This Is A Useful Discussion Of The Value That Can Be Found In Deployment Of Health IT, Especially The More Advanced Forms.

The following appeared a little while ago.

How to measure the value of health IT

Posted on Mar 07, 2014

By Mike Miliard, Managing Editor

There's been a whole lot of capital invested in health information technology these past few years. And some people – especially those who are in charge of spending more of it – want to know whether it's money well spent.

It may seem obvious to some in this industry, but it's still a question that bears asking: Is the value of health IT self-evident at this point, five years after HITECH? Or is the jury still out?

"I think in the United States we've passed a tipping point," says John Hoyt, executive vice president of HIMSS Analytics. "People understand that IT can create value."

The catch? "It's not automatic."

Instead, recognizing and reaping the value of IT systems comes only with careful planning – and commitment to seeing project through, says Hoyt.

"It has to be designed for, as part of implementation and post-implementation optimization," he says.

And after install, even when it's there, that value can sometimes be hard to quantify, says HIMSS Analytics Senior Director of Research Jennifer Horowitz: "I would argue that people aren't doing a very good job of measuring the value they get."

In July 2013, HIMSS unveiled its new Health IT Value Suite, a trove of quantitative and anecdotal data meant to help healthcare stakeholders assess technology's value. Its 1,000 case studies are meant to offer evidence that health IT works – even if the notion of value could have 80 different meanings.

That fact is illustrated by the Value Suite's STEPS taxonomy – the acronym stands for satisfaction, treatment/clinical, electronic information/data, prevention/patient education and savings – which lays out dozens of documented real-world examples of the myriad ways health IT has led to improved care and financial gains.

"Pinpointing the clinical and financial impact of health IT investments is complex," said Carla Smith, executive vice president of HIMSS, at a press conference this past summer announcing the suite's launch.

"The value of health IT is demonstrated in many ways; some may be unique to an organization, while others may be highly adoptable and scalable," she said. "HIMSS created the Health IT Value Suite to organize and create a common vocabulary to identify, classify and discuss the many known examples of health IT value, to create a comprehensive library of case studies from which we can research impact, and to educate all on the findings."

MORE THAN JUST ROI
One of the challenges, of course, is that different types – and different sizes – of providers arrive at value in different ways. A fully tricked-out academic medical center is in a different position, after all, than a tiny rural physician practice.

"The leading-edge institutions are investing the effort to measure before they implement and after they implement, and they've got demonstrable evidence," says Hoyt.

Indeed, when HIMSS is bestowing Davies and Stage 7 Awards to top-notch facilities, part of the requirement to qualify is that the provider "present to us evidentiary data that quality has improved, efficiency has improved, something," says Hoyt.

That's not necessarily a return on investment, however.

"Quality has a measure of value, financially, but it's harder to derive," says Hoyt. "It's not mathematical." It's not necessarily as easy, in other words, as installing a PACS system and immediately reaping the efficiency benefits of getting rid of film, for instance. "That's why we use the term 'value,' and not ROI."

At the same time, just because an organization is implementing an EHR or other system, "that doesn't mean they're getting value," he says. "That just means they're going along with a wave."

For instance, there are big differences between the ambulatory and inpatient spaces in terms of how immediately they recognize value. "It might be a little harder for the docs," says Hoyt with a laugh. "Because they're not as big and screwed up as a lot of hospitals."

More to the point, it's critical that organizations be fully committed to health IT transformation to see tangible improvements in their care delivery. It's not beneficial to merely dip a toe in the water with a rudimentary EHR; you have to be in it to win it.

Hoyt points to evidence from HIMSS Analytics showing that value-based purchasing scores correspond closely to where an organization sits on the HIMSS EMR Adoption Model.

"Fundamentally it shows that there's not a big payoff in quality until Stage 6," says Hoyt. "Because you're still building the pieces. You don't get the payoff."

"You can see that Stages 2, 3, 4, 5 the scores are sort of not changing much," say Hoyt (see chart below). "Then at 6 there's a bump. And at 7 there's a big bump up."

It's just another indication, he says, that there is value in health IT.

"You do get quality improvements, you do get efficiency improvements. But it doesn't really happen until probably Stage 6. Because you're still building the bridges. And your traffic volume doesn't improve until the thing is damn near finished. So that's really the message."

There is a lot more:

http://www.healthcareitnews.com/news/how-measure-value-health-it

Little more needs to be said with this article. It provides pointers to a useful set of resources and concepts that need to be considered as Health IT is planned and delivered.

A good read and some good links!

David.

The Former ONC Coordinator Says Health IT Will Deliver Over Time And Explains Some Other Things.

This appeared a little while ago.

David Blumenthal: Benefits of HIT programs will surface with time

March 20, 2014 | By Dan Bowman

An "asymmetry of benefits" for providers has kept the healthcare industry from ubiquitous adoption of health IT--and electronic health records, in particular--and thus realizing its full potential, according to David Blumenthal, former national coordinator for health IT and current president of The Commonwealth Fund.

"From the patient's perspective, this is a no-brainer. The benefits are substantial," Blumenthal told The Atlantic in a recent interview. "But from the provider's perspective, there are substantial costs in setting up and using the systems. Until now, providers haven't recovered those costs, either in payment or in increased satisfaction, or in any other way."

While to that end, Blumenthal said, the medical marketplace is broken, he added that there is still some hope. He pointed to systems like the U.S. Department of Veterans Affairs and Kaiser Permanente as examples where technology has thrived due to "internalized" benefits that have led to better and faster adoption.

"You don't need a thought experiment to find living, breathing examples of what happens when the incentives work right," Blumenthal said.

Lots more here:

http://www.fiercehealthit.com/story/david-blumenthal-benefits-hit-programs-will-surface-time/2014-03-20

Here is the source article.

Why Doctors Still Use Pen and Paper

The healthcare reformer David Blumenthal explains why the medical system can’t move into the digital age.

James Fallows  Mar 19 2014, 9:06 PM ET

The health-care system is one of the most technology-dependent parts of the American economy, and one of the most primitive. Every patient knows, and dreads, the first stage of any doctor visit: sitting down with a clipboard and filling out forms by hand.

David Blumenthal, a physician and former Harvard Medical School professor, was from 2009 to 2011 the national coordinator for health information technology, in charge of modernizing the nation’s medical-records systems. He now directs The Commonwealth Fund, a foundation that conducts health-policy research. Here, he talks about why progress has been so slow, and when and how that might change.

James Fallows: From the lay public’s point of view, medical records seem incredibly backward. Is the situation any better than it looks?

David Blumenthal: It’s on the way to getting better. But we still have a long way to go. The reason why the medical profession has been so slow to adopt technology at the point of contact with patients is that there is an asymmetry of benefits.

From the patient’s perspective, this is a no-brainer. The benefits are substantial. But from the provider’s perspective, there are substantial costs in setting up and using the systems. Until now, providers haven’t recovered those costs, either in payment or in increased satisfaction, or in any other way. Ultimately, there are of course benefits to the professional as well. It’s beyond question that you become a better physician, a better nurse, a better manager when you have the digital data at your fingertips. But the costs are considerable, and they have fallen on people who have no economic incentive to make the transition. The benefits of a more efficient practice largely accrue to people paying the bills. The way economists would describe this is that the medical marketplace is broken.

This is the link:

http://www.theatlantic.com/magazine/archive/2014/04/the-paper-cure/358639/

A well worth while discussion on the view from the US and the progress being made on the broad view.

David.

Pre - Budget Review Of The Health Sector - 10th April 2014.

As we head towards the Budget in Early to Mid-May 2014 I thought It would be useful to keep a closer eye than usual on what was being said regarding what we might see coming out of the Budget.

According to the Australian Parliament web site Budget Night will be on Tuesday 13^th May, 2014.

Here are some of the more interesting articles I have spotted this week.

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http://www.afr.com/p/national/everyone_must_bear_budget_burden_iWD3IHs6L5H0aJYnd1nWOM

Everyone must bear budget burden: Hockey

March 31, 2014

Jacob Greber Economics correspondent

Treasurer Joe Hockey has ramped-up warnings that all parts of the community and business must contribute to the budget repair task or risk having the burden fall on a few.

With the government now considering the second and final report of its Audit Commission, Mr Hockey said without swift action Australians could expect to see standards of living fall.

“What we need to do is ensure the whole nation helps to do the heavy lifting to make the budget repair work, so we can not just maintain our quality of living but maybe improve our quality of living into the future,” he said on Monday.

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http://blogs.crikey.com.au/croakey/2014/04/06/finding-savings-in-healthcare-moving-from-theory-to-reality/

Finding savings in healthcare: moving from theory to reality

Jennifer Doggett | Apr 06, 2014 8:47AM

With a tough federal Budget fast approaching, many in the health sector are offering up suggestions for where the Abbott Government might find savings. Some of these options were outlined in an article published in Croakey earlier this week. They include:

• cutting the price paid for generic drugs and encouraging substituting brand name drugs with generics,
• expanding the range of tele-health services that can be funded under Medicare,
• ensuring treatments listed on the Medical Benefits Schedule are effective and offer value for tax-payers, reducing use of those that are wasteful, and  
• reducing the price paid for prosthesis, such as hip and knee replacements.

These options and more were discussed in detail at a roundtable, hosted by the Australian Healthcare and Hospitals Association (AHHA), on options for finding savings in health and improving quality in health care. Dr Anne-marie Boxall, Director, Deeble Institute for Health Policy Research at the AHHA and co-author of Making Medicare, provided the following report from the Roundtable.

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http://www.theage.com.au/federal-politics/political-news/worse-alternatives-than-higher-gst-20140404-zqqqb.html

Worse alternatives than higher GST

Date April 6, 2014

Peter Martin

Economics correspondent

So you’re frightened by the prospect of a higher GST? You shouldn’t be. The alternatives are worse.

One of them, outlined by Treasury secretary Martin Parkinson on Wednesday, is deceptively painful.

It’s doing nothing – just leaving the tax system on hold for 10 years and letting climbing revenues eat away at the projected deficits as inflation pushes more of our incomes into higher tax brackets.

It’s called “bracket creep”, although it can happen even if inflation doesn’t push your wage into a higher tax bracket. Every time your wage goes up, a greater proportion of it becomes taxed (above the tax-free threshold) rather than untaxed (below the threshold). It means that by doing nothing other than accepting ordinary annual wage rises, each of us is made to pay an ever increasing proportion of our income in tax.

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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton029.htm

Funding for Mental Health

The Australian Government has provided $170 million for the continuation of 150 programs as part of its ongoing commitment to mental health.

Page last updated: 04 April 2014

PDF printable version of Funding for Mental Health - PDF 236 KB

4 April 2014

The Australian Government has provided $170 million for the continuation of 150 programs as part of its ongoing commitment to mental health.

The Minister for Health Peter Dutton said the funding would see the projects continue their work through 2014-15.

“It is essential to ensure the continuity for mental health services, suicide prevention and postvention programmes while the National Mental Health Commission undertakes its review of all existing services,” Mr Dutton said.

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http://www.medicalobserver.com.au/news/changes-to-qld-doctor-contracts-passed

Changes to Qld doctor contracts passed

4th Apr 2014

AAP

GOVERNMENT concessions made in the long-running dispute over senior doctors’ contracts have been passed in Queensland's parliament.

The changes passed on Thursday night mean senior medical officers will be offered life-long contracts that can't be varied to negatively affect doctors without an act of parliament.

It also limits the Queensland Health director-general's powers so directives can't affect a doctor's contract except when increased remuneration or improved benefits are offered.

However, the concessions may not be enough to resolve the dispute, with assistant health minister Dr Chris Davies on Thursday threatening to resign if the dispute was not resolved by the 30 April contract deadline.

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http://www.medicalobserver.com.au/news/qld-govt-takes-doctors-to-court

Qld govt takes doctors to court

2nd Apr 2014

AAP

THE feud between Queensland doctors and the state government over contracts is moving to a new battleground.

Lawyers for the state were due to appear before the Federal Court on Wednesday to try to stop doctors' groups and others spreading "misinformation" about proposed new contracts.

Some doctors and unions claim the contracts will strip employment protections and potentially compromise patient care.

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http://www.australiandoctor.com.au/news/latest-news/pollies-move-to-stop-ipn-medibank-deal

Greens move to stop IPN-Medibank deal

2 April, 2014 Paul Smith

The Greens have stepped in to try to ban Medibank Private from paying a GP corporate to offer bulk-billed Medicare services to its customers.

It emerged this year that private health insurer Medibank Private had agreed to pay an "administration fee" to IPN for doctors at six of of the corporate's clinics to offer so-called priority access.

It translates into about 4500 Medibank policyholders having access to guaranteed appointments and bulk-billed services — including after-hours care.

But Greens Senator Richard Di Natale has introduced an amendment bill that would make it illegal for private health insurers to team up with primary care providers to provide preferential treatment for some patients.

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http://www.abc.net.au/news/2014-03-31/fed-health-minister-urged-to-help-resolve-doctors-contracts-row/5355608

Federal Health Minister Peter Dutton urged to step in to resolve Queensland doctors' contract row

March 31, 2014

The Federal Opposition says Health Minister Peter Dutton should help resolve Queensland's doctors' contracts dispute.

Federal Opposition health spokeswoman Catherine King says there does not appear to be a back-up plan if Queensland doctors carry out their threat to resign en masse over the State Government's public hospital employment contracts.

The Federal Court will this week hear an application by Queensland Health to try to stop unions from allegedly misrepresenting proposed employment contracts for doctors.

Queensland Health is seeking an injunction to stop the circulation of documents that it claims misrepresents the State Government contracts.

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http://www.smh.com.au/federal-politics/political-news/australian-medical-association-says-push-to-stop-union-advice-a-grim-prognosis-for-nation-20140330-35rv7.html

Australian Medical Association says push to stop union advice a grim prognosis for nation

Date March 31, 2014

Anna Patty

Workplace Editor

The Australian Medical Association fears the Queensland government's unprecedented attempt to stop unions from providing advice to members and its introduction of individual contracts for public hospital doctors could embolden other states to follow its example.

This week, Queensland Health will launch legal action in the Federal Court to stop the AMA, the Australian Salaried Medical Officers Federation (ASMOF) and Together, another union representing senior doctors, from passing on what is says is inaccurate information to its members.

It is unheard of for an employer to assert that a union, by talking to its members ... is engaging in misleading and deceptive conduct. 

The unions have provided advice to senior salaried doctors about the government's introduction of individual contracts to override collective bargaining agreements.

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http://www.theaustralian.com.au/news/health-science/cancer-treatment-funding-under-threat/story-e6frg8y6-1226873656218

Cancer treatment funding under threat

• SEAN PARNELL
• The Australian
• April 03, 2014 3:03PM

HEALTH officials are in crisis talks after discovering certain cancer treatments have not been properly costed for a new national funding scheme being implemented in July.

The much-heralded introduction of activity-based funding, one of the key Labor health reforms, has come with a last-minute challenge for policymakers that appears to threaten the availability and affordability of radiotherapy.

The Australian Health Ministers Advisory Council — comprising the heads of commonwealth, state and territory health departments and key agencies — recently discussed the issue and agreed “further costing work should be undertaken as a matter of urgency”.

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http://www.smh.com.au/federal-politics/political-opinion/hockey-is-right-gst-is-worth-talking-about-20140402-35yvx.html

Hockey is right, GST is worth talking about

Date April 3, 2014

Peter Martin

Economics correspondent

Treasurer Joe Hockey was aware of the broad content of Martin Parkinson's speech before he delivered it. His personal position on the goods and services tax remains unchanged.

Along with Tony Abbott, Hockey spent the entire election campaign never entirely ruling out an expanded GST. Why would he when he was about to commission a tax review that would examine everything?

Hockey has had the report of the National Commission of Audit for six weeks now. If it too has suggested an expanded GST it is something we are going have to take seriously.

At 10 per cent, Australia's GST is embarrassingly low by international standards. New Zealand started at 10 and went to 12.5 and then 15.

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http://www.pharmacynews.com.au/news/latest-news/pharmacy-jobs-losses-likely-guild

Pharmacy jobs losses likely: Guild

2 April, 2014 Nick O'Donoghue

Almost 9000 pharmacy jobs are set to be lost in the next 12 months as a result of increasing financial pressures, according to a survey carried out by the Pharmacy Guild of Australia.

The Guild’s Employment Expectations Report, released today, revealed that the pharmacy workforce is set to shrink by up to 14% in 2014, as the impacts of price disclosure and the loss of trading terms hit owners.

The survey found that pharmacy owners expected to lay-off more than 2200 pharmacists, 4400 pharmacy assistants and 2300 other staff members during the course of the year, due to growing financial pressures.

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http://news.ninemsn.com.au/health/2014/04/01/10/42/health-plan-launched-in-wa

Health plan launched in WA

10:38am April 1, 2014

The federal government has set aside $56.3 million for regional health and hospital services in Western Australia.

Federal cabinet is meeting in Perth on Tuesday ahead of Saturday's WA Senate election re-run.

Federal Health Minister Peter Dutton said new agreements would provide extra funds for kidney dialysis treatment, pathology and dental care.

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http://www.smh.com.au/federal-politics/political-news/health-academic-says-140m-could-be-saved-by-following-drug-advice-20140331-35u9s.html

Health academic says $140m could be saved by following drug advice

Date April 1, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

The Abbott government could save more than $140 million over the next eight months simply by adhering to a recommendation from the expert body that advises it on medicines, a health expert says.

In 2012, the Pharmaceutical Benefits Advisory Committee recommended that the price difference between the cholesterol-lowering drug simvastatin and a newer cholesterol-lowering medicine, atorvastatin, should, on average, be 12.5 per cent.

But the recommendation was not implemented. Simvastatin is one of scores of drugs that will drop in price by an average of 40 per cent from Tuesday under a policy limiting drug costs according to the market price.

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http://www.afr.com/p/business/healthcare2-0/medibank_sale_raises_members_rights_R6LbJaIan9URjBgKjPiYRK

Medibank sale raises members’ rights

PUBLISHED: 31 Mar 2014 19:56:00 | UPDATED: 01 Apr 2014 07:08:21

Ben Potter

In the four years since the Rudd ­government converted Medibank Private into a profit-making insurer, the Commonwealth has peeled off $1.366 billion in dividends and taxes. Profits after tax for Medibank Private have totalled just $964 million, and the he alth fund’s net assets have been whittled down from $1.72 billion in 2010 to $1.4 billion at June 30.

The Commonwealth’s haul amounts to a 16-fold return on the $85 million it put into Medibank, and revives an old debate over whether any prior rights of the 1.8 million members to the net assets have been trampled in the process.

The Abbott government has kicked off a sale process aimed at pulling in as much as $4 billion to help cut federal deficits. Lazard Australia – whose directors include former Labor prime minister Paul Keating, former finance minister Lindsay Tanner and former Victorian treasurer Alan Stockdale – is advising the government.

The position of members – whose con­tributions have overwhelmingly funded Medibank Private since 1976 – was widely debated when the Howard government tried to sell it in 2006 .

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http://www.theaustralian.com.au/news/health-science/backlash-looms-on-health-funding/story-e6frg8y6-1226870222526

Backlash looms on health funding

• SEAN PARNELL
• The Australian
• April 01, 2014 12:00AM

RISING insurance premiums are funding more services in public hospitals, a sign that cost-shifting and budgetary pressures are altering the experience of universal health cover.

As insurance premiums today rise an average of 6.2 per cent, consumers and health industry stakeholders await the federal government’s response to the Commission of Audit to determine the future of hospital, primary and preventive care funding.

Health Minister Peter Dutton has used several recent speeches to suggest governments stop paying almost 100 per cent of public medical bills “when the patient is prepared to contribute to their own costs”. “To build a health system that is sustainable, the Coalition is interested in policies which offer longer-term system reform, making smarter use of funds to provide better care,’’ Mr Dutton said last week.

“The universal health system means that there will always be value in leveraging people into supporting their own health needs in the private sector.’’

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http://blogs.crikey.com.au/croakey/2014/03/31/proposals-for-health-budget-savings/

Proposals for health budget savings

Jennifer Doggett | Mar 31, 2014 11:59PM

It’s fair to say that Peter Dutton has one of the more difficult jobs in Federal Parliament – particularly at the moment, with just over a month to go before the Federal Budget.  Under pressure from a Treasurer desperate to deliver Budget savings, the Health Minister will need to offer up something in his rapidly growing portfolio.  Luckily for him, there is no shortage of helpful advice from experts across the sector on how to achieve savings within the health sector.

While there appear to be a number of options for saving health dollars, many of the proposals may not offer the short-term budgetary impact that the Government seeks.  Others are unlikely to deliver sustainable savings over the longer term while ensuring our health system remains fair and viable.   Some may be politically or practically unrealistic or simply unethical.  Finding one or more options which will deliver the savings required without losing the support of crucial stakeholders is the Government’s challenge.  

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Comment:

The drumbeat suggesting a tough budget has been building. The final report of the Commission of Audit (COA) has been handed to Government and I am sure the leaks will start soon.

Economically we have both the Reserve Bank Governor and the Secretary of The Treasury saying we have very serious budgetary problems - and we can be sure they have seen the COA.

Really it seems to me the only question is just how big the cuts are and where they will fall. I suspect the answer is pretty big and everywhere!

To remind people there is also a great deal of useful discussion here from The Conversation.

https://theconversation.com/topics/paying-for-health

As usual - no real news on the PCEHR Review.

More next week.

David.

This Really Is Getting Sillier And Sillier! What Is It The Government Is Trying to Hide?

This appeared a few days ago.

 “No public interest” in PCEHR review release

news The Department of Health has stated it does not believe there is a public interest case for the Federal Government’s review of the troubled Personally Controlled Electronic Health Records project to be released publicly, despite the fact that Health Minister Peter Dutton has stated the document contains “a comprehensive plan for the future of electronic health records in Australia”.

The PCEHR project was initially funded in the 2010 Federal Budget to the tune of $466.7 million after years of health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients’ records and achieve clinical outcomes. The project is overseen by the Department of Health in coalition with the National E-Health Transition Authority (NEHTA).

However, in July the Government revealed it had failed to meet it initial 500,000 target for adoption of the system, with only close to 400,000 Australians using the system at that point.

Due to the problems, on 4 November new Coalition Government Health Minister Peter Dutton kicked off a promised review of the PCEHR project. On 20 December, only a month and a half after the review was initiated, Dutton issued a statement noting that he had received its report. “Their report provides a comprehensive plan for the future of electronic health records in Australia,” the Minister said at the time.

However, Dutton has not committed to publicly releasing the findings of the PCEHR Review. As a consequence, in early January, Delimiter filed a Freedom of Information request with the Department of Health seeking to have the full text of the document released under the Freedom of Information Act. Although the department initially stated it did not have a copy of the document at the time of the initial FOI request, a subsequent FOI request showed that the department had by then obtained a copy.

Read the rest of the saga and some commentary here:

http://delimiter.com.au/2014/03/31/public-interest-pcehr-review-release/

It is hard to know what to add to what Renai has written, other than to wish him luck with the new request.

It really is hard to know just what the Government is trying to hide with regard to the fabulously designed, delivered and managed program. Surely nothing of any sort has gone wrong, there has been no waste and the program is now delivering clear cut benefits for the public.

I guess this must not be the case otherwise the Government would have been keen to release such a wonderful score card - or is it that it is a mess and they can’t quite work out what to do despite having been given the PCEHR Review in December which provided a comprehensive way forward?

I wonder where the truth lies?

David.

NEHTA and DoH Break Cover Re CDA Security Issues In EHRs and The PCEHR..

Read all about it here:

http://www.nehta.gov.au/media-centre/news/633-update-on-clinical-document-architecture-and-e-health-records

Enjoy!

David.

Again We Seem To Be Seeing Implementation Issues In A Major Hospital System. It Just Seems To Keep Happening.

This appeared a few days ago.

Hospital in chaos over new booking system

Date April 1, 2014

Julia Medew

Health Editor

EXCLUSIVE

Staff at one of Melbourne's largest hospital networks say a new computerised booking system has wreaked havoc over the past year, causing untold distress for vulnerable people and putting lives at risk.

Senior Austin Health employees have told Fairfax Media that the new Patient Choice Booking service at the Austin Hospital and Olivia Newton-John Cancer and Wellness Centre has caused scores of patients to miss crucial appointments with specialists responsible for their care.

This included seriously ill patients, such as organ transplant recipients, cancer patients and those with infectious diseases such as TB and HIV who needed to be seen at particular times to receive continuing tests, medications and other treatment.

When the system was introduced last May, hospital management cancelled about 49,000 future patient bookings with specialist doctors and sent these patients letters advising them of the cancellations and a new booking system.

Under the new regime, patients would receive a letter offering them an appointment around the time that they were previously due to come in.

When they received this letter of offer, they were told to call the hospital if they wanted to negotiate a different time. The letter, which was allegedly only written in English, said patients who needed an interpreter should call to organise one.

Unlike the old system where patients could make bookings up to two years in advance, the new system was meant to provide patients with greater flexibility and reduce the number of patients cancelling, rescheduling or not showing up.

But according to angry staff, the system has been a ''complete disaster'', with many patients either not receiving their letters or not understanding them. This has allegedly caused scores of patients to not attend their appointments or show up at the wrong time.

 Lots more detail here:

http://www.theage.com.au/technology/technology-news/hospital-in-chaos-over-new-booking-system-20140331-35u9w.html

This was followed up the next day with the personal view.

Austin Hospital booking system brings grief to cancer sufferer

Date April 2, 2014

Julia Medew

Health Editor

Until May last year, Kevin Biaggini had no reason to doubt his care at the Austin Hospital. In November 2012, the Ivanhoe father was treated there for liver cancer and thought the medical and administrative staff were excellent.

But when the hospital introduced its new ''Patient Choice'' booking system in May last year, Mr Biaggini said things started to deteriorate. After having a routine MRI scan on May 15 to check his liver was clear of cancer, he received an unexpected phone call 10 days later. The nurse wanted to know why he had not attended an appointment that week.

''Straight away I knew what was in the wind,'' he said.

The nurse went on to tell him the MRI had found more cancer and that he had been scheduled for treatment that week.

''They called me on the assumption I had already been informed, but no letter had been generated, there was no text message, no email - nothing. I said to her, 'This is the first I've heard of it, I'm really shocked,' and she said, 'Oh, maybe it's something to do with the new system.'''

Mr Biaggini, 64, said after having treatment that month, he had a follow-up scan last July, followed by the same experience.

Again a nurse called to ask about a follow-up appointment on the assumption Mr Biaggini knew his most recent scan had found more cancer.

''I just shook my head and thought, 'This is unbelievable,''' he said.

Mr Biaggini, who is now well after receiving a liver transplant in December, said he believed the new booking system had caused the ''appalling cock-ups'' and was letting hospital staff down.

More here:

http://www.smh.com.au/technology/technology-news/austin-hospital-booking-system-brings-grief-to-cancer-sufferer-20140401-35whp.html

This has all the hallmarks of a failure of the technical, managerial and project management staff failing to design a ‘fool proof’ migration approach and then testing the plans against the needs of all the different stakeholders.

This is by no means  an unusual story with migration from  the from the old to the newly installed systems being sufficiently tricky project to make many systems last a great deal longer than perhaps they should as many users and managers are wary of the associated risks and disruption.

This has meant for example that I know of laboratory and PMI/ATS systems that have been in place for over 20 years and which are only replaced when the software or hardware vendor goes out of business.

I hope there will be a report in due course that properly analyses what happened and suggests how to avoid such migration issues for others.

David.

Grahame Grieve Provides Analysis Of The PCEHR and More General Security Issues.

For those who need to look closely at the details and possible risks.

Go here:

Further Analysis of CDA vulnerabilities

Posted on April 8, 2014 by Grahame Grieve

This is a follow up to my previous post about the CDA associated vulnerabilities, based on what’s been learnt and what questions have been asked.


The link to full blog is :

http://www.healthintersections.com.au/?p=2005

Thanks Grahame.

I guess we will see some official reaction in due course. We sure should.

David.

DoH and NEHTA Are Working To Fix PCEHR Security Issues.

No names and no pack drill but 3 facts regarding the PCEHR are now clear.

1. There is a serious security issue with the PCEHR.

2. NEHTA, Accenture and DoH are aware and are working to see how they can fix it.

3. As of now the problem is not solved.

A press release from someone is expected in due course!

David.