”My understanding of the report is that one of the key issues was the recognition that a broader set of issues needs to be addressed, not just the devices, but the entire system of how care is delivered, how training is done, and how workflows are done,” he said.

The report cites the need to balance the innovation agenda, and some of the concerns they expressed around the expertise needed for this may be different from device regulation in general, he said.

More here

http://govhealthit.com/news/mostashari-assures-patient-safety-plan-sooner-12-months

To me the time for DoHA and NEHTA to come out and formally announce just what they plan in a policy and implementation sense in this area has now well and truly arrived.

It is just not good enough to have a Clinical Safety Unit beavering away (or apparently not) within NEHTA without some public indication of what they are doing, how it is being done and providing some evidence that what they are doing is actually working - not only for the PCEHR but for the e-Health domain as a whole.

We have been warned and NEHTA and DoHA need to respond properly to retain public trust and confidence.

David.