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."

Wednesday, October 24, 2012

Transcript Of Senate Estimates Hearing - 17 October 2012 - Community Affairs Committee.



Here is the Hansard Transcript.
The Departmental Contributors are:
Ms Jane Halton - Secretary - DoHA.
Ms Huxtable - Deputy Secretary - DoHA
Mr Hallett - Role Not Listed That I Could Find
Mr Peter Fleming - CEO NEHTA
Mr Paul Madden - CIO DoHA
[19:58]
Senator FIERRAVANTI-WELLS: Let's do 10.2—e-Health Implementation.
Senator FIERRAVANTI-WELLS: I will start with the PCEHR, the electronic health records. Could you tell me how many people have signed up to date since 1 July?
Mr Morris : As of midnight last night, 13,340 people had signed up.
Senator FIERRAVANTI-WELLS: Does the department stand by the figure in the 2012-13 budget papers of 500,000 as the number of consumers who will register for a PCEHR? That was at page 192 of the portfolio budget statement.
Ms Huxtable : The 500,000 figure referred to the expectation that we had on the basis of international evidence and the like around the rate of consumer take-up that has been seen in other countries. A number of scenarios sit around that. The 500,000 relates to the first full year of operation. As I think we discussed at the last estimates, the PCEHR is being rolled out in a staged way. The first stage of the rollout was consumer registration, which took effect from 1 July. Then there was the staging of a provider portal, which took effect from mid-August—I think 19 August was the date. And we are gradually having software providers coming on board. A number of software providers have incorporated the PCEHR into what is called a companion tool, and there are other software providers that are well advanced in enabling connectivity. So we will see a gradual upgrading of software into GP practices. That will happen over a period of time. The first tranche of that will start from around the end of this month. The 500,000 figure was used for operational planning purposes to get a sense of where we would be heading in the first full year of operation. It needs to be read in that context.
Senator FIERRAVANTI-WELLS: Does that mean that 1.5 million, then 2.2 million and then 2.6 million in the forward years is really achievable given where we are at the moment?
Ms Huxtable : There are a number of processes that will be and have already been put in place that accompany the staging of the rollout. You would be aware that there has been clarification provided for GPs in respect of use of MBS items for their participation in the electronic health record. There have also been announcements made around the Practice Incentives Program and the expectations of practices in terms of their engagement with electronic health. These will all be drivers for adoption. As you would know, this is an opt-in system for both consumers and providers, but the expectation that we have, based on international evidence and our own experience, is that providers will be an important part of driving consumer take-up. We are very focused on the value of the participation in the PCEHR. Overall numbers is one metric but equally important is the metric around the types of people who are participating in the electronic health record. The focus of the development work has been very much around those cohorts who will benefit the most—people with chronic disease, mothers and newborns, Indigenous people, older Australians et cetera. That has been the focus and we are driving toward that.
Senator FIERRAVANTI-WELLS: So the telephone number that you call for assistance—
Ms Huxtable : To register?
Ms Huxtable : Yes, it is actually in the Department of Human Services. So there are three registration channels, one of which is a phone channel, but there is also the Medicare shopfront and the online channel.
Ms Halton : And I have to say: I am delighted that we have got 13,000. We are not even at the point of having the GP software available and yet, despite that, literally, day on day—we get the numbers everyday of how many people have registered—I open it and think, 'Goodness me'. People really want this. It is amazing. Most of those registrations are coming online.
Senator FIERRAVANTI-WELLS: Ms Halton, let me share with you my experience on 4 July.
Mr Hallett : You have tried, yes.
Senator FIERRAVANTI-WELLS: Let me tell you about my experience on 4 July. So I ring up and I spell my surname—three times. There was a problem with the hyphen—lots of problems with hyphens. So, after 20 minutes the person at the other end of the phone says, 'Can you go to a Medicare office?' I said, 'Great, terrific—I'll go off to a Medicare office to register for something online.' Ms Halton, not good enough.
Ms Huxtable : Senator, the online registration capability came into effect from 6 July, so the online channel has been opened from 6 July—
Senator FIERRAVANTI-WELLS: Does it take hyphens?
Ms Huxtable : It does.
Ms Huxtable : Yes, all of the above. And 90 per cent of registrations are coming through the online channel.
Ms Halton : Senator, I think it is important to understand here: this is a huge piece of software—softwares, lots of it. This is a huge change. This capability was stood up in the time that was actually requested of us to stand it up. Yes, there are all sorts of things that we are learning as part of this process. In fact, as we move to roll out the GP software—and my colleagues down this end of the table can talk to you about the early software we now have available to the profession. But the main bits of GP software will become available later this year. The last bit is available early next year. Essentially we are in the early phases of this. So you actually constitute an attempted early adopter. This is my point about the 13,000—we have not gone out and promoted registration to anybody.
Senator FIERRAVANTI-WELLS: Ms Halton, you qualified it by saying, 'as far as the department is concerned'. Doesn't it smack of an implementation that was rushed without properly—
Ms Halton : No.
Senator FIERRAVANTI-WELLS: Why didn't you do it properly? You wouldn't have had so many problems.
Ms Halton : No. Senator, I actually have to strongly disagree with you.
Senator FIERRAVANTI-WELLS: It has been done properly?
Ms Halton : It has been done properly.
Senator FIERRAVANTI-WELLS: How many people do you think may have tried and had a problem and may be put off—
Ms Halton : The thing we know—and it is definitely the case and we are working on this—is that there are some difficulties for people with online registration. There are some barriers in terms of what is referred to in the trade as 'useability'. My colleagues can all talk to you about that issue. My point is exactly this. Early adopters are giving us a lot of feedback about the registration process—some of the barriers, some of the issues, some of the challenges. When the GP software becomes available this is when we actually expect to see, and when we indeed expect to drive, registration. What we are doing is working through some of those issues in this early phase. And, yes, it is freely acknowledged that there are some challenges in people actually registering, and we tried to deal with some of these issues early on, with information provided on the website about what you might need to verify your identity. If you ask people along this table, they can all give you a variety of experiences about registration. Rosemary registered in about three minutes flat because she had—
Ms Huxtable : An aus.gov.au account.
Ms Halton : an aus.gov.au account. I did not. Everyone has got different experiences. The truth is that this is a long-term change. It was delivered, as we promised registration would be available, from1 July, and the electronic registration from the 6th. That is exactly what we promised.
Senator FIERRAVANTI-WELLS: Can I ask NEHTA: do you think this target is achievable?
Mr Fleming : Yes, it is achievable and yes, it was achieved—absolutely. As Ms Halton said, registration was available on those dates.
In terms of the software vendors that Ms Halton mentioned, we are working with four groups of software vendors at the moment. In terms of GP desktop vendors, there are nine of them; two of them are in the category of the companion tools, and the others are the traditional desktop providers. The companion tools have been built out and are operational in beta sites at the moment, and they will roll out before the end of the month to other sites. So that is a normal process.
In terms of the GP desktop vendors, who represent 98 per cent of the market, they have all built the HI system into there. They have an objective: by the 31st of this month to have the functionality of the PCEHR finalised, and they will do that. Then they have another objective for February.
In conjunction with that group, we are working with the aged-care vendors. Once again, the major vendors in that market are approximately 90 per cent of the market, and they have a series of objectives that they are working to. We will make announcements very soon about the community pharmacy vendors who are also signed up and working. The fourth group of vendors are ones that are not part of our vendor panel but are working with us for various reasons and, once again, progressing quite strongly down that path. So, yes, it is absolutely achievable.
Senator FIERRAVANTI-WELLS: How many shared health summaries have been created and uploaded to the PCEHR?
Ms Huxtable : I do not know that I know the exact number. With the companion software, there has been a shared health summary uploaded—that is correct, isn't it, someone? But it is in the very early stages, so, as Mr Fleming said, the companion tools are in use. I think there are two practices that have used those companion tools. It must have been at least a month or six weeks ago.
Mr Madden : Mid-September.
Ms Huxtable : The really important next step is when those software vendors are rolling out their desktop software, which will be starting later this month.
Senator FIERRAVANTI-WELLS: How many have been created? Do you need to take that on notice? I would have thought that that would be information Mr Fleming or somebody would have.
Ms Halton : Mr Fleming is not the operator so he will not have that information. We can get that information for you, but I just need to remind you that what we have here is actually ahead of what we were anticipating. It was not our expectation that there would be any summaries available until the GP software actually became available. The fact that we have had two software providers come out early because they are trying to get into the market is actually a bonus. We were not expecting summaries to be provided until the GP software started to roll out.
Ms Huxtable : I can tell you that 791,764 Medicare documents have been uploaded to Personally Controlled Electronic Health Records, however, as at the end of September 2012.
Senator FIERRAVANTI-WELLS: Medicare documents?
Ms Huxtable : Yes: information about MBS claims, PBS claims, organ donation registry records and immunisation records.
Senator FIERRAVANTI-WELLS: But the summaries number would be less than that?
Ms Huxtable : Yes, definitely, because, as Ms Halton and I both tried to say, we are not really at the stage—
Senator FIERRAVANTI-WELLS: I was just asking for the summaries.
Ms Huxtable : where we are getting the roll-out of software to enable the summaries to be uploaded.
Senator FIERRAVANTI-WELLS: Can you take on notice the summaries?
Ms Huxtable : Yes. Certainly the national infrastructure has the capacity to upload shared health summaries, event summaries and discharge summaries. So that functionality has been delivered.
Senator FIERRAVANTI-WELLS: Mr Fleming, now that the PCEHR has gone live, what is your focus over the next 24 months going to be?
Mr Fleming : NEHTA, as you know, is funded through two sources: the Council of Australian Governments—and within that context there was significant work to do around infrastructure-type services, the HI service, discharge referral et cetera—and, through PCEHR, the Commonwealth. We are still completing some of the COAG activities, and indeed our focus is now very much on supporting implementation. So we are working very closely with all vendors. One of the things we have built out within NEHTA is: every time we write a specification, we write sample code, build it ourselves and then make that available to vendors and help them implement. So our focus is very much now on helping the implementation of this throughout the country, whether that be with vendors or others. On the clinical side we have a group of people who are working with clinicians and those services on process re-engineering and so on, so it is very much around implementation. We are also finalising certain aspects.
We are working on medication management will flow through in the near future, for example.
Senator FIERRAVANTI-WELLS: What is the status of the National Authentication Service for Health?
Mr Fleming : As you are probably aware, we did terminate the contract with IBM. We have been working with DOHA and DHS. We have implemented a NASH solution with DHS, which is in operation and rolling out. That is progressing.
Senator FIERRAVANTI-WELLS: When will this be complete?
Mr Fleming : NASH is doing what we need now. For PCEHRS there is a second component which will support secure messaging. DHS is working with some final phases there, and they will make some announcements in the very near future. Certainly everything we need NASH to do it is capable of and it is doing.
Senator FIERRAVANTI-WELLS: Could I just give you a copy of this article. It is 'Experts brand e-health audit trail as "gobbledygook"'. Did you see that article?
Mr Fleming : I am aware of it from a little while ago.
Ms Halton : This is the infamous David More, the well-known blogger. 'E-health consultant and medico Dr David More', otherwise known as the well-known blogger.
Senator FIERRAVANTI-WELLS: You have not actually heard what my question was going to be.
Ms Halton : No. I have not seen before.
Senator FIERRAVANTI-WELLS: It is about the audit trail. Are you questioning Dr More just because he is a serial blogger?
Ms Halton : I was just reading the second paragraph, so I know can what this is about.
Senator FIERRAVANTI-WELLS: Are you saying his comments should be dismissed?
Ms Halton : I have not even got to the next part of the comment.
Senator FIERRAVANTI-WELLS: I will let you read it. That would be good.
Ms Halton : We might let the chief information and knowledge officer start talking while I read.
Mr Madden : I did see that blog some time ago. I cannot remember the exact date. Ms Halton mentioned earlier there were a range of issues around usability. We had delivered an audit log. We had expected that there would be low numbers of registrations, and the intention was to reformat and provide that information in what I will call a more user-friendly style, which has been done since. Back at that point what we had set out to do was to make sure that we were capturing all of the auditable records and the changes and the creation of things in the PCEHRS. All of the audit logs and all of those activities that have been undertaken have been recorded. How we format that and put it on a screen to make it usable has been updated to make more user-friendly.
Senator FIERRAVANTI-WELLS: If you are dismissive of Dr More's comments—he styles himself as an e-health consultant and medico, and I think he makes some pretty valid points there—over the page there are some other comments. One is by Carol Bennett. She makes the comment on page 2 of that article:
… the ability of consumers to track who had accessed their e-Health record was a "critical component" …
"For the audit to work it has to be user friendly and it currently isn't," she said.
What is your response? She also makes some other comments:
… have to make it a high priority to make the audit user friendly so it can generate confidence that consumers have the ability to have control over who accesses their record ...
What is your response to Ms Bennett?
Mr Madden : The response to Ms Bennett is that the usability and the ability for users to navigate the audit records is a priority, and we will continue to work on those usability aspects. I guess the critical aspect is that we have kept a record of every creation of record, access of record, change to record. So all of those elements of information are there. How we present them into the future to make them more useful and usable to the user will continue to be a focus for us.
Senator FIERRAVANTI-WELLS: What about the comments by the Australian Privacy Foundation in that article that the audit trail data was 'absolutely meaningless'? The quote continues: 'How the heck is a consumer expected to interpret machine addresses, that's all they've got to track their record.' And you have comments there. What is your response to those comments?
Mr Madden : Again, the feedback we got when the blog was first published was a very important set of feedback that has actually turned our focus to how we present that information in a more user-friendly style. Again, the information we have collected and will maintain is the audit trails and logs of all of the activities in the PCHR, and we are turning that into a user-friendly log that is more usable and easier for people to read.
Senator FIERRAVANTI-WELLS: Have you done that or do you have a time frame to do that?
Mr Madden : The first part of turning that into a user-friendly audit log has already occurred.
Senator FIERRAVANTI-WELLS: In relation to the glitches, I mentioned hyphens and commas. Have apostrophes been sorted out.
Ms Halton : There is no issue there.
Mr Madden : No. We only ever had issues with the apostrophes. We did not have issues with the hyphens.
Senator FIERRAVANTI-WELLS: Well, Mr Madden, I had a problem with hyphens.
Mr Madden : Okay.
Senator FIERRAVANTI-WELLS: I have a long name with a hyphen. I was told 'Can't do hyphens.' If you tell me there is no problem—
Ms Halton : I can guarantee you that you can do hyphens.
Senator FIERRAVANTI-WELLS: I might go back and try.
Ms Halton : When you try—and this is important—because of the aus.gov.au front end, there are a series of questions you are asked that enable Medicare Australia database to confirm that you are you. We put this information on the website, but as I said there are still some useability issues about it, which is why we are not out promoting this very hard at the moment as we try to sort through those. When you try, have with you the information about the last time you went to the doctor—so, the last time you claimed a Medicare benefit. If you have that kind of information—where it was, when it was and how much it was—that will help you verify your identity to the Medicare database. It basically says that, if you know that, that is really who you are. That is a little hint.
Senator FIERRAVANTI-WELLS: I will try again. I now have questions in 10.4 and 10.5 and that will complete my questions.
CHAIR: As there are no further questions in 10.2 or NEHTA, thank you for your evidence. Are there questions on 10.3?
Senator FIERRAVANTI-WELLS: I will put those on notice.
[10:22]
Here is the direct link to the relevant - very long segment.
Here is the link to the offending blog on the Audit Trail.
I just had another look at the Audit Trail and it is better spaced out but I still think it just needs a ½ page description of what you are looking at. I have to say it is great that the Department is actually listening and trying to fix the more obvious issues.
I will leave it to others to reflect on the take-up rates and what it means.
As far as the claims of progress in all the various areas traversed in this rather short session I am sure readers will feel free to clarify just what is happening as far as they are seeing things on the ground.
Re: NASH Mr Fleming has told us the contract with IBM has been cancelled but what is not clear is just what has been delivered for how much, what is still to be done and who owes whom at the end of the day. We also note from the NEHTA comments that the NASH saga is still not over. It also is, of course, hardly widely implemented as yet. Another ‘time will tell’ situation I would suggest.
I also note the 'using the early users as testers' approach seems to be very much alive and well!
David.

Tuesday, October 23, 2012

E-Health Gets Some Interesting Coverage From The Mainstream Press Again. Government Transparency Seems To Be Missing in Action.

The Australian has two related articles on e-Health in the IT Section today.
First we have:

No risk guarantee on e-health

THE Department of Health and Ageing has refused to guarantee that its much vaunted e-health record system is risk-free after more than 140 risks were identified before it went live on July 1.
The Gillard government's personally controlled e-health record system, developed by Accenture, contained a staggering 142 risks of which 32 were rated extreme, 77 high and 33 medium.
The detailed risk assessment study, obtained by The Australian, was prepared by the National E-Health Transition Authority (Nehta) and submitted to the Health Department and other relevant parties about two months before the July go-live date.
The department did not directly respond when asked to confirm that all the risks were resolved by July 1.
However, a spokeswoman said: "By July 1 we had safeguards in place to avoid those risks we identified from occurring.
"For example, to safeguard against security breaches, we have put in place strong encryption and firewalls and implemented all of the recommendations from (Defence's) information security manual," she said.
One severe risk cited in the report was individuals being granted access to health information they were not entitled to if the PCEHR registration process did not adequately authenticate a user.
The five consequences of such access included a user's safety being compromised or, worse, inappropriate medical treatment being given to an individual.
The report did not spell out that this could lead to death, but it is well known that people can pay a high price when they receive wrong medical advice or treatment. Another adverse result could be that an individual's privacy would be compromised.
The report also said that under these circumstances the Health Department could be exposed to legal action and penalties if deemed to be negligent.
Lots more here:
Second we have:

Medical agency blocks request for report's release

THE Department of Health and Ageing has refused to release details of a crucial risk-assessment study conducted by Ernst & Young on the personally controlled e-health record system.
The department's e-health division head, Matthew Corkhill, ruled that it was against the public interest to release the 21-page report, Assessment of PCEHR Information Security Threat and Risk Assessments, in response to a Freedom of Information request lodged by The Australian in July.
Mr Corkhill said the report, which recommends strategies to mitigate potential vulnerabilities in the PCEHR program, continued to inform the ongoing operation and management of the program.
He said it was prepared for the sole use of the department to provide advice and proposals in relation to information security risk-management processes for the PCEHR system.
More here:
Dealing with the second report first it seems to me that at the very least the Government should be releasing a summary of the findings with a summary of what has been done to remedy each of the issues identified. To just bat the whole thing away leaves the public with the sense that something is being hidden and this will only result in a lack of trust in the overall system. Openness is clearly the best policy in areas like this in my view.
On the first article again openness would have said - yes we had a lot of problems prior to ‘go live’ and here is how each of them has now been addressed. Given the rocky start from the ‘go live’ for the first few months it seems unlikely we are being provided with the whole truth on the status just prior to ‘go live’ and since that the date the silence has been deafening. We are no in the situation where really no-one outside Government has a clue as to what is going on.
David.

Non E-Health - But Just Wonderful!

Go here and just be amazed.

http://www.htwins.net/scale2/

Best web site I have seen in I can't remember how long.

You do need to click the Start Button and then use the scroll bar!

David

Monday, October 22, 2012

Weekly Australian Health IT Links – 22nd October, 2012.

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

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

The most amusing news this week came from the Senate Estimates hearing last week where your humble blogger was described by the Secretary of the Department of Health as ‘infamous David More’ and by a Senator as a ‘serial blogger’ - whatever that means!

What I see as good about all this - and we can do without the name calling - it that clearly the blog and the comments made are being read by the ‘powers that be’ - so if you have a serious point to make it is possible to make it pretty directly. For serious points probably using your real name might be a good idea!

Reports of the details from Senate Estimates will hopefully be provided later this week.

The other big news is that this is the week when Window 8 is to drop on us all. See last item. It seems the new has more than a few a little nervous. I for one think I might wait for version 8.1 before updating!

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Patient sign-up to PCEHR steady

19 October, 2012 Kate newton
Uptake of Australia’s new e-health system is gradually increasing, with more than 12,500 people signed up for a personally controlled electronic health record by mid-October.
However, the number is still a long way short of the 500,000 target the Federal Government has set for 1 July 2013.
There are also 68 individual health practitioners and 86 health organisations — including hospitals and practices — signed up to access the e-health system, which was launched this year on 1 July.
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E-health ramp-up awaits GP software

Summary: The Australian government is banking on the roll-out of software for GPs to boost uptake of e-health records from 13,000 today to 500,000 at the end of June 2013.
By Josh Taylor | October 19, 2012 -- 03:37 GMT (14:37 AEST)
The Department of Health and Ageing has said it is pleased that 13,000 Australian residents have signed up for e-health records since July 1, and has downplayed the original forecast that 500,000 will be signed up by the end of June 2013.
Since the federal government's AU$466.7 million personally controlled e-health record (PCEHR) system launched on July 1, take-up has been slow. But the government has stated that a slow take-up was the aim.
In the 109 days since the launch (to October 17), there has been a total of 13,340 sign-ups for the records either online, on the phone, or in writing — an average of 122 people per day. On this average, just over 44,500 people will have signed up for the service by the end of June next year. A total of 791,764 documents have been uploaded to those records.
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PCEHR targets depend on new medical software

Half a million users registered by June still feasible, Health officials claim.

The most important factor in getting more consumers to use the Government’s Personally Controlled Electronic Health Record (PCEHR) will be medical provider-friendly software that will be released by the end of October, a Senate Estimates Committee has been told.
Heath & Ageing secretary Jane Halton told the Committee yesterday that she was "delighted" with the early numbers of consumers registering for the $628.3 million initiative since it launched on July 1.
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US cyber crime sparks concern for PCEHR

17th Oct 2012
WARNINGS from a leading internet fraud investigator that e-health crime is the fastest growing crime in the US and is spreading have sparked renewed criticism of the security of the government’s personally controlled e-health record system (PCEHR).
Detective Superintendent Brian Hay from Queensland’s Fraud and Corporate Crime Group has told MO that doctors in Australia are unprepared for cyber attacks on their business computer files.
His comments follow a series of attacks on Australian medical centre business file servers in recent weeks in which hackers blocked access to patients’ data and demanded $1000 ransoms.
“Over 21 million medical files have allegedly been stolen since 2009 in America. It’s been reported that a medical file can sell for $50. It’s already a US$10.5 billion dollar industry.
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Mandatory privacy breach paper should become law: Pilgrim

Privacy Commissioner Timothy Pilgrim supports federal government's discussion paper, says data breach incidents that may go unreported are concerning.
The federal Attorney General’s discussion paper, Australian Privacy Breach Notification should be considered by all Australian organisations and passed into law, according to Privacy Commissioner Timothy Pilgrim.
The paper covers a number of discussion questions including the possible introduction of mandatory data breach notification laws, the kind of breaches that should trigger notification requirements and how a data breach notification requirement should be enforced.
“Privacy breach notification is an important issue that needs community debate, and I’m sure there will be a wide range of views expressed on whether this notification should be mandatory.” Pilgrim said in a statement.
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Consumers irked by pharmacist access to medical records

15 October, 2012 Nick O'Donoghue
Most health consumers do not feel comfortable with the idea of pharmacists or practice nurses having access to their medical records, a study reveals.
Australian research into pharmacists’, GPs’ and consumers’ views on integrating pharmacists into general practice found there was overall support for the move.
However, the majority of patients (63 per cent) did not want pharmacists to have access to their medical files, despite 73 per cent of consumers saying that pharmacists should have a role within general practice.
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National E-health Transition Authority (NEHTA) and the Personally Controlled Health Record (PCEHR)

Posted on October 18, 2012 by Amy Wong
The National E-Health Transition Authority (NEHTA), in association with Cor Mentes Health Consulting, has recently delivered a series of 23 interactive information sessions in hospitals around Australia to help Doctors in Training understand the Personally Controlled Health Record (PCEHR), the National eHealth Records System (NEHRS) that supports this, and how Doctors in Training – so often on the patient front line in hospitals – will be able to interact with them.
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AARNet helps students and staff cut the cable in Qld hospitals

AARNet providing wireless access to online resources from multiple healthcare facilities across the state
Australia’s Academic Research Network (AARNet) has expanded its “eduroam” high speed wireless network in several hospitals across Queensland.
The wireless service enables staff and students at the University of Queensland to gain access to the institution’s online resources from multiple healthcare facilities across the state.
It is the result of a five-year initiative between AARNet, Queensland Health and Queensland universities, under the Queensland Regional Network Organisation.
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NeHTA Conformance

Wed, 10/10/2012 - 12:15pm
We are pleased to announce that we have passed all four of the National eHealth Transitional Authority (NeHTA)’s CDA (Clinical Document Architecture) conformance tests.
The CDA is a standard developed by HL7 that defines the format and semantics of clinical documents (eg, progress notes and discharge summaries) that are to be exchanged between health services. Now that we are compliant, this means that Communicare can send, receive and unpack any CDA message and display these within Communicare.
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Raising standards to save lives: Klaus Veil

It can be difficult to imagine a clear connection between someone clinging to life in an emergency room and the interoperability standards governing the use of healthcare technology.
Yet for Associate Professor Klaus Veil, one of the nation’s leading experts on interoperability standards and long time ehealth educator, the link is too important to overlook.
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Redefining medicine with apps and iPads

Date October 14, 2012

Katie Hafner

Dr Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level.
As a third-year resident in internal medicine, Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain swelling, seizures or even death.
Rajkomar had been on-call for 24 hours and was exhausted, but the clinical uncertainty was "like a shot of adrenaline", he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his iPhone.
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Using Your iPhone To Detect Ear Infections Also Keeps The Doctor Away

Andrew Liszewski 13 October, 2012 1:30 AM
Forget that daily apple. Researchers at Georgia Tech and Emory University have developed the Remotoscope, an accessory that turns the iPhone into an ear-inspecting otoscope so doctors can diagnose and treat kids remotely in the event of an ear infection.
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Bench test : putting medical apps through their paces

NAME: iQuit ItPUBLISHER: FlexibleCodeCOST: Free (previously $1.99)PLATFORM: iPhone
PURPOSE: It claims to assist in weaning people off various addictions by recording the date when quit attempts will begin and allowing users to register when they have been tempted or relapsed.
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Media Release
Senator the Hon Stephen Conroy
Minister for Broadband, Communications and the Digital Economy
Deputy Leader of the Government in the Senate
Minister Assisting the Prime Minister on Digital Productivity

Construction begins on $12.5 million rural medical training facility in Armidale

The Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, today officially started construction on a new medical training facility at the University of New England.
The Tablelands Clinical School, which is part of UNE’s School of Rural Medicine, will provide medical training, deliver rural health care, and promote medical research for regional and rural Australia.
“The Gillard Government is proud to be contributing $10.5 million dollars to build this wonderful new facility, which will be at the forefront of training medical professionals here in regional Australia,” Senator Conroy said.
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Tasmanian health agency gives external contractors the flick

Tasmania’s Department of Health and Human Services uses technology to upgrade its core services in-house and plans to create shared services for use by all agencies across the state
Tasmania’s Department of Health and Human Services (DHHS) has saved hundreds of thousands of dollars by using technology to upgrade its enterprise software in-house rather than spend vital funds engaging costly external IT consultants.
In the 2011/2012 financial year DHHS – Tasmania’s largest government agency which delivers services through 300 health-related facilities –needed to achieve $100 million in savings within a $1.8 billion budget.
It also needed to decentralise its operations by establishing three regional statutory authorities called Tasmanian Health Organisations as part of the National Health Reform agreement.
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Only 6400 NBN fibre connections so far

Just over 25,000 premises now connected to NBN
NBN Co has hooked up just shy of 6400 fibre broadband connections to the National Broadband Network. Of the 25,495 NBN-connected premises, “just under 6400 are fibre, just under 600 are fixed wireless and just over 17,000 are for satellite,” Jim Hassell, head of product development and sales at NBN Co, told a Senate Estimates committee yesterday.
Of those 17,000 satellite connections, around 8000 were new customers and 9000 were customers who were previously on the Australian Broadband Guarantee (ABG) for more than three years, the committee heard.
The ABG ended in June last year and was designed to help residential and small business premises access broadband services regardless of where they were located.
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Early look at Windows 8 baffles consumers

  • By Peter Svensson
  • AAP
  • October 20, 2012 5:08PM
THE release of Microsoft's Windows 8 operating system is a week away, and consumers are in for a shock.
Windows, used in one form or another for a generation, is getting a completely different look that will force users to learn new ways to do things.
Microsoft is making a radical break with the past to stay relevant in a world where smartphones and tablets have eroded the three-decade dominance of the personal computer.
Windows 8 is supposed to tie together Microsoft's PC, tablet and phone software with one look. But judging by the reactions of some people who have tried the PC version, it's a move that risks confusing and alienating customers.
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Enjoy!
David.

Today’s Mini Budget Has Implications for Telehealth, and Private Health Insurance.

On page 231 we read:
“The Government will restrict telehealth services to those patients for whom distance is the most significant barrier to accessing specialist care.
This is estimated to save $134.4 million over four years. This restriction will align eligibility to Medicare Benefits Schedule (MBS) telehealth items with the Australian Standard Geographical Classification Remoteness Area (ASGC-RA), the standard remoteness classification used by the Australian Bureau of Statistics. From 1 January 2013, geographic eligibility criteria for MBS telehealth services will be amended to exclude patients in outer metropolitan areas and major cities of Australia, in accordance with the ASGC-RA. The amendment to geographical eligibility will not affect services that are provided to patients of an Aboriginal Medical Service or care recipients of a residential aged care facility.
Savings from this measure will be redirected to partially offset the cost of the Dental
Health Reform package announced on 29 August 2012.”
You can see the whole document here:
There has also been a rather complex change to the Private Health Insurance rebate:

Private health insurance takes another hit

The federal government will cut another $700 million from private health insurance (PHI) as it attempts to shore up its budget position.
In the mid-year fiscal update released on Monday, Labor announced it will no longer pay the PHI rebate on people’s entire premiums when they rise more than the consumer price index (CPI).
From April 2014 “the premium to which the rebate is applied will move in line with CPI or the commercial premium increase, whichever is lower”, Treasurer Wayne Swan said in a statement on Monday.
In April this year, health fund premiums rose an average of 5.06 per cent. In 2011, they rose 5.56 per cent across the board.
In the year to June, the CPI was just 1.2 per cent.
“This measure will save approximately $700 million over the forward estimates helping ensure that the PHI rebate remains on a sustainable footing,” Mr Swan said.
Full article is here:
More broadly health expenditure seems to be only taking small other changes as far as I have spotted to date.
I could not find any e-health or ehealth changes. Let me know if you spot any.
David.

AusHealthIT Poll Number 141 – Results – 22nd October, 2012.

The question was:

Are The Plans DoHA Has For Rolling Out The NEHRS / PCEHR Using Medicare Locals Realistic? See amlalliance.com.au For All The Details - Under Support Tab.

They Are Great 12% (5)
Need A Bit Of Work 14% (6)
Need A Great Deal Of Work 26% (11)
Simply Won't Work 49% (21)
I Have No Idea 0% (0)
Total votes: 43
Very interesting.  Many are a very sceptical this will work without major change. (75%)
Again, many thanks to those that voted!
David.

Sunday, October 21, 2012

A Colleague Provides An Unsolicited Clinician’s Impression on The NEHRS. Not Really Thrilled!

A physician mate (Terry Hannan) was approached by a more senior colleague after having had a try of the NEHRS. Here is what the colleague wrote (quoted with permission of both).

“Greetings Terry,

I thought that I would write to you out of interest, knowing that you are interested in this sort of thing, now that I have established an eHealth record, having got a bit confused about it all and to detail my experiences.

I had always rather thought that it was a good idea and my application was following the receipt of a pamphlet put out by the Government "The health record that works for you".

Being a more or less retired 71 year old physician, I thought it would be good to get my data into it. Although I need no eHealth record as things stand as I can account very well for all my health facts to any doctor while travelling, but noting that in due course old age our infirmity will get one in the end, like the colo-rectal surgeon, I should set it up and I could provide a better than average medical record for the system.

Now my troubles began. In spite of having better than average computer skills, and much better than average for a 71 year old, I could not get any really meaningful data into this record.

The setting up was cumbersome, having to set up an Australian Government number and then linking it to other accounts, in my case the Centrelink account, finding that I now have two separate Australian Government Numbers to add to the confusion, but in due course, after becoming duly passworded against that number, I had to go through the security set up, cumbersome, but perhaps necessary. It was a bit tricky to set up and use, and in using it, I found that it was not case sensitive, but absolutely strict as to what one put in as an answer. For instance if one put in the name of the street in which line was raised, one had to get the whole lot correct, and in retrospect I wish I had used simpler criteria. For instance, If one put in Bluegum Street, one could not satisfy the security by just typing in "bluegum".

But the real problem came in trying to input data.

I could get in my medications and allergies and next of kin and contact details without any great stress, but when it came to the important stuff, like putting in my medical history, I could find absolutely no way of doing it. There was no editing function so the whole things remains a waste of time for me as things stand. I could get no other medical data from any of those doctors whom I have seen, presumably because they are not on the system, but i will find out.

I could access and add data to my "personal notes", but that is mort really any use as I know all that stuff and health professionals cannot access it anyhow. The more important shared details zone would not let me into it to add details.

Quite separately, it gives a list of PBS Pharmaceutical supply dates, but one can get no details as to what was supplied, which is a pity.

On checking access to Medicare benefits services, one can get detail of who provide the basic service by going into a complicated sub-menu, but the initial presentation on the list mentions only dates, not the service supplier, which means it very difficult and time consuming to actually discover who did what when. This surely could be easily redesigned as the data is all there.

Anyhow, to date is it is all a waste of time and effort for me until the situation is jigged up.

Can you tell the powers that be that a 71year old physician wants to be a serious user but cannot be.

Best wishes,

John.

Dr.J.M.Sands
Email: doxanz@nixanz.com”

I think this really says it all. The system as it presently exists is really not suitable for even a computer literate clinician who is in a target demographic (The over 60’s).

Pretty sad and yet another reflection of the way all this was designed and rushed without real consumer or clinician input.

What is described here is the ‘lived experience’ (as the Government likes to call it) of all who have tried the system. It is tedious, clunky and simply not fit for purpose - whatever that was - at present.

You really wonder how long it will take for reality to dawn. Somehow I suspect the description of one wag might come true. “NEHRS: Never Ending Health Record Scandal”.

Right now there does not seem to be any understanding of a need for change.

David.