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."

Tuesday, January 17, 2012

An Interesting Question To Contemplate. Does NEHTA Have Any Grasp of Commercial Reality?

A correspondent has just pointed out a very interesting quote from NEHTA in the Article in The Australian on 17/1/2012.
“Vendors "looking at different investment opportunities or where you can maximise your return, if you want to be early to market I'd encourage you to get involved in user- acceptance testing". Those looking to launch product sets between July and December should attend the masterclasses, he said.”
This is the last paragraph of the article which is found here:
PCEHR investing opportunities or maximising returns? How exactly does that work as they say?
As my correspondent wrote:
“- Investment opportunity?
- Maximise your return?
- Early to market?
I think all vendors understand what these words mean - do NEHTA and DOHA?
As we all know.
-Patients aren't going to have to pay for PCEHR access.
-GP's and specialists aren't going to pay extra for PCEHR features in their software.
-The government is explicitly turning off the tap on July 1.
As I am asked - and I have not a clue or the remotest idea of the “answer’
“Is there some other magic money fairy ready to bestow cash on the PCEHR vendors? What exactly is the market - and if the entire premise for why vendors are involved is because of this market - I presume there will be next to no vendor involvement (other than those from wave 1 and 2)?”
The answer is, as far as we all have been told, NO and to be more emphatic one gets the sense the position is ‘not a chance”!
It is transparently clear from this the NEHTA / DoHA axis are just ‘blowing smoke’ and have no idea what the words actually mean!
What a staggering appalling joke!
David.

This Strikes Me As Something That Might Be Missing From The PCEHR Program - An Exploration and Analysis of the Downsides and Risks!

The following news release appeared a little while ago and I spotted in the monthly RAND newsletter.

Online Guide Helps Health Organizations Adopt Electronic Health Records

Wednesday
December 14, 2011
A new online guide is available from the U.S. Agency for Healthcare Research and Quality to help hospitals and other health care organizations anticipate, avoid and address problems that can occur when adopting and using electronic health records.
The free tool, called the "Unintended Consequences Guide," was created to provide practical troubleshooting knowledge and resources. Experts from the RAND Corporation, the University of Pennsylvania School of Medicine, Kaiser Permanente-Colorado and the American Health Information Management Association Foundation created the guide. The work was supported by a contract from the Agency for Healthcare Research and Quality.
The guide can be found at www.ucguide.org.
"The goal is to provide administrators, technology officers and health care providers with information that will help them successfully adopt and use electronic health records," said Spencer Jones, an information scientist at RAND and a co-author of the guide. "Moving from paper records to electronic records is a major undertaking and the 'Unintended Consequences Guide' is an essential tool to help that migration."
"One of the purposes in funding this effort was to help health IT implementers understand the interactions between humans and technology that are often the source of unintended consequences," said Michael Harrison, a senior social scientist with the Agency for Healthcare Research and Quality and a collaborator on the guide.
"Having recently completed the largest civilian roll out of a national electronic health record system in the United States, we want to share our knowledge about implementation and how electronic records can transform health care delivery," said Dr. Ted Palen of the Kaiser Permanente-Colorado Institute for Health Research.
Use of electronic health records is growing rapidly among hospitals and other health care providers in the United States, spurred in part by major federal investments in the technology. Legislation approved in 2009 eventually may provide as much as $30 billion in federal aid to hospitals and physicians that invest in electronic health records. The guide was developed for use by all types of health care organizations — from large hospital systems to solo physician practices.
The creators anticipate that the primary users will be those responsible for adopting electronic health records, including federally designated Regional Extension Centers, chief information officers, directors of clinical informatics, electronic health records "champions" or "super users," administrators, information technology specialists and clinicians involved in adoption of the technology. Frontline users of electronic health records such as physicians and nurses also may also find the guide useful.
The online resource is based on the research literature, other practice-oriented guides for electronic health record adoption, research by its authors and interviews with leaders of organizations that have recently switched to electronic health records. The guide represents a compilation of the known-best practices for anticipating, avoiding and addressing unintended consequences of adopting electronic health records. However, researchers say, this area of research is still in its infancy.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
You can find the press release here:
If you visit the site you will find a wealth of very, very useful material.
In the introduction to the site the authors have the following to say:

Guide to Reducing Unintended Consequences of Electronic Health Records

The Guide to Reducing Unintended Consequences of Electronic Health Records is an online resource designed to help you and your organization anticipate, avoid, and address problems that can occur when implementing and using an electronic health record (EHR). Our purpose in developing the Guide was to provide practical, troubleshooting knowledge and resources.
The Guide was developed with all types of health care organizations in mind — from large hospital systems to solo physician practices. We anticipate that the primary users will be EHR implementers such as Regional Extension Centers, chief information officers, directors of clinical informatics, EHR champions or "super users," administrators, information technology specialists, and clinicians involved in the implementation of an EHR. Frontline EHR users (such as physicians and nurses) may also find the Guide useful.
The Guide is based on the research literature, other practice-oriented guides for EHR implementation and use, research by its authors, and interviews with organizations that have recently implemented EHR. The Guide represents a compilation of the known best practices for anticipating, avoiding, and addressing EHR-related unintended consequences. However, this area of research is still in its infancy. Therefore, the Guide is a work in progress. We invite you to revise its tools and recommendations in keeping with your own experience and in response to emerging research findings.
The full resource is found here:
The following question and answer makes it clear what is being addressed:

Question 2: What are some examples of unintended consequences?

Here are some examples of common unintended consequences:
1.       More work for clinicians
Example: After the introduction of an EHR, physicians often have to spend more time on documentation because they are required to (and facilitated to) provide more and more detailed information than with a paper chart. While this information may be helpful, the process of entering the information may be time consuming, especially at first.
2.       Unfavorable workflow changes
Example: Computerized physician order entry (CPOE) automates the medication and test ordering process by reducing the number of clinicians and clerical staff involved, but by doing so it also eliminates checks and counterchecks in the manual ordering process. That is, with the older system, nurses or clerks may have noticed errors, whereas now the order goes directly from the physician to the pharmacy or lab.
3.       Never-ending demands for system changes
Example: As EHRs evolve, users rely more heavily on the software, and demand more sophisticated functionality and new features (e.g., custom order sets). The addition of new functionalities necessitates that more resources be devoted to EHR implementation and maintenance.
4.       Conflicts between electronic and paper-based systems
Example: Physicians who prefer paper records annotate printouts and place these in patient charts as formal documentation, thus creating two distinct and sometimes conflicting medical records.
5.       Unfavorable changes in communication patterns and practices
Example: EHRs create an "illusion of communication," (i.e., a belief that simply entering an order ensures that others will see it and act upon it.) For example, a physician fails to speak with a nurse about administering a medication, assuming that the nurse will see the note in the EHR and act upon it.
6.       Negative user emotions
Example: Physicians become frustrated with hard-to-use software.
7.       Generation of new kinds of errors
Example: Busy physicians enter data in a miscellaneous section, rather than in the intended location. Improper placement can cause confusion, duplication, and even medical error.
8.       Unexpected and unintended changes in institutional power structure
Example: IT, quality assurance departments, and the administration gain power by requiring physicians to comply with EHR-based directives (e.g., clinical decision support alerts).
9.       Overdependence on technology
Example: Physicians dependent on clinical decision support may have trouble remembering standard dosages, formulary recommendations, and medication contraindications during system downtimes.
Source: Campbell, EM, Sittig DF, Ash JS, et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc. 2006 Sep-Oct; 13(5): 547-556.
More here:
Consideration of this list in the light of the current PCEHR proposals might be a very sensible idea to see just how badly the present PCEHR proposal is likely to perform.
Browsing the other pages is just fascinating to see just how many traps there are that we already know about and should be planning to avoid.
The External Resources link is especially useful
RAND, the AHRQ and the US Department of Human Services deserve thanks for making this invaluable resource available.
David.

AusHealthIT Poll Number 104 – Results – 17th January, 2012.

The question was:
Who Do You Think Bears Most Responsibility For The Mess The PCEHR Seems To Be Becoming?
The Federal Health Minister
- 5 (14%)
DoHA
-  12 (35%)
NEHTA
- 16 (47%)
Health IT Providers
-  0 (0%)
Health IT Consultants and Advisors
-  0 (0%)
Privacy Advocates
-  1 (2%)
Clinicians (AMA, RACGP etc.)
- 0 (0%)
Consumers
- 0 (0%)
Others
-  0 (0%)
Votes 34
It appears that the Bureaucracy has a lot to answer for in all this with 82% blaming either NEHTA or DoHA for the mess. Pretty clear that!
Again, many thanks to those that voted!
David.

It Seems Someone is Having Great Fun Spending Our Money! Pretty Sad.

The following popped up this morning.

Rush to deliver e-health eating $1m a day

THE Gillard government is "burning $1 million a day" to deliver its personally controlled electronic health record system on time and is sending coding work to India in the process.
The National E-Health Transition Authority head of PCEHR implementation, Andrew Howard, said the Accenture consortium was "on track" to deliver a key part of the program's national infrastructure by February 1.
That should set the scene for delivery of an operational system by the July 1 deadline, he said.
"Over the Christmas break, Accenture has been extremely busy building out software," Mr Howard told a vendors web-based seminar. "We're building some of the code offshore in India, and the Indians didn't take a break over the Christmas period. So I'm pleased to say that Accenture is on track to deploy release 1a to us early next month."
Mr Howard said NEHTA was working on some "incredibly tight" timelines. "Everyone says that about every project, but the reality here is we are literally burning around $1m a day at the moment pushing this program through . . . getting things out the door," he said.
Lots more here:
I wonder where the comments on how quality and safety for patients are?
That they are ‘burning’ money like this does not sound much like due care to me.
Just hopeless and really revealing a lack of understanding about what is being attempted - albeit very badly - here!
David.

Monday, January 16, 2012

Weekly Australian Health IT Links – 16th January, 2012.

Here are a few I have come across the last week or so.
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

-----
The main news this week has been reporting of the submissions made to the Senate Enquiry into the PCEHR Legislation.
Here is the link to get you to the extra submissions as they appear.
There are certainly a range of views out there about the PCEHR, what is should do, who should access it and so on. Some even seem to think it might not be such a good idea - what a surprise!
As an aside has anyone seen anything actually emerging from the Adoption and Change Management Partner. One might have expected we would be hearing heaps from them - especially in response to the submissions but I am yet to hear a peep. They are fast running out of runway as they say!
Other than that some interesting developments on other fronts and some amazing news that really dwarfs the PCEHR in importance!
-----

Frustration as e-health questions go unanswered

10th Jan 2012
VITAL questions about the personally controlled e-health record system (PCEHR) – that the government expects GPs to manage – have gone unanswered by the health department almost three months after they were asked in Senate estimates hearings.
The department’s silence on the 38 questions has hamstrung medical software providers who were counting on the responses for the preparation of submissions for a Senate inquiry into the legislation that will enable the scheme.
With the window for submissions to the inquiry due to close this Thursday, sources within the medical software industry have told MO the department’s lack of response has caused considerable angst among providers.
-----

NeHTA rejects electronic health record fears

Despite the warning of healthcare professionals around consumers controlling the information in their e-health record, NeHTA will not alter the system's design
The National E-Health Transition Authority (NeHTA) will maintain its current design for personal e-health records despite acknowledging concerns that increased consumer control over health information could potentially result in poorer health outcomes for patients.
In its submission (PDF) to the Senate inquiry into the Federal Government’s Personally Controlled Electronic Health Records (PCEHR) Bill 2011, introduced in November, the body charged with the rollout of the PCEHR conceded that access to accurate clinical information was essential for healthcare professionals but said the system’s design would not be changed.
“Some medical professionals have raised concerns that if consumers are able to restrict access to information in their PCEHR, this will create clinical risk because healthcare providers will be basing their decisions on only part of the story,” the submission reads.
-----

Senate Inquiry Holds PCEHR Program

Thu, 01/12/2012 - 09:57 by Makomborero Midzi
In a recent report, it has been made clear that Former health minister Nicola Roxon effort of making way for PCEHR program to bring about changes in the nationwide health IT and change management project would take some time to draw the desired level of results. It has been known that Nicola Roxon had done a lot to bring the PCEHR program available "to every Australian who wants one” by July 1 this year, but the Senate Community Affairs committee which reviewed the proposal has found some loopholes in it.
-----

Diagnostics delayed in e-health plan

  • by: Karen Dearne
  • From: Australian IT
  • January 13, 2012 8:07AM
WORK on integration of diagnostic images into the Gillard government's personally controlled e-health record scheme is yet to commence, despite the system being due for operational launch on July 1.
The Royal Australian and New Zealand College of Radiologists says it has been involved with the National E-Health Transition Authority's diagnostic services reference group for some years, but work has not progressed beyond a draft plan.
While private pathology and radiology providers have long been able to send their test results to doctors electronically, and digital imaging and picture archival systems allow labs and doctors to exchange x-rays and scans, Nehta ruled diagnostic imaging out of scope for the lead PCEHR implementation sites until "more work can be done on defining a model of access".
-----

Rural sites overlooked in e-health plan

  • by: Karen Dearne
  • From: Australian IT
  • January 13, 2012 8:21AM
RURAL and remote communities say they've been overlooked with lead sites for the $500 million personally controlled e-health record rollout concentrated in well-equipped centres.
"The implementation approach so far has focused mainly on sites that are well supported to take up new technology and business approaches," the National Rural Health Alliance has told the Senate inquiry into the PCEHR Bill and related matters.
"There is a need to establish implementation sites in challenging but high need primary care settings, so as to seed rural/remote uptake and lead the widespread adoption that will be necessary.
-----

Calls for greater e-health transparency

  • by: Karen Dearne
  • From: Australian IT
  • January 13, 2012 8:28AM
THE Consumers Health Forum has called for greater accountability and independence in governance arrangements for the Gillard government's personally controlled e-health record system, due for launch on July 1.
The peak body also wants strong consumer controls over access to medical records, and suggests reconsideration of the opt-in model in its submission to the Senate inquiry into the PCEHR Bill and related matters.
Former health minister Nicola Roxon introduced enabling legislation for the $500 million PCEHR program into parliament late last year, without addressing key governance issues raised in earlier consultations.
While the Information Commissioner will be able to investigate complaints of breaches of patient data under the 24-year-old Privacy Act, the present patchwork of state and territory health and privacy laws will still apply where medical records are held in local systems.
-----

Whither the PCEHR?

Techno Blog | 12 January 2012 |
BY KAREN DEARNE
2012 will be a pivotal year for local health IT initiatives, with the Senate inquiry into the Gillard government’s $500 million personally controlled e-health record program already under way.
The nationwide PCEHR system is due for launch on July 1.
The first submissions have been published on the Community Affairs committee website, and we can expect many more over the next few weeks ahead of public hearings in early February.
Co-founder and chief executive of HealthLink, Tom Bowden, and his operations chief and immediate past president of the Medical Software Industry Association Geoffrey Sayer, have provided a useful scene-setter in a thoughtful submission that questions whether the PCEHR is the right approach for Australia.
-----

Healthy growth in eScripts but large gap remains

Written by Kate McDonald on 10 January 2012.
The companies behind Australia's two electronic prescription platforms say transactions are up by several magnitudes from the same time last year, although many GPs and pharmacists are not yet using the technology.
eRx Script Exchange has seen overall dispense transactions grow by 40 per cent in 2011, while MediSecure Script Vault has seen an increase of 287 per cent in original scripts to the end of November 2011.
While final numbers are not yet available, eRx said it expected to pass previous records and handle more than 4.2 million dispensing transactions in a single week in the week leading up to Christmas, traditionally the busiest time of the year for dispensing.
-----

Insurance firm wants to mine e-health data

By Josh Taylor, ZDNet.com.au on January 12th, 2012
Insurance company Bupa wants the Federal Government to provide anonymous patient data from the Personally-Controlled E-Health Records (PCEHR) system to companies for research on Australian health.
Under legislation currently before parliament, only the consumer has control over access to information in their own e-health record, and decides which health practitioners are able to see what information contained in their e-health record.
However, Bupa Health Dialog, a subsidiary of the insurance giant, believes that this is far too constrained, and that in the interests of research, all data should be anonymised and made available to research Australian health consumers.
-----

Teens to control own e-health records

BY PETER JEAN, HEALTH REPORTER
14 Jan, 2012 10:47 AM
Teenagers will be able to stop their parents accessing their personally controlled electronic health records which are due this year.
Under a Bill before Parliament, Australians could voluntarily sign up for personally controlled electronic health records that would contain clinical information entered by health-care providers such as medical history, medicines, hospital summaries, referrals, specialist letters and event summaries.
Health consumers or their authorised representatives would also be able to enter information about over-the-counter medications they were taking, allergies and adverse reactions they suffered.
-----

E-health records plan high risk, Senate inquiry told

  • by: Karen Dearne
  • From: Australian IT
  • January 12, 2012 11:01AM
THE Gillard government's $500 million personally controlled e-health record program has diverted funds and attention from other more useful health IT projects, a Senate inquiry has been told.
"It would be most unwise to count upon the PCEHR implementation going to plan,” HealthLink chief executive Tom Bowden and head of operations Geoffrey Sayer say in a joint submission to the PCEHR inquiry.
"It is a high-risk strategy. Other centrally directed projects elsewhere (are failing) and in some cases have been halted.
"There are also mounting concerns that attempting to roll out a national solution within a very tight timeframe is placing considerable pressure on the sector, and may well hold back sustainable e-health service development for a long time to come.”
-----

Mater coders start e-health ball rolling

By Suzanne Tindal, ZDNet.com.au on January 12th, 2012
As the deadline approaches for the government to launch its personally controlled e-health record program scheme, which will enable any Australian to say yes to a national record that links their medical consultations, Queensland Mater hospitals have been working feverishly to do their part.
Mater Health Services operates seven hospitals in South-East Queensland. Its Brisbane hospital was one of the sites that received money from the government to be one of the first to try to implement e-health records to integrate with the national system.
Mater Health Services has an obligation under its contract for the funding, which is required to get e-health records running on its systems and hook up to the national system on 30 June. When the organisation signed on, it had been using InterSystems as a platform for its patient administration services.
Now, Mater hoped to tweak the platform to be able to talk to Medicare, fetching health identifiers for its patents. Every Australian has been allocated with a unique health identifier, which will enable the individual entries made by doctors be linked to form a cohesive electronic health record.
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InterSystems HealthShare Supports National Healthcare Identifiers Service and Secure Messaging Delivery Standards

Mater Health Services’ electronic health record interface to the Australian Government’s Healthcare Identifiers Service one of the first to gain NEHTA accreditation
SYDNEY, Australia -- January 11, 2012 -- InterSystems Corporation today announced that it has provided software to healthcare organisations -- including InterSystems HealthShare™ to Queensland’s Mater Health Services -- to rapidly develop systems that support the Australian national Healthcare Identifiers Service and Secure Messaging Delivery standards.
InterSystems HealthShare is a strategic platform for healthcare informatics and the creation of an Electronic Health Record on a regional or national scale.
By supporting Australian connected healthcare services and standards, InterSystems is accelerating the delivery of systems under government electronic health record initiatives. Through compliance with Australian standards, InterSystems will also lower the cost of maintaining connected care systems.
Mater Health Services, which operates seven Mater hospitals in South-East Queensland, has already used HealthShare to develop an interface to the national Healthcare Identifiers Service. The interface was one of the first to gain accreditation under the Compliance, Conformance and Accreditation program operated by the National E-Health Transition Authority (NEHTA).
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E-health law to block overseas access: CSC

By Josh Taylor, ZDNet.com.au on January 9th, 2012
A legislative ban on storing data for personally controlled e-health records (PCEHR) overseas could inadvertently prevent consumers from accessing their records while abroad, according to IT services company CSC.
The legislation currently before parliament that will enable the PCEHRs has a requirement "not to hold or take records outside Australia". This is designed to prevent Australian customer data to be held outside of the country where there is less control over privacy of the data held, but, as CSC Healthcare Australia New Zealand national director Lisa Pettigrew noted, it could effectively ban patients who are overseas from accessing their own data because data from the records may be cached outside of Australia.
"CSC understands the intent of this section to limit storage of records in repositories overseas; however, as written, this section will evolve to become problematic with the proliferation of devices used by consumers. Consumers will access their data via mobile devices overseas, and this will result in data, de facto, being accessed and potentially held or cached, outside of Australia," she said in a submission (PDF) to the parliamentary inquiry on the legislation.
-----

Registry to record all breast implants

January 15, 2012
EVERY woman who has a breast implant will have her details recorded on a new national registry so that faulty devices can be detected early.
As the scandal over defective French-made PIP implants continues, the Australian Society of Plastic Surgeons is preparing to record the information of every breast implant patient, the surgeon and the type of operation.
The registry, one of the first in the world, would act as an early-warning system for any future problems with implants. It would be similar to the National Joint Replacement Registry, which gets some government funding and quickly detected problems in Australia with DePuy hip replacements, now the subject of global litigation over their failure rate.
-----

Stanford encourages Oz entrepreneur

By Mahesh Sharma, ZDNet.com.au on January 12th, 2012
PhD student Jenna Tregarthen felt helpless as she watched her best friend suffer from an eating disorder, but that all changed when she was accepted into one of the world's most exclusive entrepreneurship programs.
Her Recovery Record app proposal was one of 10 accepted into the Summer Institute for Entrepreneurship program at Stanford, where she developed the app that allows patients to track their behaviour, and also uses positive engagement and game mechanics to encourage patients to complete homework that has been assigned by their therapist.
At the time, Tregarthen was completing a PhD in health psychology at the University of Wollongong, specifically looking at how to change people's behaviours over a prolonged period of time. She was motivated to apply for the program after becoming frustrated by the limits of research and associated data to translate to real-world change in peoples' lives.
-----

Internet addiction as damaging as drugs

13th Jan 2012
AAP
INTERNET addiction affects nerve fibres in the brain causing similar changes to those exposed to alcohol, cocaine and cannabis, a Chinese study shows.
The discovery indicates that being hooked on the internet can be just as physically damaging as addiction to drugs.
Internet addiction disorder (IAD) is a recently recognised condition characterised by out-of-control internet use that impairs quality of life.
Denied access to their computers, people with this disorder may experience distress and withdrawal symptoms including tremors, obsessive thoughts, and involuntary typing movements of the fingers.-----

GLOBAL HEALTH LTD : Global Health and GP2U Telehealth announce new secure eHealth communication service

10 Jan 2012
In an exciting step forward in the area of eHealth Australian companies Global Health and GP2U Telehealth today announced an exclusive collaboration combining Global Health's secure messaging platform ReferralNet with the new GP2U Telehealth video conferencing service.
The combined service provides a simple, highly secure, easy to use and more importantly, interoperable Telehealth solution which allows Australian health professionals and specialists to make video conference consultations freely available to GPs and their patients.
Telehealth is where a patient and specialist undertake a consultation via video conference in real time. While video conferencing may never replace the need for face to face consultations, in some circumstances it is acknowledged that it is a highly desirable and valuable solution particularly for those situations where physical access to a specialist or health professional may be difficult or impossible for a patient.
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See eHealth in action in Canberra January 2012

Visit the the Model Healthcare Community in Canberra in January 2012 and see eHealth in action.
The Model Healthcare Community will be on display in Canberra in January 2012 at the Department of Health and Ageing, Sirius Building, Furzer Street, Woden from 16-20 January. Please click Click here to register for a tour.
It will then move to Calvary Hospital, Bruce for tours from 23-27 January - to register for a tour click here Click here
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Intel exploring ways to help Stephen Hawking speak

Racphael Satter
January 11, 2012 - 9:10AM
CAMBRIDGE, England – Intel is looking for ways to help famed British physicist Stephen Hawking reverse the slowing of his speech, according to a senior executive with the American chipmaker.
Hawking was 21 when he was diagnosed Lou Gehrig's disease, an incurable degenerative disorder that has left him almost completely paralysed. While an infrared sensor attached to his glasses translates the pulses in his right cheek into words spoken by a voice synthesiser, the nerves in his face have deteriorated and those close to him say his rate of speech has slowed to about a word a minute.
Speaking late Sunday on the sidelines of a conference celebrating Hawking's 70th birthday in the English city of Cambridge, Intel chief technology officer Justin Rattner said his company had a team in England to explore ways to help the celebrity scientist communicate more quickly.
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Survey throws light on the mysterious dark matter that holds the galaxies together

  • by: Jonathan Leake
  • From: The Times
  • January 09, 2012 12:00AM
DARK matter, the mysterious, invisible substance once seen as an astronomical oddity, could have helped form the entire cosmos - including our own Milky Way.
An international team of astronomers has spent five years building the most detailed map yet of the distribution of dark matter through the universe. Their findings suggest that the billions of stars that make up galaxies are held together only by the huge gravitational pull generated by clumps of dark matter.
The findings have emerged from the Canada-France-Hawaii Telescope Lensing Survey, which studied 10 million distant galaxies to measure how light from them had been "lensed" - bent by the gravitational pull of clumps of dark matter near its path.
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Milky Way teeming with 'billions of planets'

January 12, 2012
The Milky Way is home to far more planets than previously thought, boosting the odds that at least one of them may harbour life, according to a study.
Not long ago, astronomers counted the number of "exoplanets" detected outside our own solar system in the teens, then in the hundreds. Today the tally stands at just over 700.
But the new study, published in Nature on Wednesday, provides evidence that there are more planets than stars in our own stellar neighbourhood.
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Enjoy!
David.

Sunday, January 15, 2012

From This We Can Really Grasp Just How Hard A National E-Health Program Can Turn Out To Be! Way Beyond NEHTA / DoHA Can I Suggest!

The following paper appeared recently. The Abstract follows and the link below provides access to the full paper and a .pdf file.

Why National eHealth Programs Need Dead Philosophers: Wittgensteinian Reflections on Policymakers’ Reluctance to Learn from History

Trisha Greenhalgh, Jill Russell, Richard E. Ashcroft, and Wayne Parsons
Queen Mary University of London
Context: Policymakers seeking to introduce expensive national eHealth programs would be advised to study lessons from elsewhere. But these lessons are unclear, partly because a paradigm war (controlled experiment versus interpretive case study) is raging. England’s $20.6 billion National Programme for Information Technology (NPfIT) ran from 2003 to 2010, but its overall success was limited. Although case study evaluations were published, policymakers appeared to overlook many of their recommendations and persisted with some of the NPfIT’s most criticized components and implementation methods.
Methods: In this reflective analysis, illustrated by a case fragment from the NPfIT, we apply ideas from Ludwig Wittgenstein’s postanalytic philosophy to justify the place of the “n of 1” case study and consider why those in charge of national eHealth programs appear reluctant to learn from such studies.
Findings: National eHealth programs unfold as they do partly because no one fully understands what is going on. They fail when this lack of understanding becomes critical to the programs’ mission. Detailed analyses of the fortunes of individual programs, articulated in such a way as to illuminate the contextualized talk and action (“language games”) of multiple stakeholders, offer unique and important insights. Such accounts, portrayals rather than models, deliver neither statistical generalization (as with experiments) nor theoretical generalization (as with multisite case comparisons or realist evaluations). But they do provide the facility for heuristic generalization (i.e., to achieve a clearer understanding of what is going on), thereby enabling more productive debate about eHealth programs’ complex, interdependent social practices. A national eHealth program is best conceptualized not as a blueprint and implementation plan for a state-of-the-art technical system but as a series of overlapping, conflicting, and mutually misunderstood language games that combine to produce a situation of ambiguity, paradox, incompleteness, and confusion. But going beyond technical “solutions” and engaging with these language games would clash with the bounded rationality that policymakers typically employ to make their eHealth programs manageable. This may explain their limited and contained response to the nuanced messages of in-depth case study reports.
Conclusion: The complexity of contemporary health care, combined with the multiple stakeholders in large technology initiatives, means that national eHealth programs require considerably more thinking through than has sometimes occurred. We need fewer grand plans and more learning communities. The onus, therefore, is on academics to develop ways of drawing judiciously on the richness of case studies to inform and influence eHealth policy, which necessarily occurs in a simplified decision environment.
Keywords: eHealth, policymaking, case study, ethnography, evaluation, Wittgenstein, sensemaking, learning community.
Here is the link to the full (free) paper.
The paper needs to be carefully read two or three times as there is a huge amount of information in it, and it is by no means an easy read.
These two sentences from the abstract seem to say it all!
“National e-Health programs unfold as they do partly because no one fully understands what is going on. They fail when this lack of understanding becomes critical to the programs’ mission.”
It seems to me that having most of us not understanding just what is going on has actually been a managerial strategy for NEHTA and DoHA and that it is now really coming back to bite them!
I must say that I find a great deal of what is said very compelling. As I read it, the authors clearly recognise the complexity of healthcare and also recognise that deployment of technology within such an incredibly complex beast is not something that can be planned in a fully rational mechanistic way without recognising that the health ecosystem (and the breadth of stakeholders) defies simple rationally driven imposition of technology.
The section discussing “A Case within a Case: The Newtown Integrated Records Pilot” in the paper seems to me to be utterly typical of how apparently simple interventions can wind up in frustration, mis - communication and ultimately a sense bordering on despair. It is just too painful to read!
Seldom was the following more apt:
Those who ignore history are doomed to repeat it. —George Santayana (1863–1952)
To me part of the problem in all this is both the usual lack of leadership and governance but also a failure to remember just why the effort is being attempted.
There is only one reason for e-Health implementations to be undertaken and that is to improve the quality, safety and efficiency of the care each of us receives from the health system. Until NEHTA and DoHA get back to focussing on that simple proposition we are all in deep dodo.
All we see is a focus on systems, standards and technology and no clear exposition of the why we are doing this and what the evidence is that this is the right thing to be doing.
Until we step back from the mad helter skelter rush to have operational an ill-conceived and overly complex system those running the PCEHR program will be guilty of simply not bothering to learn from elsewhere.
That the Secretary of the Federal Department of Health can claim essentially we need to do it this way because we are different - as she did at a recent Senate Estimates Hearing - displays the sort of hubris that guarantees failure.
It has always been a source of amazement to me that the analysis of overseas National E-Health programs in the recently released ConOps ran to 2-3 pages. It should have been 20 times that - so anyone could have any confidence any lessons have been learnt!
David.