Quote Of The Year

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

or

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

Thursday, June 28, 2012

The Design For the NASH Smartcard Leaks!

I am assured this is a late working draft of the NASH Smartcard.

We always have the freshest news here.Otherwise how would such a still evolving plan get out?


Here is the Smartcard design coming to the pocket of a healthcare provider near you some time! How soon is anyone's guess.

(Click on Card For a Larger View)

On a totally separate matter we are hearing lots of rumours that there is a mad push to have some way of online registration for the NEHRS / PCEHR on Sunday 1, July 2012 at exactly 1 minute past 12. I won't be staying up put people are welcome to see if it is true!

Enjoy.

David.


Wednesday, June 27, 2012

One Week Out From The NEHRS / PCEHR We Need To Grasp Just How Badly NEHTA Has Performed. See For Yourself How Claims And Reality Contrast.

With us being just under one week out from the start of the new national E-Health Record System it seems reasonable to ask if there is any chance of real delivery of the NEHRS Program.
The National Authentication Service for Health (NASH) has become a poster boy for just not actually seeming to make a great deal of progress over what seems like geological time.
Here is the NEHTA blurb produced regarding NASH dated 6/6/2008.

National Authentication service for health (NASH) - June 2008



In this electronic age, where significant amounts of sensitive and personal information are being sent electronically, there is a need to guarantee the authenticity and validity of the information being exchanged.

When the information being transferred is your personal medical information, there is an even greater imperative to ensure that information is collected and securely electronically exchanged only by those authorised to do so.

The National Authentication Service for Health (NASH) project being delivered through NEHTA will deliver the first nationwide secure and authenticated service for healthcare organisations and personnel to exchange e-health information.

Together with clinical terminology, messaging standards and unique healthcare identifiers, the NASH will provide one of the fundamental building blocks for a national e-health system, as well as providing security credentials for use at the organisational and local level.

NASH & the Authentication Vision

The vision for authentication in the Australian health sector is that provider authentication should use a strong credential (smartcard with PKI certificate) issued by a NASH-accredited organisation. All e-health transactions and records that need to be electronically signed will use standard credentials.
The goal is to issue NASH credentials to all healthcare professionals over the next five years.
NEHTA‘s vision for NASH is:
  • A healthcare community and professional smartcard system that supports and facilitates the use of e-health information, for example unique healthcare identifiers and the individual electronic health record (IEHR), within the whole Australian community.
  • Coordination of smartcards and reader supply arrangements for health professionals and employees.
  • Provision of support for the smartcard implementation and operation to jurisdictions, software vendors and end users.
  • Design and delivery of support arrangements that meet the needs of jurisdictions and software vendors.
  • Provision of a trusted authentication service that addresses the data protection and privacy requirements of stakeholders and regulators.

What will the future look like with NASH?


Once the NASH is operational, healthcare workers will insert their smartcard into a slot in their desk top computer and enter a PIN. Once accepted this should be sufficient to meet the majority of their daily authentication requirements.

Mobile workers such as nurses will use their smartcard as they move from one workstation to the next, with not only immediate and convenient access to information systems but also session portability. Their NASH smartcard will enable them to seamlessly send and receive secure health messages and attached digital signatures.

It will be possible to add new credentials during the life of the smartcard at any time in response to initial and new/changed authentication requirements. Such credentials will be added to the card by authorised local staff, or by using an automated online service.

More than just a PKI and smartcard!

The NASH will provide:
  • The technology, infrastructure, frameworks, processes and support services to enable health organisations to issue credentials within their own community of interest.
  • Information and support about the use, integration and support of NASH credentials for software vendors and jurisdictions.
  • Provision of robust setup and on-boarding processes for credential issuing points that protect the integrity of the overall scheme.
  • Provision of a governance mechanism that will enable jurisdictional participation in the operational policies and services.
  • Provision of support to software vendors and jurisdictions in transitioning existing systems to use the NASH.
NASH credentials can be used for whatever purpose is deemed suitable by the issuing community, for example signing electronic prescriptions, hospital discharges, hospital admissions, or government reports. By leveraging the national infrastructure, participants can also strongly authenticate and securely exchange health information.

Implementation Approach

As the NASH is a foundation service for wider e-health initiatives, it will be designed, developed and operated in collaboration with the healthcare community at all stages
of implementation. The following milestones are likely, with detailed timelines being developed with our stakeholders:
  • 2008 – NASH specification, design and build test and development environments, develop software interface specifications.
  • 2009 - Deployment commences through early adopter organisations and through software vendor adoption.
----  End Blurb
We all know essentially zilch has happened since with no real implementation progress really having been made and interim approaches now being used.
And from August 2006 we have a just wonderful FACT SHEET.

 A NATIONAL APPROACH TO SHARING HEALTH INFORMATION - August 2006

 Background

NEHTA Limited is a not-for-profit company established by the Australian Federal, State and Territory governments in July 2005 to develop better ways of electronically collecting and securely exchanging health information.
Electronic health information (or e-health) systems that can securely and effectively exchange data can significantly improve how healthcare providers communicate important clinical information about patients. As a result, e-health systems have the potential to unlock substantial healthcare quality, safety and efficiency benefits.
People require health care throughout the course of their lives, regardless of where they are. However, the ability of healthcare professionals to access up-to-date health information about an individual whenever and wherever necessary, is limited and fragmented. This is due to the shortcomings of paper-based records, or, where computerised clinical records are available, the inability of these records to be shared across different computer software systems. This results in individual points of care becoming ‘islands of information’.
Lack of timely access to relevant information increases the risk of individuals not receiving appropriate care. For example, the 1994 Quality in Health Care study concluded that there was a clear link between avoidable deaths in hospital and communication problems and poor record keeping. It also results in an accumulation of inefficiencies in the health care system, such as the unnecessary repetition of diagnostic tests.

Establishing national foundations

The sharing of health information is best addressed through a national approach.
NEHTA is therefore establishing the national foundations to Shared Electronic Health Records (SEHRs) – records which will contain selected health information about an individual, which can be shared between multiple points of care while maintaining high standards of privacy and security.
The primary purpose of the SEHR will be to improve the quality and safety of healthcare experiences. Secondary purposes of the SEHR include public health and policy planning, and supporting safety initiatives, disease detection, research and education.
The national SEHR approach will involve the creation of one (or more) SEHR Service(s), which will maintain, and provide access to, the SEHR of those individuals who choose to participate in that Service.
Healthcare providers and organisations will be able to contribute information to an individual’s SEHR by keeping electronic records of patient interactions, and using software which is compatible with the SEHR Service(s). This software will allow healthcare providers to maintain their own detailed records, while ensuring that the most critical information can be easily included in the individual’s SEHR, without the need for double data entry. Providers will also be able to see summarised views from the individual’s SEHR.
The national approach to SEHRs provides an opportunity for vendors to create solutions that are capable of bridging the gap between the needs of particular clinical groups/specialities and the broader care continuum supported by the SEHR Service(s).

NEHTA’s SEHR Contribution

NEHTA’s work program is currently centred on producing specifications and standards for the SEHR, including:
  • Recommending SEHR standards for adoption in the Australian health sector. NEHTA has retained an independent e-health consultant to review the standards being developed around the world. From this NEHTA will define the structure and content of SEHRs; assess their use and potential impact on future Australian developments; and recommend the most appropriate SEHR specifications for adoption.
  • Defining requirements for a national approach to SEHRs. NEHTA is developing, for consultation, operating concepts for a national approach to SEHRs. Based on these operating concepts, the requirements for a national approach to SEHRs will be defined and a privacy impact assessment process will be undertaken.

Relationship to other NEHTA Initiatives

NEHTA currently has a number of initiatives underway to deliver secure, interoperable e-health systems, many of which are highly relevant to NEHTA’s SEHR work. This includes:
  • Establishing standard clinical terms for diagnoses, medicines, treatments and therapies so that one e-health system can understand the information produced by another system;
  • Setting standards for the types of priority clinical information – for example, discharge summaries, referrals, etc. - to be communicated by e-health systems;
  • Identifying a secure means of electronically transferring clinical information - such as prescriptions for example - between authorised healthcare professionals in a way that maintain privacy;
  • Establishing an overall framework for how the various e-health systems interoperate;
  • Developing unique identifiers for individuals and healthcare providers to ensure that the information is attributed to the right patient and the right provider;
  • Developing a framework for involving local and international standards organisations, to support implementation; and
  • Pursuing opportunities for supply chain reform across the health sector – supporting the purchasing of medications and medical devices in particular.
For further information go to www.nehta.gov.au.
----- End Fact Sheet.
I leave it as an exercise for the reader to see just how much of this now six year old plan - that has had NEHTA funded to the tune of hundreds of millions of dollars has actually been delivered in any real and clinically meaningful sense.
It really would have the be the ‘triumph of hope over experience’ to hope all this will come right over the next two years for which funding has been apparently provided.
Without dramatically improved leadership and governance frameworks we are just wasting time and money.
David.

Tuesday, June 26, 2012

It Has Taken Me Many Reads To Figure Out Just What A Fiasco This News Conveys. It Is Just Amazing.

The following appeared today.

Leading e-health sites to undergo $52m record transition

THE Gillard government will spend $52 million transitioning work done at three lead sites to the new personally controlled e-health record system over the next six months.
Three former GP divisions (now rebadged as Medicare Locals) -- in Brisbane North, Hunter Valley, NSW and in Melbourne East -- each received $5 million in mid-2010 to implement software supporting the PCEHR system and to trial the use of records by doctors and patients.
.....
A Health Department spokeswoman said the National E-Health Transition Authority had been given $51.8m in order to "support transition of the lead e-health sites to the PCEHR infrastructure over the next six months".
"This transition is occurring progressively until December," she said.
A further $33.4m had been paid to NEHTA as the commonwealth's half-share of the body's COAG-funded work program for the next financial year, the spokeswoman said.
The rest of the article can be read here:
What on earth is going on here?
Why were the lead sites not built to the specifications required to fit the PCEHR Infrastructure first off?
What on earth went wrong with the overall project co-ordination and planning?
Why do the sites now seem to need the three times the original allocation over just six months - when they have been doing all this for the last 18 months or so?
When did they suddenly figure out it was all falling in an utter heap?
What about all the other Wave II sites - how much extra are they going to cost? Even if they are covered in this sum it is still an awesome cost overrun. (Wave 1 was initially allocated $12.5M and the 9 Wave 2 Sites received $55M as I recall)
All I can say this whole thing is a runaway train-wreck.
The Australian also has a lot more - given the PCEHR Start-up next week.
Go here:

Underdone e-health record system set for launch

and here:

Fact and fiction of e-health changes

to browse.
Amazing stuff you could not make up. A bit like the Greek PM and Finance Minister not turning up for the Eurozone Summit at the end of the week because they are in hospital. I wonder why? Someone must have shown them the books!
David.

Monday, June 25, 2012

Weekly Australian Health IT Links – 25th June, 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

There was really only one bit of news this week - and that was the passage through both houses of the PCEHR legislation.
Now all we have to just wait and see what is delivered in about a week or so and to see, after a year or so if there is any measurable impact on the health of the Australian populace.
I would be interested to hear from readers any suggestions for metrics we could use to assess the success or not of the overall program.
-----

Plotting a path to the PCEHR

Electronic health records go “live” on 1 July. Will everything change?
The much trumpeted personally controlled electronic health record (PCEHR) officially launches on 1 July, but if you’re feeling a little underprepared, you’re not alone.
The $467 million project to provide a seamless source of patient health data has hit a few obstacles along the way.
As a result the PCEHR  “go-live” date is likely to pass by quietly and without fanfare - something most medical practitioners will be grateful for.
There are a few hoops to jump through to participate in the PCEHR: once a practice is registered, doctors will need to familiarise themselves with the web-based system, upgrade their clinical software to integrate with the system and, ultimately, create and manage patients’ shared health summaries.
-----

Defiant doctors force e-Health backdown on PCEHR liability

TWO weeks before the introduction of the Gillard government's $1 billion e-Health scheme not one medical practice has signed up to use it, forcing Canberra to back down on a move to compel doctors to accept full liability for problems with the initiative.
The Department of Health and Ageing this week agreed to remove contentious contract conditions that would have made doctors liable if one of their employees leaked information contained in a patient's electronic health record.
It has also amended a clause that would have allowed government officials to raid surgeries and remove computers and records when a breach of the e-Health system was being investigated.
-----

Medical insurers still refusing to endorse e-health records

18th Jun 2012
A HEALTH department backdown has freed GPs of liability for “compromised or hacked” e-health records but the government is still demanding GPs obtain permission from the author of every document they upload to the system before doing so.
The issues of liability and intellectual property management are the main impediments to medical insurers endorsing the participation agreement practices will be required to sign in order to use the system.
MDA National president Professor Julian Rait told MO the department had agreed last week to waive its original demand that practices accept liability for the security of the system but had yet to provide a solution to the problem of how to handle intellectual property issues.
“Under the PCEHR bill… a GP would have to obtain consent from the author [of a specialist report, for example] before uploading any document to the system, which would be an absurd level of work,” he said.
“We don’t have an easy answer for [how intellectual property issues should be resolved], but until it is worked out, we won’t recommend our clients be involved.”
-----

Last minute talks trigger 'breakthrough' in e-heath endorsement

21st Jun 2012
DOCTORS' groups and MDOs are ready to endorse the government’s e-health records contract almost three months after MO’s report on the first draft of the contract sparked outrage across the profession.
In April, MO reported AMA secretary general Francis Sullivan had warned the department that the first draft of the participation agreement was so onerous it would “deter every medical practice in Australia from participating”.
The draft agreement required practices using the system to assume all legal liability and to grant government officials unrestricted access to their premises and records, while GPs were required to obtain permission from the author of every document they uploaded.
-----

E-Health: are we ready for this brave new world?

On July 1, Australia is going to "change the world", "dive in the sand" and "realise the dream".
The date represents "our big chance to make a difference", and apparently we have to compare it to "putting a man on the moon". Exciting, isn't it? Surely we are finally going to Mars, initiate world peace or establish brotherhood amongst men? Or not, of course.
When Peter Fleming uttered these inspirational words last August, he was unfortunately not talking about finding a cure for cancer, but about the start of a national electronic health system in Australia.
-----

e-health record grinds to July deadline

Ten days from now Australians should be able to sign up for a personally controlled electronic health record – the centrepiece of the Federal government’s e-health programme which has already cost it $467 million. However the peak body representing GPs in Australia has yet to finalise the terms and conditions for healthcare providers actually using the records and a $23 million key security system being built by IBM won’t be ready by 1 July.
The Government has always said that from 1 July 2012 Australians would be able to opt in and sign up to have their own PCEHR. While that deadline is still in place it now seems likely that while Australians will be able to register for a PCEHR, they won’t be able to do much more.
-----

E-health record service delayed by incomplete infrastructure

PLANS for Health Minister Tanya Plibersek to mark the start of the $1.1 billion e-health record service are on hold, as key parts of the system are not ready for the much-feted July 1 launch.
Sources who declined to be named say a ceremony planned at St Vincent's Hospital in Sydney on Monday, July 2 -- the first working day of the new system -- has been cancelled.
The minister's office was tight-lipped when The Australian asked whether the event had been postponed to a later date.
"We look forward to the launch of e-health, an important government reform that will cut down on medical errors and mean patients won't have to repeat their medical history every time they see a new doctor," her spokesman said.
-----

Jobs may go as Health Solutions Group abandoned by Microsoft in favour of joint venture

MICROSOFT has confirmed it is ditching the Australian operation of its Health Solutions Group as it shifts gears to a joint venture with General Electric.
The joint venture, announced in the US last year, aims to offer platform support along with system-wide crunching of data to assist organisations manage health data across populations.
Microsoft's Health Solutions Group in contrast mainly sought to sell software tools aimed at "people, clinics, hospitals, research institutions, and governments", according to Microsoft's website.
-----

E-health 'bank-strength' secure, but online registration scrapped

20th Jun 2012
THE government has assured consumers the national e-health record system would feature “bank-strength” security, but grudgingly admitted online registration has been scrapped, as its e-health legislation passed the Senate last night.
Coalition senators supported the legislation but raised a number of concerns about the implementation of the system and the security of patient information.
Parliamentary Secretary for Disabilities and Carers Senator Jan McLucas assured consumers’ privacy and security were “fundamental to the effectiveness of an e-health record system”, which she said would have “bank-strength security features, including extremely strong encryption and firewalls”.
-----

E-health records' security at risk

Fran Molloy
June 19, 2012 - 11:18AM
The national electronic health record database to be launched on July 1 has both medical and security experts calling for better e-health controls.
Australia has no co-ordinated approach to e-health safety and security – and with the national Personally Controlled Electronic Health Record (PCEHR) just weeks away, the risk of a safety crisis is growing daily.
People who choose to register for a PCEHR from July 1 will have access to a range of their medical data from Medicare, and over time also doctor's summaries, pathology results, scans and prescriptions.
-----

E-health records laws pass Parliament

BILLS governing the operation of the personally controlled e-health record system have been passed just 10 days before the scheme is set to go-live, albeit in a limited capacity.
After the PCEHR Bills were passed by the Senate with 32 amendments on Monday, the lower house has today agreed to the changes.
Health Minister Tanya Plibersek said it was "a once in a generation opportunity to deliver these important reforms" and "make it easier for consumers to receive the right care when and where they need it".
Coalition e-health spokesman Andrew Southcott said the opposition would not oppose the "sensible" amendments, which arose from the Senate inquiry into the PCEHR Bills requested by the opposition.
-----

E-health records laws pass Parliament

  • From: AAP
  • June 19, 2012 8:52PM
PATIENTS will no longer have to repeatedly re-tell their medical histories to doctors after legislation passed Parliament to set up an electronic health record system.
The Federal Government says the system will bring the management of health records into the 21st century and provide life saving information in emergencies.
The legislation passed the Senate this evening with the support of the Coalition despite the concerns about privacy from some Opposition senators.
-----

E-health laws pass parliament

By AAP, ZDNet.com.au on June 20th, 2012
The legislation required to set up the government's planned personally controlled electronic health record (PCEHR) system passed parliament yesterday.
The Federal Government said that the system will bring the management of health records into the 21st century, and will provide life-saving information in emergencies.
The legislation passed the Senate with the support of the Coalition, despite concerns about privacy from some opposition senators.
The system aims to reduce the number of hospital admissions from medication errors, which equate to around 190,000 per year, as well as cutting down on medical errors because of inadequate patient information.
-----

PCEHR passes Senate after sides lay cards on table

The Australian Senate has passed legislation necessary for the PCEHR to be instituted as part of Australia’s health system. The go ahead followed a debate where Labor, Opposition and Greens Senators summarised their stance on the major national ehealth reform.
Labor senator Carol Brown restated the need for the PCEHR as part of an “accountable, affordable and sustainable” future for healthcare, while senator Jan McLucas defended the development of Labor’s handling of implementation, saying there had been “extensive consultation with clinicians, consumers and the health IT industry.”
-----

Website to help paramedics avoid hospital bottlenecks

Updated June 21, 2012 07:55:21
SA Health will set up a real-time monitoring system aimed at improving the flow of patients from ambulances to hospital emergency departments.
It will advise on the number of patients being treated, average waiting times and the occupancy and expected discharge times for inpatient beds.
The website will go live on Friday and is similar to other emergency department and inpatient information available electronically.
-----

AMA calls for e-Health penalty delay until 2014

THE withdrawal of incentive payments to doctors who fail to sign up to the e-Health scheme must be delayed until 2014, says the AMA because of the multiple problems dogging the scheme ahead of its July 1 launch date.
Australian Medical Association president Dr Steve Hambleton said as things stood doctors would be penalised for failing to sign up to a system that is far from operational.
Eleven days before the launch of the new system that will see patient medical records digitalised, legislation underpinning it is still before the parliament.
The system needed to authenticate the identity of doctors using it is not ready and no doctors are signed up to use it.
-----

Call to delay cuts to e-health PIP

20 June, 2012 AAP and Paul Smith
Moves to pull up to $50,000 in funding from general practices who do not sign up to the personally controlled electronic health record (PCEHR) should be shelved because of the delays blighting its rollout, the AMA has urged.
The Federal Government announced in the budget that practices would not receive any e-health Practice Incentives Program payments from next February unless their IT infrastructure was compatible with the $467 million PCEHR system. About 4200 practices currently claim the incentives.
-----

e-Records database slated for a slow, incomplete start

Fran Molloy
May 28, 2012
The July 1 launch of the national Personally Controlled Electronic Health Record (PCEHR) is likely to be more fizz than fireworks, with only data from Medicare available to new registrants.
More functionality is expected later in the year, provided the government-funded National eHealth Transition Authority (NEHTA) can placate various interest groups including the doctor's lobby group Australian Medical Association (AMA).
"Given what was attempted in the timeframe, it wasn't reasonable to expect a sophisticated solution would be available by July 1," says Medical Software Industry Association (MSIA) President, Jon Hughes.
-----

E-health boost in Tassie bail-out

By Suzanne Tindal, ZDNet.com.au on June 18th, 2012 
As part of a $325 million rescue package for the Tasmanian health system, Health Minister Tanya Plibersek has pledged $36.8 million to roll out the government's planned personally controlled electronic health record system.
The Federal Government decided to reach out a helping hand to Tasmania, because the state's system wasn't coping with its older population and higher rates of chronic disease. Funding has been found for areas of need, including additional surgery facilities, chronic disease management and training, as well as e-health.
-----

$11.5 billion PCEHR benefit conservative: Deloitte

The organisation responsible for the federal government's economic modelling of the personally controlled electronic health record (PCEHR) has confirmed the business case for the national system is strong.
Adam Powick, lead partner of Deloitte Australia's Consulting practice, told eHealthspace.org the recently released figure of $11.5 billion in benefit to Australia by 2025 is an estimate based on global research and robust economic modelling.
-----

Victorian Government moves to fix Labor's $1.44b mistake

The Victorian Government has introduced the Victorian Information and Communications Technology Advisory Committee to provide advice on a new ICT strategy.
The Victorian Government has moved to fixed key weaknesses in the state's ICT strategy following a critical report by the auditor-general on Victoria's ICT frameworks and policies.
The revised strategy follows the November 2011 release of the Victorian Ombudsman's report into the state's ICT which slammed the then Labor government's management of ICT projects and investments.
Assistant treasurer, Gordon Rich-Phillips, said the revised ICT strategy will align processes across departments with a clear set of governance, accountability and direction.
-----

New Vic Govt strategy to end IT disasters

By Suzanne Tindal, ZDNet.com.au on June 21st, 2012
The Victorian Government has started work on a whole-of-government IT strategy, in an attempt to avoid wasting taxpayers' money on over-budget projects that have missed deadlines.
"The previous Labor government adopted a piecemeal approach to ICT that saw at least $1.44 billion of taxpayers' money wasted in cost blowouts on projects like HealthSMART, Myki and the LEAP database," Victorian Minister for Technology Gordon Rich-Phillips said.
-----

Coalition to support e-health bills in Senate

THE opposition will support passage of the Gillard government's legislation for its $1.1 billion personally controlled e-health record system in the Senate, but expects a debate over amendments to be tabled today.
Opposition e-health spokesman Andrew Southcott said the Coalition would not vote against the legislation in the Senate, "consistent with what we did in the House of Representatives".
He told The Australian: "We are supporting this legislation, but we do think it should be debated.
-----

Hospital league tables likely within months

THE National Health Performance Authority's chief Diane Watson says she's determined to name and shame underperforming hospitals, and will start publishing hospital league tables and mortality rates later this year.
"Our role is to create competition among the leading hospitals about who will be No 1," she tells Weekend Health.
"I want to point the community to where they need to work with organisations (hospitals and Medicare locals) on lifting their game."
Watson was appointed to head the new watchdog a week ago and her work at the Health Council of Canada and the NSW Bureau of Health Information makes her an expert on how health organisations try to dodge accountability.
-----

Evidence-based medicine

19th Jun 2012
This week’s Update explores the efficacy of evidence-based medicine in clinical practice.
INTRODUCTION
What is the evidence for evidence-based medicine?
Unfortunately, this is a very common question and one that is asked most often by a cynical member of the audience looking to score a point at an evidence-based medicine (EBM)
workshop.
On the other hand, answering this question is a good chance to highlight the main issues involved in this topic.
-----

Microsoft announces its own tablet computer at keynote in Los Angeles

MICROSOFT has announced it will release its own line of tablet computers at a keynote event held in Los Angeles this morning.
The new line of tablets is called Surface, and will come in ARM and Intel processor versions with the Intel version sporting a Core i5 Ivy Bridge processor.
The Surface has a 16x9 inch format, a magnesium case, USB 2.0, weighs 675 grams and is 9.3 mm thick.
It has a 1080p full HD display and has two digitisers, one for touch and one for digital ink.
It also has a unique multi-touch keyboard cover called the touch cover that snaps to the device like an iPad cover, but has an integrated keyboard. The touch cover includes an accelerometer that can deactivate the keyboard when it is folded back.
-----
Enjoy!
David.

AusHealthIT Poll Number 127 – Results – 25th June, 2012.

The question was:
What Chance Do You Give The NEHRS / PCEHR Program Of Surviving A Change Of Government?
Really High
- 5 (9%)
Pretty High
- 10 (19%)
Neutral
- 6 (11%)
Pretty Low
-  8 (15%)
Very Low Indeed
-  22 (43%)
Votes : 51
Good response and it looks like the majority are not all that optimistic about the program surviving a change of Government. Given the comments in Parliament I have to agree.
Again, many thanks to those that voted!
David.

Sunday, June 24, 2012

Is Our Democracy Up To Addressing Complex Technical Problems Sensibly? I Fear It Might Be Struggling.

Over last week I provided reports on the Hansard Record of the debate in the Senate and Reps on the PCEHR Legislation which saw the Bills passed last Thursday - 21 June, 2012.
There reports are found here:
and here:
and provide links back to the formal Government record.
In thinking about what went on I found myself asking is the adversarial political system we have well equipped to manage a topic so riddled with complexity, risk and expense as the PCEHR program.
At first blush you would have to say that maybe things could have been handled a great deal better.
The process of having the Government come up with a proposal that then is presented to the Parliament as some legislation (missing some important clarity around exact regulations etc. which are still causing considerable angst as recently as a few days ago) which then results in a brief enquiry and multiple submissions, which seem to have largely been ignored in terms of what finally becomes law, can hardly be an ideal way to handle issues of this sort I believe.
You can see how much concern there is about the heavy handed way DoHA has gone about things with recent articles like this.

Defiant doctors force e-Health backdown on PCEHR liability

TWO weeks before the introduction of the Gillard government's $1 billion e-Health scheme not one medical practice has signed up to use it, forcing Canberra to back down on a move to compel doctors to accept full liability for problems with the initiative.
The Department of Health and Ageing this week agreed to remove contentious contract conditions that would have made doctors liable if one of their employees leaked information contained in a patient's electronic health record.
It has also amended a clause that would have allowed government officials to raid surgeries and remove computers and records when a breach of the e-Health system was being investigated.
Full article here:
As late as Friday there was still no release of what is finally going be demanded that I am aware of.
What I find even more concerning is that there was no real process at the beginning of the PCEHR journey some two and a half years ago to properly research and frame an approach that might be ideal - despite having a well thought out National E-Health Strategy which at that point was unfunded and which did not in any way recommend what was then announced.
It is also a considerable worry that despite all sorts of concerns and recommendations from both the Opposition and the Greens that the legislation is just essentially ‘waved through’ without all the major concerns expressed both in submissions and by parliamentarians remaining, to my eye at least, unresolved.
I guess the issue is really whether this a systemic problem with non-experts attempting to manage complex technical and professional issues - in which case we need to work out how we can properly address highly technical matters via the present democratic processes - or is this just a poor Government which does not know how to correctly handle the resolution of stakeholder concerns in a reasonable way. Of course the third choice is that it is all fine, the system worked as it should and that the PCEHR Program is just ‘tickety boo’ in all aspects.  
In all this I would be the first one to admit I would be utterly clueless in trying to sort out issues like the Murray Darling Basin and the needed Nuclear Waste Dump where local vested interests seem to be able to endlessly delay and obstruct any real outcome. Both are clearly - among a host of others - clearly able to be rationally addressed based on the evidence but that does not somehow seem to be enough! Politics and very small sectional interests seem to be blocking the best overall outcome which is really needed.
What do readers think - is what we have fine - or do we, for complex technical issues, need a way to supplement the decision making capacities of Parliament for the good of all? If so how might this be done? You only have to watch European politicians trying to handle the aftermath of the GFC to see how technical and political complexity can lead to paralysis and potentially catastrophe.
David.

Saturday, June 23, 2012

Weekly Overseas Health IT Links - 23rd June, 2012.

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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10 Experts Give Tips to Combat Mobile Device Threats to Healthcare

Written by Kathleen Roney | June 13, 2012
Mobile devices offer a great deal of convenience as well as nearly unlimited applicability to patients, physicians and medical professionals. Mobile devices improve ease and efficiency of communicating with patients, collaborating with physicians, ordering prescriptions or drugs and inputting patient data during visits. In addition, many patients have been using mobile technology to access their medical information, refill prescriptions or make appointments.
Unfortunately, there is also a downside to mobile devices in healthcare — a greater vulnerability to data breaches. According to the report "Attack Surface: Healthcare and Public Health Sector," by the Department of Homeland Security, mobile devices face security threats such as spyware and malicious software, loss of treatment records or test results and theft of patient data. The portability of mobile devices also means they are easy to lose or steal.
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11 technologies pegged as best to tackle chronic disease

By Rene Letourneau, Editor, Healthcare Finance News
Created 06/13/2012
CAMBRIDGE, MA – Health policy institute NEHI has identified 11 emerging technologies that have the potential to improve care and lower costs for chronic disease patients, especially those in at-risk populations.
Each of the technologies are profiled in NEHI’s new report, “Getting to Value: Eleven Chronic Disease Technologies to Watch,” published with support from the California HealthCare Foundation. The report also identifies lessons learned about the role of technology in creating value and offers an overview of some of the barriers to adoption.
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Health IT, telehealth overlap

By Patty Enrado, Special Projects Editor
Created 06/12/2012
Insiders call for breaking down silos
SAN JOSE, CA – The telemedicine and health IT camps need to overcome their traditional way of operating in silos and develop partnerships to make a significant impact on improving the quality of care in the healthcare system.
If anyone is reaching out, however, it’s the telemedicine side, according to four industry executive panelists who spoke recently at the American Telemedicine Association 2012 Conference and Exhibition in San Jose, Calif.
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NY Accelerates State Health Information Exchange

Regional health information exchanges team up with IBM and other IT vendors to build the massive Statewide Health Information Network of New York.
In a bid to ramp up its statewide health information exchange, New York has corralled three Regional Health Information Organizations (RHIOs) and three health IT vendors to participate in the Statewide Health Information Network of New York (SHIN-NY).
As an increasing number of N.Y.-based private practices, nursing homes, clinics, and hospitals are using electronic health records (EHRs), many have connected their systems to RHIOs in their part of the state. These RHIOs collect health record data from the healthcare providers in their area, and, with patient consent, allow this information to be shared securely with other providers in the region.
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EHR design: A mold in need of breaking

June 13, 2012 | By Marla Durben Hirsch
Apparently I struck a nerve with last week's commentary on making the transition to electronic health records. The editorial generated quite a few comments, and every one of them were against EHRs.  They're expensive, become a crutch for the lazy or less-trained, and deter from direct patient-physician communication.  
There also was a recurring theme in the comments, which were thought-provoking and insightful: EHRs are designed poorly. Here are a few:   
"EMRs are plagued by problems and inefficiencies that harm [patient] care and potentially, security and privacy--some day when they are perfected and work the way physicians work, we will flock to them. That time is not now! Data access can be more convenient, but data entry is terrible."
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More docs questioning benefits of ACA, EHRs

By Erin McCann, Associate Editor
Created 06/14/2012
WATERTOWN, MA – Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years. 
The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based athenahealth and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practices sizes. 
This year's PSI tells a story of over-burdened physicians who are deeply concerned about where the healthcare industry is headed. The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices. 
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Consumer groups step up pressure on HIE security

June 13, 2012 | By Ken Terry
Consumers want the benefits of health information exchange, but they also wish to be assured that their personal health information (PHI) will remain private and secure, notes a new issue brief by Consumers Union and the Center for Democracy and Technology (CDT). The report, which was sponsored by the California Healthcare Foundation, recommends several ways to strike an appropriate balance between these objectives and also calls for stricter laws to protect PHI in health information exchanges (HIEs).
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Study: Computer Can Predict Drug Side Effects, Save Billions

June 11, 2012
Recent research has determined that a set of computer models can predict the negative side effects in hundreds of current drugs, based on the similarity between their chemical structures and those molecules known to cause side effects. The conclusion was driven by researchers at the University of California at San Francisco, and will appear in a paper in the journal Nature.
Led by researchers in the UCSF School of Pharmacy, Novartis Institutes for BioMedical Research (NIBR), and SeaChange Pharmaceuticals, Inc., it looked at how a computer model could help researchers eliminate risky drug prospects by identifying which ones were most likely to have adverse side effects. The researchers focused on 656 drugs that are currently prescribed, with known safety records or side effects. They were able to predict such undesirable targets — and thus potential side effects — half of the time.
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Telepsychiatry for Children Improved Symptoms, Halved ED Visits

A pilot telepsychiatry program for children significantly improved symptoms and cut emergency department visits in half, based on data from more than 8,000 patients over 2 years.
Health care costs will continue to rise, so new mechanisms are needed to combat the shortfalls in primary care medicine – including the limited number of child psychiatrists, said Alexander Vo, Ph.D., who presented the results in a webinar June 12.
"Telemedicine is the use of technology to deliver health care from a distance," said Dr. Vo of the University of Texas Medical Branch at Galveston. Faced with a shortage of pediatric psychiatrists in Texas and given a mandate to provide access to quality mental health and medical care, the University of Texas received a grant to develop pediatric psychiatry clinics for telemedicine.
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ONC to offer mobile device security tips

By Mary Mosquera
WASHINGTON – The Office of the National Coordinator for Health IT (ONC) will help small providers who use smart phones and other mobile devices learn how to easily secure them using simple steps explained in plain language.
Research shows that about 81 percent of physicians use smart phones or tablet devices. The small size of these devices make them easy to lose on subways and airplanes or stolen. Yet very few safeguard them, such as using encryption, making it easy for unauthorized users to access information.
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Thursday, June 14, 2012

Portals Hold Promise for Patient Engagement but Challenges Remain

Many believe that granting patients access to their medical information will lead to better quality and coordination of care. They contend that the easiest and most efficient way to provide this access is through portals. However, as in other areas involving health IT, there are challenges and fears.
Some challenges involve adopting and implementing technology or reconfiguring workflows to optimize benefits from portals. Other issues surround managing clinicians' concerns and expectations to gain support for this new way of communicating with patients.
Fears surrounding portals include the concern that patients will be slow to use them and that those who could benefit from better access to information won't take advantage. That worries IT executives, who fear that their ability to meet one proposed objective of Stage 2 of the meaningful use program lies outside their direct control.
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Thursday, June 14, 2012

Portals Hold Promise for Patient Engagement but Challenges Remain

Many believe that granting patients access to their medical information will lead to better quality and coordination of care. They contend that the easiest and most efficient way to provide this access is through portals. However, as in other areas involving health IT, there are challenges and fears.
Some challenges involve adopting and implementing technology or reconfiguring workflows to optimize benefits from portals. Other issues surround managing clinicians' concerns and expectations to gain support for this new way of communicating with patients.
Fears surrounding portals include the concern that patients will be slow to use them and that those who could benefit from better access to information won't take advantage. That worries IT executives, who fear that their ability to meet one proposed objective of Stage 2 of the meaningful use program lies outside their direct control.
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Discovery debuts e-health record app

By Admire Moyo, ITWeb's portals writer.
Johannesburg, 14 Jun 2012
Discovery Health has rolled out HealthID, the first electronic health record application of its kind in SA.
The company says the new app puts patients' health records in their doctors' hands, adding that electronic health records are at the heart of the application, where clinical information derived from claims data and pathology laboratories is stored.
With HealthID, doctors are able to access their patients' data and details of their previous doctors and hospital visits. Doctors can also view previously prescribed medicines, blood test results and patients' health measures such as body mass index and blood pressure.
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Centralizing healthcare big data in the cloud

June 12, 2012 11:44 AM EDT
Can the medical community make better use of big data, government regulations and the cloud to improve service and save lives? 
There is a lot of buzz going around about big data and cloud computing, but there is also a lot of confusion about how to incorporate them for an advantage. Cloud computing is all about providing services over the network, and big data is all about analyzing lots of data to gain insights and find trends. Government regulations are all about protecting the data and forcing the owners of the data to save it, just in case.
The problem is many folks are afraid of cloud-based solutions because they feel the data may not be secure, and sometimes big data may really just contain useless or redundant (what I call fat data), and regulations are just a pain to accommodate. There needs to be a better way.
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Tips to Improve Mobile Device Security

JUN 13, 2012 9:01am ET
ID Experts, a data breach prevention and remediation firm, talked with 13 experts and got 13 tips for managing mobile device threats in health care:
* Install USB locks on computers and devices to prevent unauthorized uploads and downloads;
* Consider software that can track and locate a device or wipe (erase) its data;
* Consider “brick” software that disables a missing device;
* Encrypt;
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New app maps patients' health risks

By Erin McCann, Associate Editor
Created 06/13/2012
WASHINGTON – IndiGO, an application developed by San Francisco-based Archimedes Inc., uses a patient's EHR and advanced algorithms to generate graphical analyses of that individual's health risks. The app brought its game face to last week's Health Data Initiative (HDI) in Washington, D.C., eventually walking away with a win.
IndiGO was presented with the "Best of Care Applications" award at the HDI event earlier this month for its ability to provide a graphical representation of a patient’s heart attack or stroke risk, chance of developing diabetes and the predicted impact of interventions, such as lifestyle changes and medications that are most effective at reducing these risks.
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Roundtable forecasts big changes for state HIEs

By Mike Miliard, Managing Editor
Created 06/13/2012
WASHINGTON – A new report from the HIMSS State Advisory Roundtable argues that state HIEs will need to adapt to changing approaches to reimbursement, evolving their mission and business models from "information exchange" to "coordination facilitation."
Convened about this time last year, the HIMSS State Advisory Roundtable comprises experts and advocates from state and federal governments, regional extension centers, health information exchanges and more. It seeks to target health IT issues that transcend state boundaries, helping enable different states advance their health IT programs.
Its inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.
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9 dos and don'ts of cloud computing

By Michelle McNickle, Web Content Producer
Created 06/12/2012
At this point, the trend toward cloud-computing is strong, even though some are still skeptical of its "chaotic" use and its ability to meet the needs of health IT professionals. Mariano Maluf, CTO at Atlanta-based GNAX, says now is the time to strongly consider the cloud – while keeping some basic tips in mind.
"The shifting IT landscape is prompting more and more questions around cloud computing models and their immediate value proposition," said Maluf. "Changes in work style and device formats, coupled with new application platforms and delivery methods, all coalesce to challenge the IT status quo."
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Telehealth, mobile systems among promising chronic care technologies

June 13, 2012 | By Dan Bowman
Home telehealth and extended care eVisit systems are among some of the more promising, available technologies, geared to fighting chronic care, according to a new report from the New England Healthcare Institute, a health policy research organization that focuses on enabling innovation in healthcare. The report highlights a total of 11 underused technologies that have the potential to lower costs and improve care quality for chronic care patients.
The technologies also are divided into four separate classes, with those that are on the edge of widespread adoption (home telehealth, extended care eVisits and tele-stroke) in Class I, and those that are promising but lack research to support clinical or financial benefit (in-care telemedicine, social media and mobile cardiovascular tools) in Class IV.
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June 12, 2012

Evolution in the C-Suite and the Evolving Role of the CMIO

A driving force in the evolutionary process is the need to adapt to new environments and changing situations. Healthcare is facing such an evolutionary process today and this change is reflected in C-suite transitions. While there is a great deal of change underway through healthcare reform and differing opinions on how to manage it, one thing seems clear—executive support for healthcare IT is here to stay.
Achieving meaningful use of electronic health records (EHRs) as part of the mission to improve outcomes has become one of the top strategic missions of most health systems. The increasing importance of healthcare technology in the strategic landscape is changing the manner in which hospitals operate. It also has accelerated the demand for a clinical IT skill set and physician IT leadership.
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Demographics, not practice setting, predict doctor tech use

While 81% of doctors go online, a report found which are most likely to use the most Internet communication strategies.

By Bob Cook, amednews staff. Posted June 11, 2012.
To find which physicians are most active on social media and other places online, one study says don’t look at the doctor’s specialty or practice setting.
The most consistent predictors of whether physicians used seven Internet-based communication technologies was whether the doctors were young, male and had teaching hospital privileges, according to a study posted online May 25 on the website of the Journal of the American Medical Informatics Association.
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Kalorama Tracks Mobile Medical App Market

JUN 12, 2012 5:25pm ET
The market for mobile medical applications was about $150 million in 2011, but that number will grow 25 percent annually for the next five years, according to market research firm Kalorama Information.
At best, medical apps top out at about 2 percent of the total app market, but the medical segment is growing a little faster than the 23 percent annual rate for the overall application market. Clinicians increasingly are using smartphones to perform some of the work previously done on a desktop or laptop computer, according to the firm.
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Catholic Health Initiatives to build enterprise HIE

By Patty Enrado, Special Projects Editor
Created 06/12/2012
ENGLEWOOD, CO – Catholic Health Initiatives is partnering with Orion Health to build an enterprise-wide HIE that will enable physicians and clinicians to access patient records across its 100 facilities in 19 states. Once connected, CHI plans to link to statewide HIEs in states where its 76 hospitals are located.
The second largest Catholic healthcare system in the U.S. will deploy Orion Health HIE to support its $1.5 billion OneCare program, which will create a shared, universal patient record documenting its more than 400,000 hospital admissions and nearly five million physician office visits annually.
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Health Care: A Not Too Distant Future

JUN 12, 2012 11:20am ET
Over my six-month hiatus from this blog, many things have changed in the health care industry. Two of the most significant have been the delay of the ICD-10 implementation and the Supreme Court’s review of the Affordable Care Act.
But one thing has stayed constant: We still seem to be struggling with two divergent views on how to improve health care in this country. Vested interests and ideologies are as deeply ingrained as they were six months ago, and the numerous studies and counter-studies may not have done much to shift opinion one way or another.
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Disruption, Not Destruction Will Save Medicine

Scott Mace, for HealthLeaders Media , June 12, 2012

No contemporary discussion about healthcare and tech is complete without addressing the work currently sitting on top of Amazon's Health Care Delivery bestseller list.
The book by Eric Topol, MD, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, published in January, supposes that a combination of patient activism and sheer technological innovation can largely get us out of our current healthcare mess.
I respect Topol's long track record in medicine, and his ability to crank out an entire, fact-filled book about the revolutionary changes technology is bringing to healthcare. But I'm leery of going as far as he does. As a book title from another bestselling  author on disruptive innovation suggests, healthcare definitely needs to be disrupted. But I would stop short of creatively destroying it.
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Data for GP comparison scores published

7 June 2012   Rebecca Todd
Data published today by the NHS Information Centre will be used to rank GP surgeries, which will be given an overall score out of ten based on patient experience.
The Department of Health says the information will help patients choose the right GP surgery and “help GPs and the NHS to make improvements to the way they do things.”
However, a BMA spokesperson says the rating system fails to take into account the different challenges that individual GP practices may face.
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Yorkshire e-consultation scheme extended

8 June 2012   Chris Thorne
An e-consultation system that helps specialists to decide whether GPs should refer a patient for hospital care is being extended.
Since 2007, Bradford and Airedale GPs using TPP’s SystmOne have been able to use the e-consultation service to seek advice from consultant nephrologists at Bradford Teaching Hospitals NHS Trust about patients with chronic kidney disease.
The service has since been expanded to GPs working across the NHS Airedale, Bradford and Leeds Primary Care Trust Cluster, and to a further five specialisms, with rheumatology joining the e-consultations catalogue imminently.
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Study links HIE use to less imaging in the ER

June 12, 2012 | By Susan D. Hall - Contributing Writer
Use of a health information exchange helped curb repeat imaging tests for headache patients who went to Memphis emergency departments, but didn't cut overall costs, according to a recent study.
Researchers from the University of Tennessee Health Science Center studied 1,252 adults who made at least two visits to Memphis ERs between 2007 and 2009. Patient records were shared through an HIE connecting 15 major hospitals and two regional clinic systems. Cases in which HIE records were used were compared with those that were not and the use of neuroimaging tests including CT, CT angiography, MRI or MRI angiography.
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Drug tracking database law passes in New York

June 12, 2012 | By Dan Bowman
Doctors in New York will be required to issue electronic prescriptions for painkillers within three years and will have to check patient records online before doing so after state legislators unanimously passed the Internet System for Tracking Over-Prescribing Act (I-STOP) yesterday. The bill establishes the creation of the real-time database, and also requires pharmacists to report when they fill such prescriptions, according to an announcement from state Attorney General Eric Schneiderman, who proposed the legislation in June 2011.
"With I-STOP, we are creating a national model for smart, coordinated communication between healthcare providers and pharmacists to better serve patients, stop prescription drug trafficking, and provide treatment to those who need help," Schneiderman said in a statement.
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U.S. Lags in Bettering Value of Healthcare

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: June 10, 2012
The U.S. faces major obstacles in the effort to document variations in health outcomes and improve clinical practice through value-based healthcare, according to a report from industry consultants.
While the U.S. health system has the highest per capita cost of the 12 nations studied -- spending 17.6% of its gross domestic product on healthcare -- it ranked at the bottom in terms of readiness to implement a value-based care system. The fragmented nature of the healthcare system has severely limited the collection and use of national health-outcome data.
In a value-based health system, variations in health outcomes are documented, leading to potential changes in clinical practice. "Making the data available allows clinicians to identify best practices and helps steer resources toward the clinical centers and specific clinical interventions that achieve the best results," according to a statement from the Boston Consulting Group that issued the report.
The report assessed the national health systems of 12 countries -- Australia, Austria, Canada, Germany, Hungary, Japan, the Netherlands, New Zealand, Singapore, Sweden, the U.K., and the U.S -- by the country's infrastructure to support value-based care and its ability to link health outcomes with costs.
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June 11, 2012

The App as Health Aide

By JULIE WEED
Travelers with chronic ailments like diabetes or high blood pressure have long struggled to remember when to take their pills as they cross time zones. Or they may have had a hard time finding emergency care in a foreign country or communicating about complicated health conditions.
But there are now a rapidly growing number of mobile health and medical apps that aim to deal with those types of situations.
Travelers can tap into technology before the trip begins, by storing information that can help ensure the right care is delivered if health issues crop up. Some put their medical history, latest EKG, chest X-ray or list of allergies and medications on a flash drive marked with a red cross, and attach it to a necklace, bracelet or keychain. Those who have had cardiac or other surgery may create a simple image using the free app drawMD for iPad devices that shows the exact location of a stent, for example, or an implant or bypass. For travelers who prefer a traditional method of communicating, a laminated card lists important information and physician contacts.
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mHealth: Embraced by developing world, resisted by developed countries

By Eric Wicklund, Contributing Editor
Created 06/08/2012
NEW YORK – A new study of the global mHealth market finds that consumers and developing countries are driving its growth, while physicians are reluctant to adapt.
Those are some of the conclusions drawn from “Emerging Health: Paths for Growth,” published by PricewaterhouseCoopers. The 48-page report, based on two separate surveys conducted by the Economist Intelligence Unit and analyzing 10 nations, indicates developing nations are quicker to accept and adopt telehealth because it’s seen as a way to increase access to healthcare, while developed nations like the United States are being dogged down by regulatory hurdles and a resistance to change among providers.
“Consumers are demanding and payers are willing to pay, but providers aren’t willing to provide,” said Christopher Wasden, PwC’s global healthcare innovation leader. “What we are going to need to do is get providers to think and act differently.”
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Blog Explores Immediate Chaos of Overturned Reform Law

JUN 11, 2012 11:50am ET
A posting on the KevinMD.com blog gives a sobering look at the challenges facing physicians--as clinicians, patient advocates and parents--if the Supreme Court rules the entire reform law unconstitutional.
The blog, from Bob Doherty, senior vice president of government affairs at the American College of Physicians, looks at provisions in the law that clinicians and patients take for granted now just two years after enactment.
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Another view: Neil Paul

A phone company has developed a smartphone that calls for help if its user collapses. That is just the start, says GP Dr Neil Paul.
29 May 2012
I recently saw a press release for a phone company that had developed a service that meant that if a person collapsed their phone would ring for help. I guess it works by utilising an accelerometer? A sudden bang and the program activates.
Combined with a GPS it sounds like a good way of alerting people. I can see it being useful for patients with strokes and epilepsy and, perhaps, for some people who are just frail and elderly and who want peace of mind.
I thought it was a clever idea and wondered what else could be done? At this point, I have to declare an interest, because I have thought about this before.
With a couple of colleagues I helped developed an iPhone app called iTennisElbow that we give away free. It’s meant to help you do your exercises for tennis elbow.
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Public health's 5 big data hurdles

By Kate Spies, Contributing Writer
Public health entities are inevitably sitting on massive data sets. Growing archives of stored patient records, population reports, and lab results are thrusting data volume measures into the petabyte scale.
Agencies, on average, currently store data that could require more than “20 million four-drawer filing cabinets filled with text,” according to MeriTalk’s recent report, ‘The Big Data Gap.”
The copiousness of big data doesn’t need any clarification, but the significance of it does – as health entities work to implement EHRs, convert to ICD-10, and reach meaningful use, the importance of grappling with big data needs to be defined.
Amongst the growing projects issued to the public health sector, what are big data’s challenges and what are its benefits?
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Debate over EHR value in patient care misses key point

June 10, 2012 | By Ken Terry
As more and more physicians adopt electronic health records, the debate over whether electronic health records actually improve the quality of care has risen to a new crescendo. Yet the discussion is not shedding much light on the key issues.
In the latest tit for tat, a new study in the Annals of Family Medicine found that type 2 diabetes patients in practices using paper records achieved better intermediate outcomes than did patients in practices with EHRs. In contrast, a recent paper in the New England Journal of Medicine showed that EHR-based practices provided better treatment and produced better outcomes for diabetes patients than did paper-based practices. And a paper presented at the recent American Association of Clinical Endocrinology meeting found that the use of an insulin order set in a hospital EHR improved glycemic control for hospitalized patients with diabetes.
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Diabetes registry has data on 1.1 million

Posted: June 8, 2012 - 3:15 pm ET
Researchers analyzing 15.8 million electronic health records contributed by 11 integrated health plans identified nearly 1.1 million people as having diabetes, and these patients' de-identified information is now part of a diabetes registry created by the plans.

The registry is the focus of an
article in the latest issue of the Centers for Disease Control and Prevention's Preventing Chronic Disease journal.
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OCR tells patients to use legal right to health data access

By Mary Mosquera
WASHINGTON – The administration’s top enforcer of health information privacy and security has issued an official reminder that patients have a legal right to access their medical records, and they should use it.
Patients can also print the single-page memo to take with them when they visit their provider to support their request.
Leon Rodriguez, director of the Office of Civil Rights, released the right to access memorandum to educate consumers on their legal right to obtain a copy of their health information. OCR enforces the Health Insurance Portability and Accountability Act (HIPAA) and oversees health information privacy in the Health and Human Services Department. 
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History's answer to increasing the use of computerized diagnostics

Joseph Conn
The year the dot-com bubble burst, 2001, the three largest pharmacy benefit management companies launched RxHub, an electronic prescribing network, and the two main pharmacy associations created its rival, Surescripts.
While the two exchanges battled for supremacy, both promoted the common cause, e-prescribing, as a patient-safety issue and funded a grind-it-out marketing campaign that cost millions of dollars to sustain.
I had lunch the other day with physician information technology leader Dr. Harry Greenspun, who recalled those days, saying, for years "you couldn't swing a dead cat" in health IT circles without hitting Kevin Hutchinson, Surescripts' then-omnipresent CEO.
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Monday, June 11, 2012

Electronic Quality Reporting Poses Major Challenges

One of the biggest barriers to meeting the Stage 1 meaningful use criteria for government electronic health record incentives has been the collection of data for clinical quality measures (CQMs). And, to judge by the statements of organizations representing health care providers and EHR vendors, electronic quality reporting and the software rewriting it requires may be even more difficult in Stage 2.
In its comments on the proposed rule for meaningful use Stage 2, the American Hospital Association told CMS that hospitals had encountered "significant difficulty" in using EHRs to do quality reporting in Stage 1. Citing "inaccurate e-specifications" for the electronic measures and "unworkable, but certified, vendor products," AHA asked CMS not to add any additional measures in Stage 2, but to help providers and vendors "get it right" on quality reporting.
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Tuesday, June 12, 2012
Patients' health records, containing the most sensitive of details, may be accessed by public and private doctors under a voluntary e-health scheme set to roll out in 2014.
This was confirmed yesterday by Secretary for Food and Health York Chow Yat-ngok.
Chow was addressing the Legislative Council health panel where results of a two-month public consultation on the voluntary Electronic Health Record Sharing Scheme were discussed.
"The information can only be accessed by medical staff who will protect the patients' privacy," Chow said. "It's a voluntary scheme in which patients can decide whether they want to join."
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Enjoy!
David.