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."

Saturday, April 20, 2013

Weekly Overseas Health IT Links - 20th April, 2013.

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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4 ways health IT can help minorities

By Benjamin Harris, New Media Producer, Healthcare IT News
Created 04/10/2013
While the powers of healthcare IT to radically transform the health of a patient population are widely lauded, one thing that isn't discussed as much are the areas where the technology could do the most good but doesn't often reach to. Take Washington, D.C., for example: One of the richest, most tech-savvy cities in the nation, it also has remarkably low rates of obesity. Almost. Taking a closer look reveals that the 8th Ward, a predominantly lower income section of the city populated by minorities has a high level of obesity, skewing the district's numbers.
Ivor Horn, MD, associate professor of pediatrics at Children's National Medical Center and George Washington University School of Medicine says that there is a wide variety of health IT out there that can help tackle and manage the health crisis of obesity, but that much of it is not reaching the population groups where it can do the most good: minorities.
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  • April 13, 2013, 2:17 p.m. ET

NYers can vote on design of patient portal

Associated Press
BUFFALO, N.Y. — New Yorkers are being invited to weigh in on the design of a website that will let them access their medical records online.
The New York eHealth Cooperative is working with the state Health Department in the shift toward electronic health records. From Saturday through April 23rd, the cooperative is asking people to vote on one of several "Patient Portal" designs at www.patientportalfornewyorkers.org/ .
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ONC proposes EHR vendor fee

By Bernie Monegain, Editor
Created 04/12/2013
Citing the crush of an increasing workload and dwindling government funding, the Office of the National Coordinator has proposed a health IT user fee that would be imposed on health IT vendors who certify their products through the ONC Health IT Certification Program.
The HIMSS EHR Association opposes ONC's proposal.
"EHR developers are already devoting extensive resources to successful implementation of the EHR Meaningful Use Incentive Program and other healthcare delivery reform efforts, including the significant fees associated with EHR product certification," the group said in a statement."
"The fee would be a separate and dedicated resource that ONC would put right back into the administration of the certification program; to maintain, upgrade, and develop new electronic testing tools; develop new standards; and to ultimately improve the certification experience by making it faster and more efficient for the health IT developers that go through the certification process," ONC spokesman Peter Ashkenaz told Healthcare IT News. "The President’s budget proposes that the fee would need to be equitable. If Congress supports this proposal, ONC will work with industry to ensure the proposed fee creates the most value through a notice and comment rulemaking process."
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The future of mobile technology in healthcare

April 11, 2013 | By Greg Slabodkin
Mobile technology clearly is having an impact on healthcare, but questions still remain over how significant that impact will be in the near future. For instance, how big will the U.S. and global markets become? And how will healthcare providers take advantage of such innovations to truly improve patient care? 
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Attracting, retaining health IT staff remains a problem

April 12, 2013 | By Ashley Gold
The U.S. healthcare industry is struggling to find sufficient numbers of skilled employees and the outlook isn't bright.
A new report from Towers Watson, which surveyed more than 100 healthcare providers, including hospitals, highlights the need for information technology (IT) professionals presents an immediate challenge, as hospitals and health systems strive to meet government requirements relating to EHR systems and Meaningful Use taking effect in 2014.
Two-thirds surveyed reported problems attracting experienced IT workers, and 38 percent reported retention issues.
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When Your M.D. Is an Algorithm

By TIMOTHY W. MARTIN

ORLANDO, Fla.—Despite all that drug-enforcement agents and regulators are doing to fight prescription painkiller abuse, the most effective combatant might turn out to be a computer algorithm.
That became apparent at last week's National Rx Drug Abuse Summit in Orlando. Joining an audience of patient advocates, policy makers and law-enforcement officers were members of a burgeoning cottage industry: a swarm of firms that are taking a data-driven approach to the drug-abuse epidemic.
With the costs of abuse soaring, these firms are combining medical research and guidelines with computer analysis to guide some doctors about what prescription painkillers should be administered to which patients, and in what doses. Or, if at all.
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Health IT leaders face hiring woes

By Erin McCann, Associate Editor
Created 04/11/2013
U.S. healthcare providers nationwide have continued to experience difficulties with hiring and retaining experienced information technology professionals needed for the evolving healthcare environment, according to new research conducted by global professional services company Towers Watson. 
The Towers Watson survey, which included responses from more than 100 healthcare providers and hospitals, found that two-thirds (67 percent) are having difficulties attracting experienced IT workers, and 38 percent are reporting retention concerns. Officials say the staffing problems prove even greater for Epic-certified professionals, with nearly three-quarters (73 percent) of the respondents reporting difficulty hiring these individuals, whose specialized skills are essential to meet new electronic medical record requirements under healthcare reform.
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Proposed 2014 HHS Budget Kind to Health I.T. Initiatives

APR 10, 2013 5:13pm ET
Federal spending levels for health information technology initiatives generally get a boost in the Department of Health and Human Services’ proposed budget for fiscal year 2014.
The operational budget of the Office of the National Coordinator would rise from $61 million in fiscal 2013--the same as in 2012--to $78 million next year. The increase will enable ONC to continue investments in several programs as HITECH funds run out. These include core standards development, health information technology certification, new tools and resources to support electronic health records meaningful use and HIT workforce curricula, work with stakeholders on governance of health information exchange, address new privacy and security policy issues to support a national cybersecurity program, and launch a patient safety plan.
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Take part in The Big EPR Debate

11 April 2013  
When health secretary Jeremy Hunt makes speeches about his desire to see a paperless NHS by 2018, he likes to joke that his advisors have applauded him for his “brave” vision.
Ever since ‘Yes, Minister’ aired in the early 1980s, this has been taken as code for a minister doing something that his aides think deeply misguided and sure to end in tears.
Yet the aim of a paperless NHS – which the minister has further defined as one that uses electronic patient records and communications – is one that is worth aiming for.
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Full Access to EHRs Mostly Beneficial for Patients, Study Says

Written by Anuja Vaidya  | April 09, 2013
Viewing their electronic health records empowers patients and enhances their contributions to their own care, according to a study published in the Journal of Medical Internet Research.
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Thursday, April 11, 2013

When it Comes to ICD-10 Physician Documentation: Collaborate and Educate

Most hospitals and health systems have made progress related to the ICD-10 transition, but there undoubtedly is still more work to be done. Many have completed their readiness assessment, identified ICD-10 leadership, assembled their ICD-10 workgroups, planned coder, documentation specialist and other staff education, identified necessary IT infrastructure requirements and recognized the need to renegotiate payer contracts that reference ICD-9 codes. Still, even if all the above elements are in place, on time and functioning well, ICD-10 holds the potential to devastate a hospital's revenue cycle integrity leading to short-term, if not long-term, losses in revenue.
Another critical piece missing from the list above is: Assuring that your medical staff is ready for the ICD-10 transition. Although many argue ICD-10 is a coding issue requiring coding solutions, we see time and time again surveys that identify physician education as the most difficult challenge in preparing for ICD-10. Why the inconsistency? It actually makes sense from an operational perspective. We can mandate that coders attend necessary education, purchase computer-assisted coding (CAC) solutions and negotiate with vendors to assure that all IT platforms are ICD-10 compliant. But how do you mandate appropriate documentation for ICD-10 from your independent physicians? Short answer... you don't. It won't work. That is the most likely reason many health systems have turned a blind eye to the issue of physician documentation for ICD-10. There is a better answer -- don't mandate; collaborate and educate. 
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DH gives exclusive insight into CSC deal

8 April 2013   Lis Evenstad
The man in charge of the Department of Health’s interim deal with CSC says it wants to normalise the health IT market and expects no more than 20 trusts to take Lorenzo under the new agreement.
In an exclusive interview with EHI, the senior responsible owner for local service provider programmes at the DH, Tim Donohoe, went into never-released- before detail about the deal.
He also promised a more transparent approach moving forward.
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Joe’s view of the end of CfH

NHS Connecting for Health did not get a public send off as it finally ceased to exist on 1 April. Which is a shame, as Joe McDonald had his funeral oration all ready…
10 April 2013
I went to my first HANDI meeting before Christmas. HANDI, for anybody who doesn’t know, is the Healthcare App Network for Development and Innovation; it’s a community interest outfit that wants to promote the rapid development and deployment of “beautiful tools” that “play nicely together” and do useful stuff.
The weather in Gateshead was filthy and many roads were flooded on the day chosen for the inaugural meeting of the North East HANDI cluster.
But an interesting crowd turned up, including several clinicians, a couple of local government officials, some app developers, and some IT types who spoke a different language to the rest of us (but who could speak to each other in what I took to be fluent Klingon).
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Don't ignore optimization during health IT go-lives

April 10, 2013 | By Dan Bowman
Technology projects such as the implementation of an electronic health record system, no doubt, come with their share of headaches. CIOs that think that such work merely consists of installing new software or hardware, however, are in for a rude awakening, according to Ilene Moore, a physician advisor for Elmhurst, Ill.-based healthcare professional services firm Dearborn Advisors.
"[H]ospitals often focus all of their resources around the go-live event itself," Moore writes in a recent post for Executive Insight. "Dismissing optimization or assuming that it's simple can lead to disaster."
According to Moore, several pitfalls often plague such projects, and can have lingering effects if they aren't addressed in a timely and appropriate manner. For instance, she says, end users like doctors and nurses must have a say in process adjustments both before and after a project's completion.
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Practice Fusion Launches Doctor Appointment/Review Portal for Patients

April 9, 2013
Practice Fusion, the San Francisco-based provider of free EHR software, is launching a site that will allow patients to book an appointment, read a review of a doctor, and view their personal health record.
The site, Patient Fusion, gives patients access to a listing of 27,000 doctors, who are using the company’s EHR and can be categorized based on specialty and location.  There will also patient written “reviews” of the doctor on the site, Practice Fusion says. This could be a well-timed release for Practice Fusion since according to a recent report from PwC’s Health Research Institute (HRI), healthcare consumers are searching for reviews and ratings to guide their decision-making – but haven’t found what they need yet.
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mHealth tools need to be financially self-sustainable, report finds

By Paul Cerrato, Contributing Writer
As mobile health gains ground as a way to improve population health and curb healthcare costs, models for making mHealth financially sustainable are topmost in the minds of stakeholders in the U.S. and across the globe.
“Mobile is a global game changer,” according to David Collins, senior director of mHIMSS, a globally-focused mobile initiative of HIMSS, the parent company of Government Health IT.
In Collins’ view, there are just too many mobile health projects that are having a real impact on healthcare delivery for investors to ignore. These initiatives offer a value proposition to the Samsungs, Verizons and AT&Ts of the world, said Collins.
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5 reasons to consider clinical analytics

By Benjamin Harris, New Media Producer
Welcome to the data world. Many secrets are hidden in big data, and now, with the computing power to unearth them, analytics promises to deliver transformative power wherever it is put to work. Still, the technology is a relative newcomer in the healthcare world. Brett Furst, CEO of Arbormetrix, says there is nothing to fear – and that analysis of clinical data has much to offer the medical world. Here, he shares his top five requirements to succeed with, or at least get excited about, the power of clinical analytics.
1. Know the difference between solutions. Analytics solutions vary widely in size and shape. Furst says it is important to know what the different kinds are, and how to apply each one to specific problems, whether they have to do with population health and disease management, episodic delivery or post-acute care. Population health and disease management focuses on "improving the general health of a population and keeping them out of a hospital," according to Furst. Think screening a database to find people who might be at risk for a certain condition and reaching out to them. Episodic analytics "focuses on identifying variation in the delivery and associated outcomes of specialty and acute care." This kind of analytics is about looking back and finding ways to improve care in the future based on how it was provided previously, says Furst. Post-acute analytics centers around "utilization management so patients receive the appropriate level of care after hospitalization, with a focus on cutting down on wasted resources." Essentially, the three flavors Furst outlines could be seen as the analytical equivalents of before, during and after.
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Trends in EHR vendor strength in 6 charts

By Robert Rowley, MD, Healthcare and health IT consultant, practicing family physician
On April 2, 2013, the federal Centers for Medicare and Medicaid Services (CMS) made available their updated data table for EHR Incentive Program (Meaningful Use) attestations, with specification as to which EHR products were used. The initial file, published on data.gov in 2012, showed the first year of experience of Meaningful Use, and allowed the relative comparison of vendors in the EHR arena.
The data table disappeared from the data.gov site in the middle of 2012, but has now been updated and re-posted (after some prompting at last month’s HIMSS conference). The updated data shows all the Meaningful Use attestation to date, and can show both first-year attesters for 2011 and also 2012, as well as second-year attesters in 2012 who started their first-year attestation in 2011. Given that this comes from actual reported Meaningful Use attestation to the government (for the Medicare version of the program), it is arguably the most accurate source, free from vendor hyperbole.
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Orion to build shared record portal

4 April 2013   Rebecca Todd
The Bristol, North Somerset and South Gloucestershire health community has signed with Orion Health to develop a shared patient record.
The programme will deliver a local portal, which will integrate clinical and social health data from a variety of sources.
It is key to the community’s Connecting Care programme - a commitment between NHS providers and local authorities across Bristol, North Somerset and South Gloucestershire to share more information.
Director of informatics and business intelligence for Best West Commissioning Support and Connecting Care programme chair Andy Kinnear said patient information had been held in silos for too long.
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Health Information Exchange: Start with the right structure to find success

April 9, 2013 | By Gienna Shaw
As health information exchanges across the nation gain momentum, challenges remain. The first is choosing a model that fits within state guidelines and the culture of the community. The trial-and-error approach to HIEs led to some early failures. But jumping over that first hurdle and choosing the right structure also is the first step to long-term success.
In this exclusive interview, FierceHealthIT talked to Joy Duling (left), executive director of Central Illinois Health Information Exchange and Laura McCrary (right), executive director of the Kansas Health Information Network and about their organizations' strategies, goals and challenges--including how to get both patients and providers to participate in data exchange.
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Joint Commission outlines dangers of alarm fatigue

April 9, 2013 | By Susan D. Hall
The Joint Commission this week issued a warning that healthcare workers can become numb to the incessant beeping of medical devices, creating life-threatening situations for patients.
The hospital accreditation body based the warning on events reported to its Sentinel Event database, which tracks serious safety-related events, though it has been sounding the alarm on this issue for years.
Indeed, "alarm fatigue"--when workers tune out alarms that just create more workplace noise--again topped the ECRI Institute's 2013 list of health technology hazards.
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'Alarm fatigue' endangers patients

By Bernie Monegain, Editor
Created 04/09/2013
The constant beeping of alarms and an overabundance of information transmitted by medical devices such as ventilators, blood pressure monitors and ECG (electrocardiogram) machines is creating "alarm fatigue" that puts hospital patients at serious risk, according to a Sentinel Event Alert issued April 8 by The Joint Commission.
The Joint Commission Alert urges leaders at hospitals to take a focused look at this patient safety issue.
Over a recent four-year period, a U.S. Food and Drug Administration database shows that there were more than 560 alarm-related deaths, and The Joint Commission's sentinel event database includes reports of 80 alarm-related deaths and 13 serious alarm-related injuries during a similar period.
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Online interventions for teens effective in improving care

April 9, 2013 | By Ashley Gold
Teens, no doubt, are attached to their phones and love consuming electronic media--and a new study shows that electronic media-based health interventions can actually promote health behavior change among youth populations.
Published in JAMA Pediatrics, the study aimed to assess the type and quality of the studies evaluating the effects of electronic media-based interventions on health and safety behavior change.
Using searches in MEDLINE and PsychInfo through 2010, the review included published studies of electronic-media tailored interventions, focusing on health behavior changes in children 18 years of age or younger.
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Big data could mean big savings in health care – but here’s what has to happen first

Apr. 5, 2013 - 3:29 PM PDT
Summary:
A new report from McKinsey estimates that big data could save the health care industry up to $450 billion, but it has to overcome a few obstacles first.
Properly exploiting big data in health care could mean up to $450 billion in savings health care organizations and consumers according to a recent report from consulting firm McKinsey. But don’t get too excited yet – that data-optimized future isn’t just going to fall in our laps.
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Administration pushes toward electronic medical records

By Ben Goad - 04/08/13 05:30 PM ET
The Obama administration is moving to ease the national transition from paper to electronic health records through a pair of proposed rules to be published this week.
The rules, to hit Tuesday’s Federal Register, would update and extend existing regulations surrounding the sharing of patient electronic records.
Federal law generally prohibits hospitals from giving medical record software to doctors who would then use it to refer patients back to the facility for treatment. Violations can be charged as felonies and are punishable by prison time and fined up to $25,000.
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Joint Commission Issues Alert on Medical Device Alarm Fatigue

APR 8, 2013 12:19pm ET
The Joint Commission on April 8 issued a Sentinel Event Alert to hospitals, imploring leaders to take a focused look at the serious risk caused by “alarm fatigue” from medical devices.
“These alarm-equipped devices are essential to providing safe care to patients in many health care settings; clinicians depend on these devices for information they need to deliver appropriate care and to guide treatment decisions,” according to the Joint Commission message. “However, these devices present a multitude of challenges and opportunities for health care organizations when their alarms create similar sounds, when their default settings are not changed, and when there is a failure to respond to their alarm signals.”
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ONC forges partnership for HIE standards

By Anthony Brino, Associate Editor, Healthcare Payer News and Government Health IT
Created 04/05/2013
Rather than trying to create new information exchange governance standards, the Office of the National Coordinator is pursuing the goal of nationwide HIE interoperability and security via a cooperative agreement with Direct Trust and the EHR/HIE Interoperability Workgroup to build on current successes, while sorting out ongoing barriers.
Direct Trust, a nonprofit devoted to secure exchange, and the Interoperability Workgroup, a New York eHealth Collaborative-led coalition, will be working with ONC to develop interoperability accreditation standards and businesses practices aimed at reducing implementation costs and improving privacy and security.
It’s part of the ONC’s Exemplar HIE Governance Program, which launched late last year, as the agency looked for alternatives to new HIE governance regulations.
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What's your strategy for big data deployment?

April 8, 2013 | By Dan Bowman
Big data optimism is at a fever pitch in the healthcare industry, and with good reason. According to a recent analysis by consulting firm McKinsey & company, use of such tools and processes could help to save U.S. citizens as much as $450 billion in healthcare costs; as in, close to half a trillion dollars.
What's more, some big-name healthcare organizations are buying in. Last month, the University of California Los Angeles and IBM announced a partnership revolving around the use of big data analytics to test the effectiveness of a real time alarm designed to predict brain swelling in trauma cases. A month earlier, Salt Lake City-based Intermountain Healthcare announced plans to collaborate with Deloitte Consulting with an emphasis on making the former's data use experience commercially available to other healthcare organizations. UnitedHealth and Mayo Clinic also unveiled earlier this year a partnership in which the two entities will combine their data for more than 110 million patients to research methods for improving care while lowering costs.
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Monday, April 08, 2013

Requiring Electronic HIE as a Condition of Participation in Medicare

In conjunction with the release of its 2013 agenda to bring down costs and improve quality of care through health IT, HHS issued a request for information on ways to accelerate electronic health information exchange within the health care industry. The RFI seeks input on potential policy and programmatic changes to further advance interoperable HIE beyond what is currently being done through Office of the National Coordinator for Health IT and the electronic health record incentive programs.
One of the policy changes HHS is considering is to require that health care organizations engage in electronic HIE in order to participate in Medicare. That is, HHS is considering making electronic HIE one of the Medicare Conditions of Participation (CoPs). 
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ONC Responds to HIE Criticism with Grants

Scott Mace, for HealthLeaders Media , April 8, 2013

The federal Office of the National Coordinator (ONC) for Health Information Technology, stung by a negative report on health informati on exchanges (HIEs) last month, responded last week, handing out nearly a half million dollars to spur private efforts in the area.
ONC awarded DirectTrust and the EHR/HIE Interoperability Workgroup (IWG)each Exemplar HIE Governance Program Cooperative Agreements to continue to support their work advancing the governance of health information exchange.
"We will work closely with each of these entities and their partners to develop policies, interoperability requirements, and business practices that align with national priorities, overcome interoperability challenges, and reduce implementation costs," says Claudia Williams, director of ONC's State Health Information Exchange Program.
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Enjoy!
David.

Friday, April 19, 2013

Big Data In Health Care - A Useful Review Of The State of Play.

This appeared a little while ago:

The HIT Approach to Big Data

MAR 1, 2013
Like "The Cloud" last year or "Mobile Apps" the year before, it's the I.T. catchphrase that's considered so big it's deemed worthy of double capitalization. Computers are capturing stray scraps of information on everyone's medical conditions, shopping habits, driving records, and weekend partying patterns; data architects in every business are struggling with how to put it all together to answer big questions.
No business has bigger questions than health care, which is being pressured as never before to provide better care to more people at lower cost.
But what the heck is Big Data? What makes it different from the small data that populates spreadsheets on so many departmental desktop PCs? "Volume, velocity, variety," says Elizabeth McGlynn, director of the Kaiser Permanente Center for Effectiveness and Safety Research. Kaiser, with 9 million members in eight regions, has the volume: 30 petabytes of patient data, which McGlynn says is more than three times the amount of digitized storage at the Library of Congress.
Velocity is the speed at which the data accumulates-very quickly in the case of a hospital, which adds reams of test results, images, vital signs, and clinician notes every day.
But McGlynn says the third defining quality of Big Data-variety-is the one most people overlook.
"There's not only the data we create, but what's on social media sites, or data about people's shopping or driving habits, what's happening demographically in a given neighborhood," McGlynn says. For example, hospitals trying to reduce their readmission rates might want to know what social support networks are available in the patient's community. Maybe the neighborhood block association has a Facebook page where neighbors can check in on each other or volunteer to bring dinner to a patient who's been discharged. Combining all the available information can create a picture of which patients are at greatest risk for readmission and what interventions are most effective at keeping them healthy and out of the hospital.
As usual, health care is playing catch-up in the Big Data game. Brad Putnam, executive director of HealthShare Montana, a growing health information exchange, came from the financial industry and says banks were in the dark about their customers up until about 10 years ago. "They had all their information on slave dummy terminals, and they'd send out a survey occasionally and think that they were giving great service," he says. Once banks started tracking how customers actually behaved, they saw a gap between the services offered and the services needed. That's why today you can deposit checks via your smartphone and get pinged when a stock hits your desired price point. "It was a painful shift, but now people can actively manage their financial life instead of reacting when the monthly statement comes," Putnam says. "When we're able to look at patient populations and measure how well we're doing, we can create benchmarks and help patients change their behavior. That's when it gets fun and fascinating."
The average hospital I.T. department may feel it's drowning in data already and is not inclined to deal with more. But here are three Big Data areas to watch.
Read, at length, about the three areas to watch here:
I think some of these will take a while to get into productive delivery but clearly they will be important. Important reading.
David.

Thursday, April 18, 2013

This Is A Much Too Democratic Approach To E-Health For Australia I Suspect. Great Fun To Review.

This short article appeared a few days ago.

NYers can vote on design of patient portal

  • April 13, 2013, 2:17 p.m. ET
Associated Press
BUFFALO, N.Y. — New Yorkers are being invited to weigh in on the design of a website that will let them access their medical records online.
The New York eHealth Cooperative is working with the state Health Department in the shift toward electronic health records. From Saturday through April 23rd, the cooperative is asking people to vote on one of several "Patient Portal" designs at www.patientportalfornewyorkers.org.
The full article is here:
Amazingly there are 14 different designs for people to consider and vote on - each with a short video explaining the features and look and feel.
Do you reckon we would have got the pathetic, ill-conceived consumer portal with the PCEHR had a process like this been conducted. I think not.
A visit to see what is on offer is highly recommended.
David.

Wednesday, April 17, 2013

Is There A Real Trend Here With DoHA Slowly Stepping Away From The NEHRS /PCEHR? Not Really Given The Somewhat Covert Purpose.

A kind and diligent observer of all things PCEHR sent me this a day or so ago as a summary of Departmental comments.
2 Dec. 2010: NEHTA is now "Managing Agent" for DoHA's program
The change in NEHTA's governance became very obvious after Dec. 2010.
7 April 2011: PCEHR is for Chronic Disease and Aged Care
The scope of the PCEHR is wound back to small segments of the population!
 23 June 2011: Actual PCEHR deliverables for 1 July 2012
(Deputy Secretary Rosemary Huxtable)
The PCEHR deliverables are severely wound back to "citizens can register for the PCEHR" ...
On 1 July 2012, DoHA delivers exactly what RH outlines (on slide 15) one year before!
26 March 2012: No "Big Bang" with the PCEHR
The go-live scope of the PCEHR is further wound back to a "soft opening"... which is exactly what happened in July 2012.
20 March 2013: So what about the Future of the PCEHR?
Halton's speech says exactly nothing about the future of the PCEHR, apart from obvious operational growth...
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On a review of this collection of public utterances from DoHA  it is hard to disagree that the specific future plans have become pretty vague and diffuse - with a very interesting twist that what became obvious about 6 months ago and is now being made apparent. This is a ‘big data’ system for the Government to mine for their own purposes - not a clinically focussed system.
This is confirmed in the latest speech where there is a clear sense in the first 15 minutes that all the PCEHR is planned to be is a great big feed for the analytics efforts of the Department to manage the health system rather than actually trying to provide clinical benefit.
There is also a sense that we are going to see a multiple set of repositories separate to the NEHRS / PCEHR. The first would seem to be the National Prescribing and Dispensing Repository.
The implications of this are really quite interesting. Is it covered by the PCEHR Legislation and protections? What consent is required for these pharmacy records to be uploaded and so on?
The last 10-12 minutes were on Telehealth and were said to be an integral part of the National E-Health Strategy. While it is mentioned I think this is just a distraction from the failing part of what is going on which was not in the National Strategy at all!
All the speeches are useful but this last one lays bare the why DoHA is doing this. It is to create data for them to mine. Had it been designed to clinical care we would have seen something quite different.
David.

AusHealthIT Poll Number 163 – Results – 17th April, 2013.

The question was:

Should A New Revised National E-Health Strategy Recommend An Integrated and Simplified E-Health Governance Framework With All National E-Health Activities Under One Roof?

For Sure 49% (18)
Probably 16% (6)
Possibly 0% (0)
No Way 30% (11)
I Have No Idea 5% (2)
Total votes: 37
Looks like about 65% feel we need an improved Governance Framework for Australian E-Health.
Again, many thanks to those that voted!
David.

Tuesday, April 16, 2013

The Evidence Free Nature Of the NEHRS / PCEHR Confirmed By Independent Research.

The following appeared last week.

Analysing past mistakes to manage health records’ futures

Dr Karin Garrety is a researcher at the University of Wollongong’s Centre for e-Health and is on a mission to uncover the worst eHealth decisions ever made – so that the next generation of eHealth implementations can be more effective.
"This is a really interesting time in the development of the internet and the development of information technology for use in health," she says.
“The people implementing these systems are coming up against problems that we haven’t encountered on this scale before. It involves very complex issues, and involves many different professional groups who have different information needs.”
Dr Garrety is part of a five-person team working on an Australian Research Council (ARC) funded Discovery project under the Human Society field of research.
Other researchers include Professor Ian P McLoughlin, a management expert from Monash University and Dr Rob Wilson from Newcastle University in the UK.
The project will document the policies and processes used by government employees who tried to bring in eHealth systems in both the UK and Australia and analyse the impact of these.
The result will be a retrospective, comparative study of five attempts to set up regional and national systems for sharing electronic health records in Australia and Britain.
“We’re looking at this from a socio-technical perspective,” she says.
Big System Failures
“The majority of people in England now have a summary care record,” says Dr Rob Wilson.
“But the program initially called National Program for IT and later rebadged Connecting for Health failed to deliver on the promise of modernising hospital IT in the UK, with just three installations in ten years.”
…..
Australian approach
Dr Garrety says that Australia hasn’t made the same top-down approach that began with a big, outsourced system.
“We are going a bit more bottom-up here, which has been much better,” she says.
“There are still issues where for example, clinicians feel that NEHTA has not consulted enough with them and so they feel they are out of the loop.”
Dr Garrety says that the focus on the PCEHR came “out of the blue.”
“The idea to have personal control over your own health record didn’t come out of research into what are the current information practices in the health system,” she says.
“A better approach would have been to ask, what is it that would help people do their work better - and then to build something up from what people would find useful to help them to deliver health care.”
Lots more analysis was here:

Now here:

http://ehealthspace.org/news/lessons-past-will-drive-health-records-futures

Not sure why it moved!

The italics are mine.
It is impossible to disagree with Dr Garrety’s conclusion and indeed, as is well known, NEHTA was planning for a much different Shared EHR before the NEHRS / PCEHR was suddenly, out of a clear blue sky, dropped upon them with a large budget but very little in the way of evidence support or indeed time to execute!
The last two paragraphs really say it all!
It does need to be pointed out that I made similar points a little while ago.
Exactly two years ago indeed - but it is nice to see some academic support!
David.

Monday, April 15, 2013

Weekly Australian Health IT Links – 15th April, 2013.

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

Quite an interesting week with the Coalition actually admitting near to universal broadband was actually a good idea and being prepared to but quite a large sum of money up to have it happen. No major party now thinks universal broadband is a bid idea - Yeehaa!
Other than that we have recruiters wandering around at vast expense and glacial progress being made in sign-up and certainly usage rates of the PCEHR - which of course are secret.
Again the Queensland Health Payroll Enquiry provides some amusement and we see increasing confirmation that Windows 8 is not the success it was hoped to be.
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eHealth records: there are alternatives to the PCEHR

When Dr Mukesh Haikerwal tried to connect his Melbourne practice to the PCEHR system, the eHealth records database was offline. He contacted the Department of Health and Ageing and said: “Hey guys, the PCEHR is offline!” The answer from the help desk: “No it isn’t.”
Image: other eHealth record solutions in Australia offer advantages over the PCEHR. E.g. the confidential patient data only goes to health providers selected by the patient, and not to the government.
Dr Haikerwal commented in the Sydney Morning Herald: “If the Qantas website was like this, you would say, ‘I will go to the travel agent instead.’” I’d like to mention here that Dr Haikerwal is a clinical lead, meaning that he should get the Rolls Royce treatment from the help desk (clinical leads are also supposed to promote the PCEHR amongst colleagues). If this is the Rolls Royce treatment, then I have no hope whatsoever…
We’re all wondering what the government is doing with the eHealth budget. It appears The Australian knows the answer as it reported last year: “NEHTA has spent part of its $218 million budget on more than 731 functions for stakeholders, including lavish seafood dinners, after-dinner speakers, flights and accommodation in five-star hotels. The authority spent $871,000 on taxi fares in the past two financial years, $118,000 on business-class international airfares and $2.1m in total on travel.”
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Privacy issues barriers to PCEHR use

10 April, 2013 Nick O'Donoghue  
Pharmacists have highlighted their inability to legitimately access patient data outside consultation and the need to invest in staff training without compensation, as barriers to their use of the Personally Controlled Electronic Health Record (PCEHR).
An Australian study found many pharmacy owners and managers were concerned about medico-legal issues surrounding the PCEHR, which was introduced to consumers in July 2012, stating that they would only be able to access the data during consultations with the patient’s consent.
Results from the research, published in the International Journal of Pharmacy Practice, showed that pharmacists were concerned about the policing of their access to patients’ PCEHRs and potentially unwarranted disciplinary action for accessing and viewing a patient’s PCEHR outside of consultation time.
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Analysing past mistakes to manage health records’ futures

Dr Karin Garrety is a researcher at the University of Wollongong’s Centre for e-Health and is on a mission to uncover the worst eHealth decisions ever made – so that the next generation of eHealth implementations can be more effective.
"This is a really interesting time in the development of the internet and the development of information technology for use in health," she says.
“The people implementing these systems are coming up against problems that we haven’t encountered on this scale before. It involves very complex issues, and involves many different professional groups who have different information needs.”
Dr Garrety is part of a five-person team working on an Australian Research Council (ARC) funded Discovery project under the Human Society field of research.
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Outrage as eHealth record sign-up squads hit Australian hospital patients in bid to boost numbers

  • Sue Dunlevy
  • News Limited Network
  • April 14, 2013 12:00AM
BUREAUCRATS armed with clipboards have been sent into hospitals and nursing homes to cajole patients to sign up for an eHealth record their doctors still won't be able to use.
Nine months after it was launched, the Government's $1 billion eHealth system holds just 414 patient records and is only a fifth of the way towards its target of signing up 500,000 patient users by June 30.
There are currently only two hospitals using the personally controlled electronic health record (PCEHR) system and they have uploaded just 155 discharge summaries.
And the system remains barely operational because fewer than one per cent of doctors have signed up for the Healthcare Identifier service number they need to be able to access patient records.
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FREE peer-to-peer eHealth education seminars: registrations now open!

8 April 2013. FREE peer-to-peer eHealth education seminars: registrations now open! Are you ready for tomorrow’s clinical consultation when a patient asks you about their personally controlled electronic health (eHealth) record?
From April to June 2013, the Royal Australian College of General Practitioners (RACGP) will run free peer-to-peer education seminars across Australia. These seminars will highlight a number of key aspects on how to effectively use the national eHealth record system to get the most benefits for your patients and practice.
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See-through brains to clear up mental mysteries

Date April 11, 2013 - 10:10AM

Sharon Begley

If Dr Karl Deisseroth were an architect, he might be replacing stone or brick walls with floor-to-ceiling glass to build transparent houses. But since he is a neuroscientist at Stanford University, he has done the biological equivalent: invented a technique to make brains transparent, a breakthrough that should give researchers a truer picture of the pathways underlying both normal mental function and neurological illnesses from autism to Alzheimer's. In fact, the first human brain the scientists clarified came from someone with autism.
Deisseroth and his colleagues reported in the online edition of the journal Nature on Wednesday that they had developed a way to replace the opaque tissue in brains (harvested from lab mice or donated by people for research) with "hydrogel", a substance similar to that used for contact lenses.
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Researchers unlock mystery of how brain registers levels of pain

Date April 12, 2013
Scientists have discovered how to recognise pain in brain scans, paving the way for tests that accurately gauge its severity.
Magnetic resonance imaging brain scans were performed on 114 volunteers as heat ranging from warm to hot was applied to their left forearm.
Researchers from the University of Colorado, New York University, Johns Hopkins University and the University of Michigan believed they would find a unique pain signature in each individual, because pain is measured differently among people and some are more sensitive than others.
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Online medical records a boon for Blacktown patients

By Nick Soon

April 12, 2013, 11:30 a.m.
KILDARE Road Medical Centre has become the first in Blacktown to register more than 1000 patients for their electronic health records.
It achieved this last week with the help of WentWest and Western Sydney Medicare Local’s eHealth assisted registration team.
Patients who register don’t have to keep repeating your health summary each time they go to their your doctor.
The centre’s chief executive officer, Peter Rushton, said their eHealth records would be there with key information such as current medications, allergies, adverse reactions to medications, chronic health issues or your children’s immunisations.
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Question: Does HL7 free IP mean open?

Posted on April 12, 2013 by Grahame Grieve
Question
Now that the HL7 IP is free, can I just send someone I am working with a copy of the specification?
Answer
No. While the IP is now licensed as free for use, it’s not actually open. In particular, only HL7 is allowed to distribute the specifications themselves. So you’ll have to direct your trading partners to the HL7 website to get a copy for themselves.
This is really to drive membership. HL7 has a real legitimate case for driving membership – developing the standard isn’t cheap, and has to be paid for somehow. In the absence of selling the standard, rent has to be extracted from somewhere.
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Rapid IT development to transform healthcare in APAC

by CXOtoday News Desk Apr 08, 2013
The healthcare industry in the Asia Pacific region is undergoing a massive transformation and is increasingly looking to improve service delivery under the impact of an evolving consumer profile, disease patterns and increasing healthcare costs. According to research firm Frost & Sullivan, a large number of healthcare facilities in this region are leveraging Information and communication technology (ICT), to boost service delivery and improve ROI.
According to Natasha Gulati, Connected Health Industry Analyst, Frost & Sullivan Asia Pacific, and author of the report states that efficient, affordable and timely delivery of quality healthcare services is becoming a priority for healthcare companies. According to her, emerging technologies such as cloud computing, big data analytics, advanced visualization tools, mobile and social technologies can revolutionize healthcare delivery in Asia-Pacific.
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IBM used rival's information to win QLD Health contract

Date April 9, 2013 - 3:03PM

Nathan Paull

IT giant IBM has admitted using leaked rival information to help secure a multi-million dollar Queensland Health payroll contract.
An inquiry into the bungled system is investigating whether IBM, which eventually won the contract, was given an unfair advantage during the tender process.
The probe was triggered after thousands of public servants were underpaid, overpaid or not paid at all following the system's implementation in March 2010.
The blunder is expected to cost taxpayers $1.2 billion.
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IBM given 'dry run' in payroll system bid

Date April 12, 2013 - 10:09AM

Nathan Paull

A former IBM boss has denied urging bureaucrats to favour the global IT giant in competition for a lucrative Queensland Health payroll system contract.
The Queensland Health Payroll System Commission of Inquiry heard on Thursday that Mr Burns favoured his former employer by giving it a "dry run" presentation to iron out faults before tender proposals were put to the government's IT arm, CorpTech.
The inquiry is investigating whether IBM, which won the contract, was given an unfair advantage over its rivals during the tender process.
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IBM says it won Queensland Health contract fairly

Date April 8, 2013 - 7:44PM

Nathan Paull

Global IT giant IBM has denied it was given preferential treatment by a former staffer to win the multi-million dollar Queensland Health payroll contract.
An inquiry into Queensland Health’s bungled payroll system is investigating whether IBM, which eventually won the contract, was given an unfair advantage during the tender process.
The probe was sparked after thousands of public servants were underpaid, overpaid or not paid at all following the system’s implementation in March 2010.
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Queensland Health payroll inquiry to grill former IBM top man

Terry Burns, once IBM's "top man" in South Africa, is expected to front the Queensland Health payroll inquiry on Wednesday
  • AAP (Computerworld)
  • 10 April, 2013 09:13
A man who played a key role in the Queensland government adopting his former employer's flawed health payroll system has denied any wrongdoing.
Terry Burns, once IBM's "top man" in South Africa, is expected to front the Queensland health payroll inquiry on Wednesday.
Mr Burns led a tender process that resulted in IBM winning a Queensland government IT contract in December 2007.
In March 2010, IBM rolled out a health payroll system that subsequently incorrectly paid thousands of nurses and staff, and which continues to be costly to operate. It will ultimately cost taxpayers $1.2 billion.
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NBN and IPTV trial for dental students launches

The trial has been funded as part of an $18 million Broadband Enabled Innovation program
A trial has been launched at the University of Melbourne’s Shepparton campus which aims to deliver dental education to regional Victoria using high-speed broadband and IPTV.
The Uni TV trail will include live broadcasts, educational videos on-demand and other resources which will be accessible on the Uni TV multi-channel Internet protocol TV system.
The 18-month project will include a six-month trial by the Institute for a Broadband Enabled Society in collaboration with the Melbourne Dental School at the University of Melbourne. It will also be delivered in partnership with Ericsson Australia, AARNet and Panasonic Australia.
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Medical Students To Be Trained With Telehealth

Medical students will be trained in important areas of practice where it has been difficult to get enough clinical experience, thanks to a new telehealth network, Unicare e-health, established at the University of Adelaide. The project makes it efficient and easy to communicate via video from the university to hospitals, rural general practices, specialist practices and other health services.
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Dr Mukesh Haikerwal (AO) re-elected to WMA

10 April 2013. NEHTA's Head of Clinical Leadership and Stakeholder Management Dr Mukesh Haikerwal (AO) has been re-elected Chair of Council of the World Medical Association.
Dr Haikerwal, a Melbourne GP and former AMA president, was handed another two-year term at the association's council meeting last week.
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Melbourne virtual nurse service nominated for Asia Pacific Eldercare Innovation award

Telehealth leaders Royal District Nursing Service (RDNS) is planning a real-time video consultation between a volunteer in Singapore and a senior Australian nurse next Tuesday to demonstrate its ‘Happy Healthy Home’ project.
RDNS is a finalist in the ‘Outstanding ICT Innovation’ award category at the 1st Asia Pacific Eldercare Innovation Awards 2013for its broadband telehealth project.
Organisers hope that a senior Singaporean official will agree to a live video link with a senior nurse in Melbourne who will check the volunteer’s blood pressure and perform a medication management simulation.
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Researchers replace passwords with mind-reading 'passthoughts'

Date April 10, 2013 - 10:14AM

Camille Bautista

Remembering the passwords for all your sites can get frustrating. There are only so many punctuation, number substitutes and upper case variations you can recall, and writing them down for all to find is hardly an option.
Thanks to researchers at the University of California, Berkeley School of Information, you may not need to type those pesky passwords in the future. Instead, you'll only need to think them.
By measuring brainwaves with biosensor technology, researchers are able to replace passwords with "passthoughts" for computer authentication. A $US100 headset wirelessly connects to a computer via Bluetooth, and the device's sensor rests against the user’s forehead, providing an electroencephalogram (EEG) signal from the brain.
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Turnbull bets utility over bling in the NBN bout

Ultimately the difference between Stephen Conroy’s national broadband network and Malcolm Turnbull’s boils down to the 'vision thing' – and the best part of $15 billion, or perhaps far more.
Conroy’s gold-plated 100 Mbps fibre-to-the premises broadband network is predicated on the 'if you build it they (consumers and applications) will come' approach; Turnbull’s fibre-to-the-node network on providing fast-enough and affordable broadband sooner and far more cheaply.
Conroy’s plan makes existing infrastructure that is still perfectly useable redundant and creates a new national wholesale monopoly funded by taxpayers; Turnbull’s leverages off the existing infrastructure, envisages competition and has user-pays and private co-funding options.
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Coalition pledges cheaper, slower NBN

Date April 9, 2013

Jonathan Swan

The Coalition says its national broadband network will be about $17 billion cheaper than Labor's and will be built two years sooner, but will use slower technologies than in Labor's version.
By the time the Coalition's network is finished in 2019, Australians will pay about $24 a month less for broadband than under Labor's plan, opposition communications spokesman Malcolm Turnbull said on Tuesday.
Under the Coalition's plan every Australian will have access to ''fast'' broadband by 2016,  Mr Turnbull pledged at the policy announcement in Sydney.
Mr Turnbull defined ''fast'' broadband as 25 megabits per second download speeds, about six times faster than today's average speeds, and similar to the fastest speeds available in today's market.
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PC sales plunge as Windows 8 flops

Date April 11, 2013

Bill Rigby

Microsoft's Windows 8 appears to be driving buyers away from PCs and toward smartphones and tablets, according to research firm IDC.
That's leading to the fastest drop in PC sales the firm has ever seen.
Global shipments of PCs fell 14 per cent in the first three months this year, IDC said. That's the sharpest plunge since the firm started tracking the industry in 1994.
The report comes after a year of bad news for the PC. Consumers, especially in wealthy countries such as the US, are steering their dollars toward tablets and smartphones rather than upgrading their home PCs. It's the biggest challenge to the personal computer since the IBM PC was released in 1981.
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Enjoy!
David.

Sunday, April 14, 2013

Government Desperation With Uptake Of The NEHRS Is Reaching Fever Pitch. I Think It Is A Doomed Effort and Waste of Money.

The following appeared earlier today.

Outrage as eHealth record sign-up squads hit Australian hospital patients in bid to boost numbers

  • Sue Dunlevy
  • News Limited Network
  • April 14, 2013 12:00AM
BUREAUCRATS armed with clipboards have been sent into hospitals and nursing homes to cajole patients to sign up for an eHealth record their doctors still won't be able to use.
Nine months after it was launched, the Government's $1 billion eHealth system holds just 414 patient records and is only a fifth of the way towards its target of signing up 500,000 patient users by June 30.
There are currently only two hospitals using the personally controlled electronic health record (PCEHR) system and they have uploaded just 155 discharge summaries.
And the system remains barely operational because fewer than one per cent of doctors have signed up for the Healthcare Identifier service number they need to be able to access patient records.
Despite this, Canberra has sent out a sign-up squad in a bid to boost numbers.
A Department of Health spokeswoman said around 12 specially trained staff had been deployed in hospitals, community clinics and aged care homes in Tasmania and the ACT to sign patients up to the scheme.
The move has caused outrage on health IT blogs with experts worried about the security of signing a patient up on paper and then re-entering the data online.
Launceston Hospital's Professor Terry Hannan, who set up an eHealth record for HIV patients in Africa that was nominated for the Nobel Prize, said patients in his hospital were being asked to hand over their Medicare cards and drivers licence to get an e-health record.
"Personally I have a lot of difficulty with this data collection process - not only from patient data security but the real risk of transcription errors in the data recording," he said on the Australian Health Information Technology blog.
"This whole process seems like seems like a political stunt to enhance the PCEHR registration numbers for a project that has been costly and doomed to failure - implementation wise and politically."
More here:
I can understand e-Health awareness campaigns and providing support for the enrolment when people ask for it. But approaching people who are almost certainly not interested when they are ill in hospital - or even worse corralling unsuspecting and unfortunate public servants - is really over the top as well as being privacy invasive etc.
I have expanded on this a little here:
If you want to see how patient portals should be deployed - and not how the NEHRS / PCEHR is actually doing it - see here:

Patient Portals Resource Center

Online portals allow patients to interact with their health information and communicate with providers outside the traditional office visit. Such systems offer powerful benefits: encouraging patients to become more engaged in their own care and helping providers to improve efficiency, quality, and access.
However integrating a portal into a clinical practice is not easy. The California HealthCare Foundation (CHCF) has worked with early adopters to capture key lessons learned, as well as tools and resources to help guide other safety-net clinics considering their own patient portals.
Lots more with 2 useful video.
It is interesting to see people using such systems both mobile and on their PC’s at home and how happy they are with what they can do.
The message is actually pretty simple. If the NEHRS/PCEHR actually did what people value and want it would be adopted - until then it will just remain a white elephant - people running around in white tee-shirts or not .
David.