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."

Friday, May 24, 2013

OK, Now This Is Really, Really Silly. A PCEHR Song?!?

This appeared last week.

The PCEHR song

Published on May 13, 2013
The PCEHR song from GP The Musical performed at Gasworks April 2013 as part of the Melbourne International Comedy Festival.
Written by Gerard Ingham and Genevieve Yates
This clip features Edmund Poliness (Dr White), Patrick Kinsella (Mr Black) and Ann-Marie Elliot (Kathy the receptionist)
You may view the roughly five minute video here
Good to see 735 souls have already done so.
I will leave it to readers to form their own view.
David.

Thursday, May 23, 2013

Karen Dearne: Just How Can NEHTA Operate Without Its Supporting Agreement? The Secrecy Seems To Be Utterly Out Of Hand!

Karen alerted me to this post today.
From: Karen Dearne

May 23, 2013

Dear Ms Forman
I refer to your decision that the MoU on eHealth is an exempt document under section 47B(a) of the FOI Act.
I note that you say: "As the MoU is not yet signed by all parties and is considered not to commence until this has happened, the release of the document may pre-empt jurisdictional agreement and may cause damage to relations between the Commonwealth and a State (including a Territory)".
This is surprising news, as the previous National Partnership Agreement on E-Health, constituting joint commonwealth-state funding arrangements for the National E-Health Transition Authority's work program, expired at the end of June 2012.
A renegotiated e-health agreement was identified as a key priority for the Health Minister when Ms Plibersek took that role.
The Department of Health and Ageing advised the Senate Community Affairs committee that "the eHealth MoU, which replaces the National Partnership on E-Health, was agreed by the Standing Council on Health on 9 November 2012".
Are you advising that there is currently NO funding agreement between the parties for this purpose? If so, on what basis is NEHTA's ongoing program being funded, and by whom?
Can NEHTA legally operate in the absence of a binding agreement between the parties?
While you say the decision to refuse the document's release is due to "the interest in preserving the efficient and proper functioning of government" - clearly this condition cannot apply, as without a
signed agreement there is no "efficient and proper functioning" between the parties on the national e-health program.
Indeed, it is difficult to imagine that this agreement could go unsigned for so long - unless there are significant objections to its content by one or more of the parties.

Since hundreds of millions of dollars have been spent by Australian governments on NEHTA and various commonwealth and state e-health projects, I would suggest, quite strongly, that release "of the document in its draft state" is essential to help "inform debate on a matter of public importance" and "promote effective oversight of public expenditure".
I would appreciate a prompt response to these questions.
Regards
Karen Dearne
See here:
All the previous documents - including the Department of Health saying this is not for the public to see - are found if you scroll up from the link here.
This is a total farce in my view. Culpable maladministration? Could be.
David.

Wednesday, May 22, 2013

I Wonder Will We Ever See Accountability Like This. I Won’t Hold My Breath.

The following appeared a few days ago.

Bipartisan bill would slash iEHR funding

May 16, 2013 | Erin McCann, Contributing Editor
Members of Congress are lauding a bipartisan bill that limits funding for an integrated electronic health record system between VA and DoD and requires aggressive progress updates from both agencies, which have, in recent months, come under fire for the dilatory pace at which they're moving forward with the iEHR. 
At a subcommittee mark-up hearing Wednesday, John Culberson, R-Texas, chairman of the House Subcommittee on Military Construction, Veterans Affairs and Related Agencies, called the bill a bipartisan success. "Our bill this year has dealt with the failure of DoD and VA to develop a single unified medical record in a very straightforward, commonsense way," he said.   
The bill, Culberson explained, will limit the funding toward the iEHR to 25 percent — of the $344 million requested. The agency will not receive the remaining dollars until they can prove to both agency subcommittees that they're actually implementing a plan to create and roll out a single, unified medical record.   
Just this February, VA Secretary Eric Shinseki and then DoD Secretary Leon Panetta announced that plans for a fully-integrated EHR between departments would be scrapped due to cost concerns.  
Original estimates for the iEHR were pegged at $4 billion to $6 billion. However, in September 2012, the Interagency Program Office revised its previous estimates, figuring the final price tag to be from $8 billion to $12 billion.   
Following fierce criticism from policymakers and prior to a Congressional hearing on the agency's iEHR progress, VA Chief Information Officer Roger Baker and Chief Technology Officer Peter Levin submitted their resignations.
Congressman Sanford Bishop, D-Ga., and ranking member of the House Subcommittee on Military Construction, Veterans Affairs, & Related Agencies, also expressed positive remarks toward the funding restrictions. "I'm very pleased," he said in the hearing.   
 Lots more here:
What a good plan - provide a reasonable amount to start a major project - and then pay for success. If success does not come then change those charge and turf the old lot out on their ear. There is something we might learn from all this.
David.

AusHealthIT Poll Number 168 – Results – 22nd May, 2013.

The question was:

Are You Confident Placing Advanced Care Directives On The PCEHR Directly Will Not Lead To Unanticipated Problems?

I Am Sure 13% (4)
Just A Remote Chance 19% (6)
Could Just Be Risky 13% (4)
Seems Pretty Risky To Me 48% (15)
I Have No Idea 6% (2)
Total votes: 31
Looks like a little more than half of readers have some concerns .
Again, many thanks to those that voted!
David.

Tuesday, May 21, 2013

Excellent Papers On Doing Large Scale E-Health and EHR Quality and Safety. Must Read Stuff.

The following papers were published a few days ago.
J Am Med Inform Assoc 2013;20:e9-e13 doi:10.1136/amiajnl-2013-001684
  • Perspectives

Ten key considerations for the successful implementation and adoption of large-scale health information technology

  1. Kathrin M Cresswell,
  2. David W Bates,
  3. Aziz Sheikh

Abstract

The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians.
The full article - freely accessible is found here:
This introduction should be enough to encourage careful reading of the whole article.

Introduction

Large-scale, potentially transformative, implementations of health information technology are now being planned and undertaken in multiple countries.1 ,2 The hope is that the very substantial financial, human, and organizational investments being made in electronic health records, electronic prescribing, whole-system telehealthcare, and related technologies will streamline individual and organizational work processes and thereby improve the quality, safety, and efficiency of care. The reality is, however, that these technologies may prove frustrating for frontline clinicians and organizations as the systems may not fit their usual workflows, and the anticipated individual and organizational benefits take time to materialize.3 ,4 In this article, we reflect on our mapping of the literature (see box 1) and complement this with our experiences of studying a range of national evaluations of various large-scale health information technology systems in the UK and USA to provide key pointers that can help streamline implementation efforts.4 ,52–54 In so doing, we hope to inform policy and practice development to support the more successful integration of technology into complex healthcare environments. This is particularly timely given the US Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes a $19 billion stimulus package to promote the adoption of electronic health records and associated functionality.55
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The paper provides Ten key considerations for the successful implementation of health information technology which make a great deal of sense  to me!

I will leave it to you to work out how close DoHA and NEHTA have got to these insights
This article is part of a JAMIA special edition. The contents page is found here:
A useful introduction to the whole issue is found here:
Also included and freely accessible is a policy document from AMIA on EHR useability and safety.

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

  1. Jiajie Zhang

Abstract

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.
The whole paper is found here:
Good to see these quality and safety issues associated with EHRs getting thorough discussion and review.
Enough reading for the whole week…
David.

Monday, May 20, 2013

Weekly Australian Health IT Links – 20th May, 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

The Budget came this week and we saw the funds committed to e-Health last year continue and then an apparent drop of in 2014/15 and deeper drops following .
Other than that we learn that we have just over 150,000 people registered to the PCEHR, some trials of secure messaging between differing providers and Tasmania looking for some new systems.
Hopefully a quiet week.
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Budget 2013: eHealth round-up

The 2013 Federal Budget, delivered by Treasurer Wayne Swan last night, will deliver new spending of around $13 billion and make savings of an estimated $44 billion over the next four years.
Despite an unexpected $18 billion deficit, big-ticket social welfare programs such as the Gonski education reforms and the National Disability Insurance Scheme have been funded.
The Medicare levy will rise from 1.5 to 2 percent from 2014 and promised spending increases and tax cuts linked to mining and carbon taxes (eg lifting the tax-free threshold and raising family tax benefits) have been abandoned. 
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‘Dumbing down the health system’ – doctors dissect budget

15th May 2013
FREEZING Medicare rebates, targeting MBS double-dipping, and capping tax-deductible CPD costs claimed by doctors are all part of sweeping savings measures in the federal budget.
The government is set to reap $644.4 million over four years by freezing Medicare rebate indexation at current levels until 1 July 2014, and the raising of the Extended Medicare Safety Net (EMSN) threshold from $1221.90 to $2000 has been forecast to save $119.9 million over the same period.
MBS rebates had been due for indexation from 1 November this year.
AMA president Dr Steve Hambleton and RACGP president Dr Liz Marles both reiterated pre-budget warnings that the measures would lead to greater out-of-pocket expenses for patients, as doctors were forced to increase fees to cover the costs of quality health services.
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PCEHR Registrations starting to snowball

The rate of new registrations for the personally controlled electronic health record is starting to snowball, a DOHA spokesperson said today, with registrations increasing by 28 percent in just over a fortnight.
There were 158,847 people registered as at midnight on May 16 - an increase of more than 25,000 since April 30, when registrations were at 124, 090.
However, the Federal government's target of 500,000 registrations by July 1 2013 still looks unlikely, particularly when the Department’s low-key promotion continues and clinicians remain disinterested.
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The PCEHR – an update for emergency physicians: Stuart Stapleton

Note: The video is available from the link at the top of the entry.
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Opinion: Why national e-health is not for everyone

Australians not affected by poor health are less likely to register for a national health record than those with chronic illnesses, argues Brett Avery
The national e-health initiative is missing its take-up targets. According to a report last month in The Australian, the federal government hoped to see 500,000 Australians with a personally-controlled electronic health record (PCEHR) by July, but as of early March there were only 73,648 consumer registrations.
For those registered with a PCEHR, there were only 108 shared health summaries and 51 discharge summaries uploaded into the PCEHR system that consumers could share with their healthcare providers.
There has been a big focus on hitting targets for the PCEHR but quite frankly, Australians who are in good health are unlikely to have the same need for a PCEHR than those who require ongoing care.
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NBN rollout ‘essential’ for rural pensioners

  • 14th May 2013 8:06 AM
ROCKHAMPTON'S Jim Lawler is holding his breath in anticipation to see if tonight's Federal Government Budget will include ongoing eHealth care for regional Queensland.
The National Union of Retired Workers regional secretary said the National Broadband Network rollout for the region, he hoped, was an absolute priority for the government because it gave residents in rural areas, away from major cities, the chance to be on top of their health.
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BUDGET 2013: CSC applauds healthcare investments

Identifies three top healthcare and technology initiatives leading into the Federal Election
Solutions and services provider, CSC has welcomed the Federal Government's Budget announcement regarding health and technology.
CSC general manager for global healthcare, Lisa Pettigrew, said, in a statement, that CSC, In particular, applauded the ongoing investment in the NBN which was crucial to Australia's future in the digital economy and underpinned the future of eHealth for Australian consumers.
"We are also pleased at the investments being planned for DisabilityCare and the bi-partisan support for the DisabilityCare conceptual proposals," she said.
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Human Services ups the ante in IT

  • by: Fran Foo
  • From: Australian IT
  • May 15, 2013 12:00AM
A SLEW of IT initiatives have been earmarked at the Department of Human Services as the government seeks to increase productivity and efficiency.
As part of Budget 2013, $30 million will be provided over two years to enhance call centre services and reduce waiting times.
"This measure will provide DHS with greater capacity to answer calls during the peak period for customers in receipt of the Family Tax Benefit and/or claiming the Child Care Rebate (July through September)," budget papers revealed.
The improvements will come from a number of initiatives, including callback options; improving interactive voice response messaging; increasing the use of mobile phone applications for customer interactions with the department and improving business processes.
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Scientists take data approach to beat disease

Date  May 14, 2013

Brad Howarth

It's an unusual match, but computer scientists, mathematicians and geneticists are joining forces across Australia to improve the lives of thousands of sufferers of conditions ranging from epilepsy to prostate cancer.
New advances in the emerging field of health bio-informatics (also known as computational biology) are giving clinicians the ability to fight diseases more accurately by combining advanced computer hardware and programming with genetic sequencing tools.
These tools are being used at the Murdoch Childrens Research Institute (MCRI) at the Royal Children's Hospital to sequence the entire genome of patients to identify the source of ailments including epilepsy, heart disease and neuromuscular conditions.
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Death wishes to be on EHR in Australia

The Australian government is pushing forward the plan to allow citizens to record their dying wishes on the personally controlled electronic health record (PCEHR) system, and ensuring them to have control over their end-of-life care, said Australian Minister for Health Tanya Joan Plibersek.
The announcement came late last week as part of an additional AU$ 10 million (US$ 9.97 million) Commonwealth allocated to develop this capability to store so-called ‘Advance Care Directives’ on their PCEHR.
The funding is as part of the amount of AU$325 million (US$ 323 million) already allocated to Tasmanian Health Assistance Package announced last June, which was used to assist the Tasmanian government and the Cradle Coast eHealth site to develop an advance care directive repository.
“Most families want to be true to the wishes of their loved ones as they approach the end of their lives, and Advanced Care Directives allow that to happen,” Plibersek said.
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Australian eHealth a step closer with successful trial of Secure Message Delivery

Created on Friday, 17 May 2013
The Australian healthcare industry is one step closer to fully adopting technology in health (‘eHealth’), with healthcare providers successfully trialling electronic information transfer and sharing.
Five healthcare messaging vendors - Argus Connect, Global Health, Healthlink, LRS Health, and Medical Objects - collaborated with General Practices, the National E-Health Transition Authority (NEHTA) and associated government agencies to develop Secure Message Delivery (SMD) capabilities.
According to NEHTA’s Head of Clinical Leadership and Stakeholder Management, Dr Mukesh Haikerwal AO, the success of the Project[1] represents an opportunity for improved effectiveness and better health care.
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Australian eHealth messaging trial a success

Healthcare providers to securely exchange clinical information
A successful eHealth trial of secure message delivery means Australian healthcare professionals will soon be able to share clinical information through online messaging.
The National E-Health Transition Authority (NEHTA) trial included five healthcare messaging vendors: Argus Connect, Global Health, Healthlink, LRS Health and Medical Objects. The vendors successfully sent and received secure messages from each other, showing the interoperability of the messaging system.
“The progress that has been achieved by this project will mean any medical practitioner–be they a public or private GP, specialist or surgeon–will be able to share information over time through online secure messaging,” NEHTA head of clinical leadership and stakeholder management said in a statement.
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Health technology trial paving way for e-health adoption

The Australian healthcare industry has moved closer to full adoption of health technology, with healthcare providers successfully trialling electronic information transfer and sharing.
The successful e-health trial has just been completed by five of Australia’s healthcare messaging vendors - Argus Connect, Global Health, Healthlink, LRS Health, and Medical Objects – in collaboration with General Practices, the National E-Health Transition Authority (NEHTA) and associated government agencies.
The trial tested the use of Secure Message Delivery (SMD) capabilities.
According to NEHTA’s Head of Clinical Leadership and Stakeholder Management, Dr Mukesh Haikerwal AO, the success of the project represents an opportunity for improved effectiveness and better health care in Australia.
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Tasmania searches for $1.8 million health information system

Summary: Tasmania is searching for a contractor to take on the task of creating a single, state-wide information system for the emergency departments across four hospitals, while delivering the five-year contract within $1.8 million.
By Michael Lee | May 13, 2013 -- 07:04 GMT (17:04 AEST)
Tasmania has gone to market to find a contractor that can replace the information systems responsible for four of its public hospitals.
A large part of the Tasmanian Department of Health and Human Services' tender revolves around the accurate collection of data, processing it through the newly envisioned state-wide information system, migrating the data from three disparate systems into one, managing the project, and providing all the necessary testing and training required.
The requirements of the new system are quite high, with possibly technically challenging requirements, including the ability for more than one user to access a patient record at the same time (without locking out other users), regardless of the device being used; providing notification and reporting of patient status and wait times; managing complete patient billing; and tracking all patient movements, all while supporting 600 simultaneous users.
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What to expect in IT for Budget 2013

Health expenditure & scope creep
Structurally the Government’s IT budget strategy needs to respond to the spending increases in health and welfare (including NDIS) supported by health technology and systems such as eHealth and the PCEHR.
Last year’s Budget sought to promote the eHealth implementation program, with a key performance indicator of achieving 500,000 for its PCEHR program, with a further million consumers to sign up in 2013-2014, with 2.2 million by 2014-2015.
In practice, PCEHR may miss its initial target, with only 109,000 records registered less than a month ago.
Some 2000 health care practitioners had access to the system, and 90 percent of GPs had access to the software deployed by the National E-Health Transmission Authority.
While the government allocated an extra $233 million over three years to continue the implementation of the national eHealth program over the $466 million allocated two years ago to build the PCEHR, its investment may be spread over a longer period than suggested by its forward estimates.
The eHealth system is subject to some recent scope creep. Health Minister Tanya Plibersek revealed last week that her department would invest a further $10 million to enable “advance care directives" to be stored on the Personally Controlled Electronic Health Record.
“Because it’s online, the advance care plan will be easily available,” Ms Plibersek said.
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Smartphone app helps fight fat

  • From: AFP
  • May 13, 2013 9:33AM
USING a simple smartphone application to photograph meals is a useful slimming aid for the overweight, doctors say.
The app, designed by British doctors, aims at promoting "food memory" so people recall what they have eaten and are encouraged not to snack on high-calorie treats.
The app has three parts:
* before eating food or drinking a beverage, the user snaps a picture of what is about to be consumed;
* after finishing the meal or drink, the user then looks at the picture that was taken, and answers questions about the consumption experience "Did you finish it all?" and "How full are you now?";
* before further meals, users also look back at the file of pictures that have been taken in the course of the day and get a text message urging them to remind themselves of what they have already eaten.
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Measuring vaccine confidence online: new tool used to analyse public concerns

Date May 13, 2013 - 9:12AM

Melissa Davey

Health Reporter

A surveillance tool developed by an international team of researchers can track anti-vaccination sentiment online, allowing them to respond to vaccine concerns as they emerge.
Researchers have been monitoring 144 countries using the tool, in the hope public health officials can respond quickly to a loss of confidence in vaccines before vaccination refusal and disease outbreak occur.
The research, released Online First in The Lancet Infectious Diseases on Monday, found there were 10,380 reports on vaccines between May 2011 and April 2012. Nearly 70 per cent of the reports were positive or neutral towards vaccination, while just over 30 per cent were negative.
Of the negative reports, almost half were associated with vaccine suspension and refusal, belief systems that opposed vaccination, and risk perceptions.
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Is big data all it's cracked up to be?

Date: May 14, 2013 - 8:02AM
Kate Crawford of the MIT Centre for Civic Media goes behind the numbers to debunk five myths about big data.
"With Enough Data, the Numbers Speak for Themselves."
Not a chance.
The promoters of big data would like us to believe that behind the lines of code and vast databases lie objective and universal insights into patterns of human behaviour, be it consumer spending, criminal or terrorist acts, healthy habits, or employee productivity. But many big-data evangelists avoid taking a hard look at the weaknesses. Numbers can't speak for themselves, and data sets - no matter their scale - are still objects of human design. The tools of big-data science, such as the Apache Hadoop software framework, do not immunise us from skews, gaps, and faulty assumptions. Those factors are particularly significant when big data tries to reflect the social world we live in, yet we can often be fooled into thinking that the results are somehow more objective than human opinions. Biases and blind spots exist in big data as much as they do in individual perceptions and experiences. Yet there is a problematic belief that bigger data is always better data and that correlation is as good as causation.
For example, social media is a popular source for big-data analysis, and there's certainly a lot of information to be mined there. Twitter data, we are told, informs us that people are happier when they are farther from home and saddest on Thursday nights. But there are many reasons to ask questions about what this data really reflects. For starters, we know from the Pew Research Centre that only 16 per cent of online adults in the United States use Twitter, and they are by no means a representative sample - they skew younger and more urban than the general population. Further, we know many Twitter accounts are automated response programs called "bots," fake accounts, or "cyborgs" - human-controlled accounts assisted by bots. Recent estimates suggest there could be as many as 20 million fake accounts. So even before we get into the methodological minefield of how you assess sentiment on Twitter, let's ask whether those emotions are expressed by people or just automated algorithms.
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Free Windows 8 update to address confusion

Date May 15, 2013 - 11:49AM

Anick Jesdanun

Zoom in on this story. Explore all there is to know.
A planned Windows 8 update to address complaints and confusion with Microsoft's new operating system will be made available for free this year, the company says.
Not charging extra for Windows 8.1, previously code named "Windows Blue", is consistent with the company's practice of offering "decimal point" updates to operating systems for free. But when Microsoft announced the update last week, it didn't say that it would be free.
Tami Reller, the marketing and financial chief for Microsoft's Windows business, said the company wants to assure customers that they can buy Windows 8 now and still get the benefits of Windows 8.1 later.
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Déjà vu.

Individual Health Identifiers For Doctors and Patient Imminent

Friday, 17 May 2013 12:12 June Shannon
Ireland’s new eHealth strategy is expected to recommend that all doctors and hospitals are allocated an individual health identifier (IHI) or number, which will allow for improved data collection and tracking across the heath service, IMN understands.
The yet to be published eHealth Strategy is also expected to recommend that all patients are assigned an IHI, which will be linked to the new public service cards currently being rolled out by the Department of Social Protection.
Speaking to IMN last week at the World of Health IT conference, the Head of ICT at the Department of Health Mr Kevin Conlon explained that work on the introduction of IHIs was at an advanced stage; however, it would need to be backed by legislation under the new Health Information Bill.
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Enjoy!
David.

Sunday, May 19, 2013

I Have A Feeling This Aspect Of The NEHRS Seems A Bit Incoherent And Ill Thought Out. Confusing Even!

As mentioned a week or so ago there has been an update to the viewable NEHRS / PCEHR.
See here for the blog.
A few days ago the professional FAQ for the PCEHR was updated.
This is found here:
This section I found interesting among others. It explains what the intent of the new Medication View of the PCEHR is and it now becomes clear it is a broader implementation of the MedView Wave Site program conducted by the Pharmacy Computing Company FRED IT I believe.
MedView has been renamed the NPDR.
Here is what we learn.

What is the National Prescription and Dispense Repository (NPDR)?

New functionality has been added to Australia’s eHealth record system to make, over time, the prescribing and dispensing of medication a safer, more effective part of health care.
The National Prescription and Dispense Repository provides for the creation of an online medication history (not retrospective) for patients with an eHealth record based on information collected at the point of prescription and the point of dispense.
A new Prescription and Dispense View has been added to the eHealth record system that displays information entered by participating healthcare providers relating to the medications prescribed and dispensed to patients with an eHealth record.
The new Prescription and Dispense View displays the name and date a medication has been prescribed (both the brand and generic name), the strength or dose of the medication (e.g. 2mg, 20mg, etc), the direction for consumption (e.g. take one capsule daily) and the form of the medication prescribed (e.g. capsule, tablet, inhaler, etc). Similar information is also displayed as medications are dispensed.
For healthcare professionals participating in the eHealth record system, this gives a better view of the medications that has been prescribed and dispensed to a patient, which, over time, will help support better clinical decisions.
While the new prescribe and dispense function is now available, benefits will only be realised over time as more people – consumers and healthcare provider organisations alike – register and participate in Australia’s eHealth record system. The new Prescription and Dispense View should not be wholly relied upon to be complete record of prescribed and dispensed medicines.
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Very useful information is also found from the FRED IT website. The discussion shows how the PCEHR can be accessed and viewed from the Dispensing System.
See here:
Very interestingly it seems the Pharmacist can access the Shared Health Summary and most other documents, including Advanced Care Directives , presumably with the default security settings in place. (I would have thought such access might have been made ‘opt-in’ - but there you go).
Another wrinkle in all this was raised a month or two back:

MediSecure announces RACGP Protocol Implementation for e-Prescriptions

Published on: 7th March, 2013
Earlier this week, MediSecure met with RACGP to discuss potentially significant issues in relation to the dispense notifications provided to general practitioners through the electronic transfer of prescriptions (eTP). These RACGP concerns impact both prescription exchange services.
Under current privacy legislation, GPs are required to obtain patient consent to receive and read Dispense Notifications in their clinical system. The RACGP advises that receiving Dispense Notifications may also impact on the GP’s duty of care.
The RACGP has requested that MediSecure provide an option to both not install, and remove the dispense notification function from the practice’s clinical information system and the practitioner’s view.
MediSecure has agreed to this. Accordingly we have disabled all Dispense Notifications in the MediSecure eTP system, effective from 8 March 2013.
Any new MediSecure® installation or an existing installation will not be able to access the Dispense Notification service from this time. Over the coming weeks MediSecure will develop and deploy a new client adaptor to remove the Dispense Notification menu option from your desktop.

In summary:

The immediate fix to this patient consent and doctor medico-legal risk issue is to disable Dispense Notifications. No MediSecure® user can access Dispense Notifications from 8 March 2013.  Over the next two months, MediSecure will contact your practice to update your existing MediSecure client to remove Dispense Notifications as a menu option.
You are referred to Friday Facts for the RACGP advice in relation to dispense notifications.

Future New Dispense Notification Service

For those practices and clinicians that wish to access the Dispense Notification data after 8 March, we advise that MediSecure will release a new ehealth service as a specific opt-in Dispense Notification service with a separate Licence. Details of how to enrol for this service will be released around 15 March 2013.
For any GP or practice that decides to adopt the new Dispense Notification service after 15 March 2013, MediSecure and RACGP recommend that GPs obtain and record consent from the patient to receive dispense notifications.
More information on an appropriate Consent Protocol will be released at the time of announcement of the new service.
See here:
The eRx Script Exchange responded similarly.
The way the RACGP saw things is here:

Electronic transfer of prescriptions – update to Medisecure and eRX users

The RACGP supports electronic transfer of prescriptions (eTP) as a prescribing process to reduce transcription errors and increase medicine safety for the community. However, the College has become aware of potentially significant issues in relation to the dispense notifications provided to general practitioners by the two proprietary eTP vendors (Medisecure and eRX). The receiving of dispense notifications is a departure from current clinical practice whereby GPs are generally unaware as to whether or not a prescription has been dispensed, unless advised by the patient at a subsequent visit. Whilst GPs may find it useful to know whether their prescriptions have been dispensed, it requires patient consent to receive or read such notification; this may impact on a GPs duty of care.
This week, the RACGP met with both vendors to request that they review the current consent and product installation processes and terms of use. The College has requested advice from both vendors about the feasibility of modifying their system to not install, and remove the dispense notification function (where already installed) from the practice’s clinical information system and the practitioner’s view. In response to our request, Medisecure has advised that dispense notification functionality will be disabled effective Friday 8 March 2013. Medisecure will provide more detailed information directly to its users. When information is available from eRX, GPs will be advised in a future edition of Fridayfacts.
See here:
In my view what we have happening here is a total failure of the observance of basic system design and implementation approaches.
First we have introduction of functionality into the PCEHR and e-prescribing systems which the GPs are not at all happy with to say nothing of the whole thing being obvious scope crepe - like the planned ACD addition and the Child Care Section.
Second we have the nonsense of there now being two sources of information regarding medications in the same patient’s PCEHR which are neither synchronised or obviously related. What ever happened to the single source of information for this sort of data. Multiple differing sources are just a joke.
Why this happened was all due to the haste with which the program has been conducted and the nonsense of multiple Wave sites conducting non-integrated pilots and development and a rather obvious effort to get as much stuff as possible out there before the looming Federal Election.
It is really amazing a single patient record can have 3 different sources of medication information (Shared Summary, Medicare and the NPDR) each of which has a different delay and almost certainly different information.
What is more is that you still can't have your prescription sent to the pharmacy of your choice and the functionality overseas experience shows is liked by patients in a PHR are still not  present.
What we have now looks pretty amateurish and really confusing for the average patient.
David.