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."

Sunday, July 29, 2012

Now Here Is A Must Watch Ten Minute Video. Enough To Have One Cringe!

The following appeared a few days ago.

EHRs call for tech etiquette in the exam room

July 24, 2012 | By Susan D. Hall
Just as a teenager zoned out on texting instead of listening can drive parents crazy, doctors who ignore tech etiquette in the exam room do so at their peril, according to an article at amednews.com. And no, it's not OK to respond to texts during a patient visit. 
The way a physician handles the disruption caused by consulting an EHR "can absolutely make or break the relationship between doctor and patient," said Larry Garber, MD, an internist and medical director of informatics at the Reliant Medical Group in Worcester, Mass.
Suffice it to say that the doctor's focus should be on the patient, not a PC or tablet. 
in fact, the article says, some medical school have gone so far as to make tech etiquette part of their curricula. Among the tips it offers:
·         Pay attention to exam-room setup. Avoid having your back to the patient while consulting on a PC or tablet. A triangle design putting the doctor, patient and PC in three corners can allow the physician to face the patient even while consulting the EHR.
·         Consult the EHR before entering the room. Never go straight to the PC. First greet the patient and set an agenda for the consultation. Then make a transition, such as "OK, let me jot down a few notes."
.....
To learn more:
- read the article
- watch the YouTube video
More issues and examples here:
Enough said. Watch be video and be both educated and horrified about just how badly it can be done. Just love the patient attempting to prescribe her own major analgesics because the clinician did not log off!
Enjoy.
David.

Saturday, July 28, 2012

Weekly Overseas Health IT Links - 28th July, 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.
-----

Thursday, July 19, 2012

Informatics: The Future

From the report: "There is a seismic shift in the way information can improve the experience, quality and outcomes of health and care services. Quality information will empower patients and other service users. It will enable a culture of shared decision-making – ‘no decision about me without me’ – and it will help us all to make more informed choices about the way we live our lives.
-----

When Medical Informatics Clashes With Medical Culture

What's the sense of having IT systems in place that can help cut medical costs if physicians ignore the price tag of the care they provide?
Ever ask your family doctor how much the test she just ordered will cost? Chances are she doesn't know. Physicians have been trained to provide the best possible care and to order whatever procedures they deem necessary to diagnose and treatment disease, regardless of the cost.
That philosophy is consistent with the Hippocratic oath, but as the nation tries to cope with its runaway medical tab, that philosophy requires close scrutiny. And it's especially important given all the IT systems in place that can help contain medical costs. AdTech Ad
-----

iPad, secondary-class LCD monitors equal for medical imaging

July 17, 2012 | By Dan Bowman
Apple's iPad is just as accurate as a DICOM calibrated secondary-class monitor for reviewing MRI images, according to research featured in the August edition of the journal Academic Radiology.
For the study, 13 American Board of Radiology board-certified radiologists examined 31 cases on both devices. Thirteen of the cases contained one of four presentations: spinal cord compression, cauda equine syndrome, spinal cord hemorrhage, or spinal cord edema. The remaining 18 cases served as controls.
-----

California HIE in revamp mode

By Patty Enrado, Special Projects Editor
Created 07/20/2012
ROHNERT PARK, CA – California’s statewide health information exchange (HIE) is in transition again. But by the end of 2012, 75 percent of the Golden State’s counties will either have community-based operating HIEs or will be in the planning stages, according to the recently appointed state official tasked with taking over the program.
“Our mission has changed,” Pamela Lane, Deputy Secretary of Health Information Exchange for the California Health and Human Services Agency, told attendees at the sixth annual Redwood MedNet Conference – Connecting California to Improve Patient Care 2012. “We are about the business of HIE. We are not in state government to say no; we are there to get the barriers out of the way.”
-----

WorldOne Buys Sermo Physician Network

JUL 19, 2012 3:28pm ET
Health care survey and analytics firm WorldOne has acquired online physician network operator Sermo for an undisclosed sum.
WorldOne is a survey and analytics firm offering pharmaceutical firms and other health care businesses access to an online panel of 1.7 million physicians, health care professionals and consumers, including more than 1 million physicians in 80 nations.
-----

Why the EHR market is on the brink of mass consolidation

By Robert Rowley, MD, Healthcare and health IT consultant, practicing family physician
The number of vendors of Electronic Health Records products seems unsustainable. Stimulated by federal Meaningful Use incentives, plus the irresistible tide of pressures and encouragement from all sides (specialty societies, peers, licensing boards, insurance payers), the uptake of EHRs has been steadily increasing.
As a result, large established EHR companies, some of whom have been around for 15 years or more, are experiencing competition from a wave of smaller start-ups – some successful, others not. Two general categories of EHRs have emerged, rather distinctly: EHRs for ambulatory use, and EHRs for hospital use. These really do represent two different markets.
-----

Survey: Docs adopting health IT slowly

July 18, 2012 | By Marla Durben Hirsch
Physicians are adopting electronic health record systems and other health technology, but perhaps not as fast as the government would like, according to Physician Practice's 2012 technology survey.
According to the survey of 1,356 practices, a majority of independent practices (54 percent) reported that they have adopted an EHR. A slightly higher percentage (57.6 percent) said that their implementation is complete and that the system is being used. Less than a third (30 percent) said they are using patient portals, while more than 33 percent said they planned on joining a health information exchange for the sharing of data.
-----

Take EHR satisfaction reports with a grain of salt

July 18, 2012 | By Marla Durben Hirsch
One of the biggest problems for those who use or are considering adopting electronic health records is that the information out there can be very unreliable. It is becoming exceedingly difficult to accurately gauge what's occurring in the industry.
Just look at the spin accompanying some of the findings released this week.
The Centers for Disease Control and Prevention's National Center for Health Statistics reported that more than half of doctors in the United States (55 percent) were using EHRs by the end of 2011. It also found that almost four-fifths (77 percent) of those docs reported that their systems had met the criteria for Meaningful Use.
In the wake of the report--a follow-up analysis of a supplement to the 2011 National Ambulatory Medical Care Survey (NAMCS) of office-based providers--National Coordinator for Health IT Farzad Mostashari posted in a blog post that the physicians' experiences have been "largely positive."
-----

Humanizing eHealth tools boosts patient trust

July 19, 2012 | By Dan Bowman
Humanizing decision-support computer aids for patients helps to increase trust of such tools, according to new research out of Clemson University.
Design and look of an aid are important, according to Clemson psychology associate professor Richard Pak, who found that, for instance, adding an image of a person to an electronic support tool "significantly alters [patient] perceptions" for the better. As a result, decision-making reaction time of patients becomes quicker.
"A plausible explanation is that the increase in trust led to an increased dependence on the aid, which led to faster performance," Pak said, according to a university announcement.
-----

INSIDE THE BOX: Solutions for Data Sharing in Life Sciences

By Ari Berman  
July 16, 2012 | Inside the Box | Sharing scientific data is as fundamental to the progression of science as the research design itself. Without data sharing, experiments cannot be peer-reviewed, and scientists cannot perpetuate existing findings by taking the next steps in the laboratory.   
Unfortunately, data sharing is becoming more and more difficult. Compare scientific papers published in the early 90’s to those published in 2012 -- the differences are striking. Back then, any and all data associated with a project could fit in a figure or two, so the paper itself was the point of data sharing. Today, more and more papers are published with reams of supplementary data, e.g. PDF tables can reach hundreds of pages and are themselves a distilled and reduced version of the original data. (New initiatives such as the journal GigaScience and its associated database should help address this issue.) This illustrates the crux of the issue: modern research produces tons of data and publications are no longer a viable medium for sharing all those data.
-----

'Most Connected' hospitals of 2012 announced

By Erin McCann, Associate Editor
Created 07/18/2012
WASHINGTON – U.S. News & World Report on Tuesday published its 2012 list of the Most Connected Hospitals. The list includes 156 U.S. hospitals nationwide, ranked according to their advancement in electronic medical record (EMR) adoption.
Over the past few years, the EMR has become part of the daily routine of medical professionals throughout the country. The promise of the EMR is often widely lauded among those in the healthcare profession. Some experts say the technology could prove to make the delivery of healthcare safer and more efficient in addition to providing healthcare providers and patients with better access to health data.
The federal government, through its incentive payments to physicians and hospitals that demonstrate meaningful use of EMRs, has played a central role in spurring the technology's adoption. A burgeoning number of hospitals have embraced EMRs beyond the government benchmarks. 
-----

Top 12 reasons organizations pay too much for health IT

By Tom Sullivan, Government Health IT
Created 07/17/2012
Healthcare pays more than any other industry for information technology. At least according to a new survey.
"Our analysis shows healthcare organizations pay an average 17 percent more than that of the other 29 industries we sampled," write the authors of a paper by Net(net), which bills itself as a consultancy specializing in IT optimization, "and 33 percent more than the industry with the lowest average costs (food service).”
And that reality spans the gamut of IT, including financial applications, Microsoft desktop productivity licenses, networking equipment, servers, storage – even vertical applications specifically for healthcare from vendors including Epic, McKesson and Cerner.
-----

Bloody good show

The haematology unit at Bart’s Health NHS Trust has embraced electronic working with Cerner Millennium. Rebecca Todd took a look at the electronic patient record system in action.
11 July 2012
In some hospitals, it is piled high in reception areas or being ferried across carparks in shopping trollies, but here there is not a scrap of paper in sight.
I feel a little like an interloper with my reporter’s notebook and pen in hand, as I head down the sparse corridors of the unit to meet the health professionals that have overseen this digital transformation.
-----

5 ways telemedicine is driving down healthcare costs

By Steff Deschenes, New Media Producer
Created 07/16/2012
Telemedicine and mHealth have the potential to help the healthcare system meet the Institute of Healthcare Improvement's triple aim to simultaneously increase the quality of care, improve the health of populations and reduce the per capita cost of care.
"Collectively, investments in telemedicine and mHealth have great potential to reduce healthcare system costs," said Adam C. Powell, president of Payer+Provider Syndicate, a consulting firm that uses techniques from health services research to bring about change in the health insurance and hospital industries.
-----

Most office-based docs satisfied with their EHR system: survey

Posted: July 17, 2012 - 6:45 pm ET
About 55% of office-based physicians responding to a government-sponsored survey said they use some form of electronic health-record system, and by and large, they're a satisfied lot, according to a report on the survey.
The overwhelming majority (85%) of those who said they use an EHR also indicated that they were either very satisfied (38%) or somewhat satisfied (47%) with their systems. More than 7 in 10 said they were happy enough with their selection that they would purchase the same EHR system again. The Centers for Disease Control and Prevention's National Center for Health Statistics conducted the nationwide survey last year; findings were discussed in an HHS news release and on the CDC's website on Tuesday.
-----

Research: CPOE Industry to Hit $1.5 Billion

July 16, 2012
According to research from the San Jose, Calif.-based Global Industry Analysts (GIA), the computerized physician order entry market is poised for tremendous growth over the coming year. The report, titled “Computerized Physician Order Entry (CPOE) Systems: A Global Strategic Business Report,” says by 2018, the global market for CPOE systems will be valued at $1.5 billion. GIA says factors in this growth include the rising inclination towards patient safety, the acceptance of IT solutions in healthcare, and the growing use of EHRs.
-----

On Trak in Scotland

Within 20 months of signing a contract to provide Scotland with a patient management system, InterSystems had gone live with its TrakCare product in five health boards. Rebecca Todd reports.
5 July 2012
Scotland has been quietly getting on with what must count as one of the largest NHS IT deployments ever seen: the roll-out of InterSystems TrakCare to five NHS boards.
The project started when the five boards (Greater Glasgow and Clyde, Lanarkshire, Ayrshire and Arran, Borders and Grampian) formed a consortium in January 2008 to procure a new Patient Management System for Scotland.
After an 18-month procurement process, InterSystems won. It went on to build a country edition of TrakCare for Scotland with the common functionality and processes required by all the boards, which reduced the need for localisation on each deployment.
-----

EMIS Web roll-out accelerates

13 July 2012   Rebecca Todd
The accelerated roll out of EMIS Web has reached 747 GP practices and thousands of practices are in the familiarisation process.
EMIS Group today released a trading update for the six months ended 30 June 2012.
It shows that during the first half of the year, the roll-out of EMIS Web accelerated dramatically, with 121 practices moved onto the new system last month.
-----

NHS commissioning to shed 20,000 jobs

16 July 2012   Fiona Barr
The NHS Commissioning Board has set out plans to complete its employment of 4,000 staff by January 2013.
The vast majority will be transferred from primary care trusts, strategic health authorities and arms’ length bodies.
A further 7,000 NHS staff are expected to be employed by 23 commissioning support services, which are due to be authorised by the end of the year.
-----

Desktops still dominate at physician offices

Despite rising adoption of tablets and smartphones, a survey shows three in four doctors use a desk computer for practice management tasks.

By Emily Berry, amednews staff. Posted July 16, 2012.
More people are turning to computer tablets and other new forms of technology, but pediatric hospitalist Rishi Agrawal, MD, MPH, favors a desktop computer for doing his job.
It’s not that he’s a technophobe. It’s that using the desktop makes more sense to him: He can easily and quickly access the hospital’s electronic health record system. The computer has a large monitor that allows for multitasking, and it’s secure.
-----

Senior home monitoring set to drive wearable wireless device market

By Mike Miliard, Managing Editor
Created 07/16/2012
LONDON – A growing senior demographic, combined with other economic, social and technological developments, are driving investment and demand for home monitoring devices that can extend and improve in-home care, says a recent study from ABI research.
As the market transitions from safety-focused offerings toward health monitoring and extending and enhancing the comfort, safety and well-being for seniors living in their own homes and care homes, monitoring devices will grow to more than 36 million units in 2017, up from under 3 million units in 2011 – a compound annual growth rate of 55.9 percent.
-----

Joint Commission offers guidelines for scribes

Posted: July 16, 2012 - 2:45 pm ET
The Joint Commission has an online guide for critical-access hospitals that use unlicensed scribes to help physicians and other licensed healthcare professionals document patient encounters in an electronic health-record system.
The guide is presented as a list of frequently asked questions and is contained in the Joint Commission's comprehensive accreditation manual for critical-access hospitals.
-----

AHRQ Offers Guidance on Implementation of Preventive Health Records

Written by Jaimie Oh | July 16, 2012
The Agency for Healthcare Research and Quality has released a new handbook that offers practical guidance on the implementation of interactive preventive health records.
In an article published in the Annals of Family Medicine, researchers found that patients who used IPHRs were more likely to be up-to-date on all preventive services compared with nonusers, especially in the areas of screening tests and immunizations.
-----

CHIME Certification Gives HIT Leaders a Boost

Scott Mace, for HealthLeaders Media , July 17, 2012

If there's one thing I've learned in writing about healthcare and technology, it's that the learning never stops.
The pace of medicine, technology, regulation and business is non-stop. Watershed developments can occur weekly.
For instance, last week I learned that doctors at Orlando Health are now using software on iPads to remotely control Polycom video cameras (with startling clarity) to zoom in on the eyes of potential stroke victims.  The doctors can be anywhere on the planet..
-----

ONC announces guidance for reporting lab results for Direct

By Diana Manos, Senior Editor
Created 07/13/2012
WASHINGTON – The Office of the National Coordinator for Health Information Technology (ONC) announced on July 12 guidance for reporting laboratory results using Direct Project specifications.
ONC officials said the guidance was developed by the Direct Laboratory Reporting Workgroup to address the Clinical Laboratory Improvement Amendments (CLIA) requirements for the reporting of clinical laboratory results using Direct Project standards and specifications.
-----

Big data software combs database for cancer research

July 16, 2012 | By Susan D. Hall
New tools developed by the National Cancer Institute will allow any researcher to compare data from large collections of genomic information against thousands of drugs to find the most effective treatments for cancer, according to a study published at Cancer Research.
The software, called CellMiner, was built for use with NCI-60, the institute's massive collection of cancer cell samples used to test potential anti-cancer drugs. The free tools provide access to the 22,379 genes catalogued in the NCI-60 and to 20,503 previously analyzed chemical compounds, including 102 U.S. Food and Drug Administration-approved drugs.
-----

Gulf between health IT potential and reality remains large

July 16, 2012 | By Ken Terry
As the Meaningful Use Work Group of the Health IT Policy Committee prepares its recommendations for Meaningful Use Stage 3, its members should take a long hard look at the difference between the potential and the reality of health IT. If they ask for too much, many providers will be unable to keep up, and there will be pushback. If they ask for too little, many providers will be content to do the minimum required for incentives without using technology's full potential to improve quality of care.
While much has been achieved in a relatively short period of time, physicians and hospitals are making uneven progress toward the long-term goal of a fully digital, connected healthcare world. More than 100,000 providers have attested to Meaningful Use, but that doesn't mean they're all using their EHRs meaningfully.
-----

How To Break Into Healthcare IT

University degrees and certificate training both are valuable, but you must think strategically when choosing between them.
There's no end to the debate about the best way to break into healthcare information technology. One of the most contentious issues facing job candidates is the university degree versus certificate debate. Put another way: Are you more likely to land a position--and be better qualified to work in health IT--if you get a master's degree in the field or complete a shorter certification program?
Students I've spoken with who are enrolled in master's programs at major universities have many positive comments about what they've learned. But some also complain that there's too much theory and high-level conceptualization, and not enough hands on training. AdTech Ad
-----

Report: HIE Vendor Market Fragmented, Moving Toward Packaged Solutions

July 12, 2012
Today, the Framingham, Mass.-based IDC Health Insights released a new MarketScape report evaluating Health Information Exchange (HIE) packaged solution offerings. The comprehensive study, IDC MarketScape: U.S. Health Information Exchange Packaged Solutions 2012 Vendor Assessment, outlines the changing market landscape and profiles ten vendors, including Caradigm, Carefx, Certify Data Systems, eClinicalWorks, Infor, Informatics Company of America (ICA), Medecision, Medicity, MobileMD a Siemens Solution, and PatientKeeper.
IDC Health Insights found the market for HIE technology is fragmented with IT suppliers providing solutions with diverse origins ranging from integration engine platforms, portals, clinical messaging, composite applications, information management, and managed network services. New market entrants and merger and acquisition activity continue to change the technical and competitive landscape. Furthermore, the report cited the enterprise market as the fastest growing market segment for HIE technology, given the ability to demonstrate meaningful use and pursue a collaborative care strategy will require the ability to exchange health information across the enterprise.
-----

HIE markets evolve, shifting priorities to actionable data

By Erin McCann, Associate Editor
Created 07/16/2012
FRAMINGHAM, MA – A new report highlighting the evolving nature of health information exchanges (HIEs) found that the HIE market is shifting its priorities from that of connecting the ecosystem with exchange data and meaningful use incentives to turning data into “actionable information.” 
The IDC MarketScape study, "U.S. Health Information Exchange Platform Solutions 2012 Vendor Assessment," evaluated 16 vendors that offer a platform solution – which IDC Health Insight officials define as having development tools, published APIs, education of technical staff, a broad ecosystem of partners and professional services – for HIE and how those platforms have evolved. 
-----

5 Ways to Improve EHRs for Pediatric Providers

Written by Kathleen Roney | July 12, 2012
The National Institute of Standards and Technology has released "A Human Factors Guide to Enhance EHR Usability of Critical User Interactions when Supporting Pediatric Patient Care" to address the lag of electronic health record adoption by pediatric care providers.
NIST developed the guide because pediatric patients have unique characteristics that translate to higher complexity for providing care with paper-based charts and EHRs. According to the report, the unique characteristics of pediatric patients may be a factor in the low adoption of EHRs by pediatric providers. For this reason, the report details recommendations to enhance EHR usability when supporting pediatric patient care.
-----
Monday, July 16, 2012

Federal Gov't Continues With Health IT Activity in Q2 2012

The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the second quarter of 2012. Below is a summary of key developments and milestones achieved between April 1and June 30. 
-----

Enjoy!
David.

Friday, July 27, 2012

What Do You Notice Is Wrong With This? No Wonder The HI Service Has Very Real Problems With Adoption and Use.

In a presentation in late June (released a few days ago) David Bunker (NEHTA’s Head of Architecture) showed this slide - Slide 6.

Update – national foundations

NEHTA has made significant progress in designing, operationalising and enhancing the essential foundations required to enable eHealth:
·         Built and implemented the Healthcare Identifiers Service. As at December 2011 there are 24,350,000 IHIs, 526,000 HPI-Is and 624 HPI-Os issued.
·         More than 2 million IHIs downloaded into clinical systems, including 1.3 million in the Lead eHealth sites and in the TAS and ACT Patient Administration Systems
·         Built and implemented the National Clinical Terminology and Information Service; including Australian Medicines Terminology and SNOMED CT, the National Product Catalogue, and the Security and Access Framework. The NPC is being used by NSW, WA, SA, VIC, QLD and the ACT. VIC has begun limited AMT rollout.
·         Designed the National Authentication Service for Health – currently being built.
The full presentation is found here:
Referring to the Australian Bureau Of Statistics to population of Australia is - as of today - 22,677,692 souls.
See here for the latest figure:
This means there are 1,672,303 more Individual Health Identifiers than there are people. Even allowing for those who have died between December 2011 and now (say 50,000) and the suggestion that visitors from overseas who get a prescription or service stay on the system for ever it seems to me there is a very big information integrity problem here.
To me the problem is that there has never been the needed money spent to initiate and maintain the IHI system in a way that is really fit for purpose and this claim ‘bells that cat’ well and truly. Basically we have a Health Identifier Service which was started on the cheap and now seems to be drifting.
I wonder what the clinical safety implications of all this are. Can’t be positive.
No wonder NEHTA keeps talking about the number of identifiers issued and not about the number that are actually using their IHI with the service. I wonder what having ‘downloaded’ the identifiers into local systems actually means?
It’s interesting to note that after more than five years we are still only seeing a ‘limited rollout’ of the AMT. Again hardly a strong endorsement of what has been done.
I note, in addition, that NASH is still being built rather than implemented. I wonder when that will actually start and how much it will wind up finally costing?
NEHTA’s record would have to be described as ‘patchy’ at best. Separately the Australian is reporting the forward agreements on NEHTA’s funding have not been signed off and  we do know of considerable job losses - especially among contractors.
See here:
“Meanwhile, the National Partnership Agreement on E-Health, under which COAG funds NEHTA, expired at the end of last month.
Mr Madden (DoHA CIO) said a new intergovernmental agreement was "still being developed".
NEHTA's role was to develop the specifications and standards needed to support e-health systems under a COAG program set more than three years ago, he said.
"They don't develop clinical software and put that in the hands of practitioners to use, but the jurisdictions are using products based on their work," he said.”
Dear oh dear - looks a bit messy.
David.

Thursday, July 26, 2012

Just Where Does This Move Leave Those Who Signed Up for the NEHRS / PCEHR? In A Labyrinthine Managerial Maze With No One Accountable I Suspect.

This appeared yesterday:

Health Department to outsource PCEHR operations and management

  • by: Karen Dearne
  • From: Australian IT
  • July 25, 2012 3:31PM


THE Health Department wants to outsource its operational and management responsibilities for the personally controlled e-health record system to a single provider.

It has released a tender calling for "provision of project support services" for the PCEHR program, which went live earlier this month despite warnings that the system was unstable and plagued with known bugs.

"Over the next two years, the government will provide $161.6 million to Health to operate the PCEHR and support its gradual enhancement and adoption," the tender says.

"As the systems operator, the department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction.

"Our objective is to identify one provider with the required range of expertise, skills and quality assurance processes that will support the department in its management of the PCEHR program and its new operational role."

The supplier will also have to liaise with a "network of stakeholders" including the National E-Health Transition Authority, Human Services, Accenture and the Office of the Australian Information Commissioner.

"The successful tenderer will be required to assist the department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of healthcare by reducing the fragmentation of information across the healthcare sector," the tender says.

Based in Canberra within the department, it envisages a team of two people for high-level program management services, one person to perform contract management services, a business systems analyst and two people for operations management duties.

More details are here:

There is also coverage here:

Aus Govt looks to outsource e-health record management

Summary: The Australian Government is looking to outsource the management of its Personally-Controlled E-health Record system.

By Josh Taylor | July 26, 2012 -- 00:15 GMT (10:15 AEST)

The Department of Health and Ageing has gone to tender for an organisation to support the operation of the Personally-Controlled E-Health Record (PCEHR) system.
The Federal Government's e-health record system was launched on 1 July after two years of planning and hundreds of billions of dollars worth of investment. Although it hasn't been a smooth start for the program, over 3500 people have so far registered for their own e-health record.
The request for tender document, published yesterday, calls for a company to manage the running of the system for just under two years, to at least the end of June in 2014 and starting as soon as the contract is awarded. Up until this point, the government has been managing the operation of the system.
More details here:
This is really a very interesting Tender - for what the Department seems to be asking for is 8 reasonably high level people to work internally in the Department for the next 2 years.
The introduction and what follows is very interesting:

1. INTRODUCTION

From July 2010, the Personally Controlled Electronic Health Record (PCEHR) program has been funded to design, build and implement a national PCEHR system. The system was launched in early July 2012 and will gradually transition into an operational and management phase requiring the external support of a range of project management skill and expertise. The Department of Health and Ageing (“the Department”) is therefore seeking to engage one organisation to provide all the project support services required to assist the Department to manage the transition to and demands of the new phase of the PCEHR program. The Department will not accept tenderers who only tender for part of the required services, as specified in Condition of Participation (f). The Commonwealth may also offer contracts to preferred tenders for specific activities that are being sought under this tender.
-----

4. BACKGROUND

Commencing on the 30th of June 2010 the Australian Government allocated $466.7 million over two years to design, develop and implement a Personally Controlled Electronic Health Record (PCEHR) system to improve access to health information and avoid the proliferation of divergent and fragmented systems. From early July 2012, the PCEHR system became operational with consumers able to create their records either online, by phone or via selected Medicare shopfronts. As the capability of the system expands, Australians who choose to participate will have their health information securely available to them and their approved healthcare providers when and where it is needed. A range of health information will be able to be accessed including a patient’s general health history, pathology and radiology summaries and prescription information.

5. CONTEXT

Over the next two years the Government will provide $161.6 million to the Department of Health and Ageing to operate the PCEHR system and support its gradual enhancement and adoption through the continuation of the PCEHR program. As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.

6. OBJECTIVES

The objective of the project is to identify one provider with the required range of expertise, skills, and quality assurance processes that will support the Department in its management of the PCEHR program and its new operational role, and will provide value for money.
The successful tenderer will be required to assist the Department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of health care by reducing the fragmentation of information across the health care sector through a personally controlled electronic health record. The operation and continued development of the national PCEHR system will enable a seamless transition between health care settings, a reduction in time spent reiterating clinical history or waiting for test results to be located, and a reduction in adverse medical events.

7. REQUIREMENT

The successful tenderer will be required to provide personnel with the requisite skill and experience to co-locate in Canberra with the Department, and work collaboratively with the Department, its staff and its contracted business partners. In addition, the successful tenderer will be required to provide a flexible number of personnel to meet a variable workload demand as the requirements to operate the PCEHR system are progressively rolled out.
Here seems to be the core of the staff requirement:
-----
The Commonwealth may offer contracts to preferred tenders for specific activities that are being sought under this tender. The successful tenderer will be required to provide a minimum of the following numbers of personnel with the following skill and expertise to undertake the following services:
(a) Two people to perform High Level Program Management services, that include but are not limited to:
  •  Assistance with determining strategy and its application to the implementation of the PCEHR Program;
  • Integration and coordination of decisions and initiatives within the PCEHR Program;
  • Direction and coherent management of numerous parallel projects and multiple service providers and stakeholders through strong governance models;
  • Monitoring of the overall PCEHR Program and project performance and benefits realisation;
  • Ensuring rigour in the PCEHR Program and its associated projects;
  • Focusing the PCEHR Program and individual projects on delivery of business benefits in time, cost and quality measures, with well-defined metrics that demonstrate success;
  • Ensuring a balance between short term tactical and longer term strategic objectives;
  • Providing well defined statements of work, evaluation plans, requests for quote/requests for tender documentation and contracts, as well as business and technical requirements for third party suppliers; and
  • Ensuring individual projects are aligned within the overall PCEHR
Program thus enabling:
(i) critical dependencies to be established and managed;
(ii) critical path to be understood;
(iii) critical risks and issues to be identified and managed;
(iv) high level administrative and clerical support; and
(v) meaningful reporting against program objectives
Program Management personnel will be required to have skills and experience including, but not limited to: Demonstrated ability in administering Prince2 project management methodology.
(b) One person to perform Contract Management services.
- lots omitted
(c) One person to perform Business Systems Analysis services, that include but are not limited to:
  • Supporting the Department to set the required outcomes and overall business design of the PCEHR operational period;
  • Establish, maintain and support the
(i) Reporting structures and standards;
(ii) Issue/risk management and escalation procedures;
(iii) Status reporting; and
(iv) Resources and cost forecasting of the PCEHR Program.
  • Manage, store and quality assure PCEHR Program and project documentation;
  •  Assess the effectiveness of the policy through the evaluation of Program benefits.
(d) Two people to perform Operations Management services, that include but are not limited to:
  • Supporting the Department to manage uptake, complaints, systemic issues, performance reporting, system integrity, data custodianship, and strategic direction;
  • Ensuring the PCEHR program complies with legislative constraints, to achieve the policy intent.
(e) One person to perform Capability Development services, that include but are not limited to:
  • Establishing long term governance structures;
  • Monitoring and revising as required:
(i) Sourcing strategies for the Department’s operational partners;
(ii) Policies and procedures for contract staff;
  • Provide job descriptions and assistance with the sourcing of additional resources as requested by the Department.
(f) One person to perform Change Management and Continuous Improvement services
----- End abbreviated extract.
So one organisation, eight pretty senior people to take the PCEHR forward. The scope of what these people are meant to do is just staggering and what is more - as far as I can tell there is no associated control of the various activity arms that are in place.
This paragraph is pretty telling:
“As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.”
So you have all these roles and objectives but have to work through all these other entities and stakeholders.
Frankly this is utter madness. Either you outsource control, budget and staff and ask a contractor to get on with things - with appropriate accountability - or not. This is a seriously half pregnant proposal if ever I saw one.
What is needed is a separate agency to do the lot - properly governed and led - and separate from DoHA, NEHTA and the DHS. Anything else will just implode on itself in confusion and mayhem.
What nonsense.
There is no doubt, however, serious help is needed. The Access To Medicare Services tab still crashes after 2 weeks.
On the matter of yesterday's rather messy COAG meeting it seems NEHTA funding has been shunted off to a committee. It will be interesting to see if the Liberal states are similarly hesitant with the NEHTA funding as they are with the NDIS. Time will tell I guess.
David.