Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, December 17, 2014

It Looks Like Using An EHR Can Cost Time But Also Reduce Errors To A Significant Degree.

These appeared a little while ago:

Doctors Say Electronic Records Waste Time

A new study shows that technology has slowed doctors' work.

By Kimberly Leonard Sept. 8, 2014 | 4:00 p.m. EDT + More
Doctors complain that they waste an average of 48 minutes a day, or four hours a week, when they record their patients’ health information into digital records, a new study shows.
The results were collected in a small survey, whose findings were put into a letter that was published Monday in the online edition of JAMA Internal Medicine. A draft of the letter was released Monday to a group of health care reporters at the National Library of Medicine. Dr. Clement McDonald, lead author of the study and director of the NLM Lister Hill National Center for Biomedical Communications, presented the letter, “The Use of Internist's Free Time by Ambulatory Care Electronic Medical Record Systems.”
The findings came from a 19-question survey that the American College of Physicians sent in December 2012 to 900 ACP members and 102 non-members. They received a 53.6 percent response rate; respondents had used 61 different EMR systems.
The mean loss for trainees was lower than the average, at 18 minutes a day. “We can only speculate as to whether better computer skills, shorter (half-day) clinic assignments with proportionately less exposure to EMR time costs, or other factors account for the trainees’ smaller per-day time loss,” the study read.
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Proponents of electronic health records say they have the potential to reduce medical errors, better coordinate care, and save time. Some say the technology, however, hasn't reached that point. “It simply takes longer [to enter patient information into a computer]," says McDonald, who is a proponent of EHRs and was among a group which created the first system in the country. "There is already so much to do and you have to look at patient safety.” Deep consequences can come out of one typo, he adds, and adding another data point carries additional time cost.
McDonald expected the results from the study because he has heard complaints from doctors who said they were spending extra time with EHRs after work, he says.
The time lost, the letter points out, could decrease access to care, given the opportunity cost of meeting with a patient during that time. It also could increase the cost of care. “Policy makers should consider these time costs in future EHR mandates,” McDonald says.
The full article is here:
And to point out just why it might be worth it we have this.

ONC Data Brief: Physicians Report EHRs Prevent Medication Errors

September 5, 2014
Three times as many physicians report that electronic health records (EHRs) are preventing a potential medication error than causing one, according to a newly released data brief from the Office of the National Coordinator for Health IT (ONC).
The data brief used the 2013 National Ambulatory Medical Care Physician Workflow Survey to assess the physician-reported impacts of EHR use – both positive and negative – on quality and patient safety related outcomes. More than half of the approximately 11,000 physician respondents reported that the EHR alerted them to a critical laboratory value and 45 percent said it alerted them to a potential medical error. Only 15 percent said it led to a medical error.
See here:
So the bottom line is slower but better with the EHR. I hope it is really true!
David.

This Seems To Be Pretty Good News For Those Ramping Up Hospital Automation. Some Actual Evidence EHRs Save Lives.

This appeared a little while ago.

Are EHRs Life Savers? Maybe So, According to Preliminary Research

August 25, 2014
Can the adoption and implementation of electronic health records (EHRs) be tied to hospital performance and lowered mortality rates? While we might be a bit of time away from being able to make that precise claim, new research does suggest a measurable beneficial relationship.
The findings were revealed by HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society (HIMSS), and Healthgrades, an online resource for comprehensive information about physicians and hospitals. The value of EHRs has long been discussed, but until now evaluations have lacked comprehensive clinical data, according to HIMSS officials.
Using HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) and mortality rate measures collected by Healthgrades across 19 unique procedure and condition based clinical cohorts, the analysis found that hospitals with advanced EHR capabilities (as reflected in high EMRAM scores) demonstrated significantly improved actual mortality rates, most notably for heart attack, respiratory failure, and small intestine surgery.
Most cohorts experienced improvement in predicted mortality rates when compared to hospitals with lower EMRAM scores. The predicted mortality rate is an indicator of the level of documentation and capture of patient risk factors that are correlated to increased risk of mortality.  In total, 4,583 facility records were selected from the HIMSS Analytics database, representing the total number of facilities with complete data from 2010 through 2012.
Lots more here:
A very interesting study that is well worth a read. We are gradually seeing more clarity emerging as to what works as well as to what the risks are as will. A balanced view will emerge - but it may still be a good while yet before that happens!
David.

Tuesday, December 16, 2014

It Seems All Governments Just Don’t Want To See If Their Health IT Is Working. Why I Wonder?

This appeared a little while ago.

NSW Ambulance losing revenue from billing system issues: Auditor

eHealth NSW also chastised in new report.

…..
eHealth NSW also came under the auditor's fire for having half of its IT projects running behind time and for failing to review completed projects. The body - which provides governance for NSW Health’s IT strategy and delivery - was established in July this year when the functions of HealthShare NSW were transferred to the new organisation.
Hehir had recommended last year that HealthShare conduct post-implementation reviews of IT projects but today said nothing had been done.
“Formal post implementation reviews have not been conducted on any completed or substantially completed projects for the past two years,” he said.
‘These include the Oracle R12 upgrade, integrated medical imaging program, infrastructure strategy 2, state-wide management reporting tool, the business information program, the billing and revenue system and the payroll system.”
He urged the agency to start reviewing completed IT projects as soon as possible in order to assess whether they had achieved their intended outcomes, whether project management practices had been effective, whether the new systems could be further enhanced, and to ascertain any lessons able to be learned.
The auditor recommended eHealth NSW set up a process to ensure completed IT projects are reviewed by June 30 next year.
Hehir also revealed that the highest security threat to the Health cluster was currently weak user and password controls.
Lots more here:
Here is the direct link to the Audit Report .pdf.
Seems there needs to be much more scrutiny on and reporting of just how eHealth in NSW is actually performing.
What a good idea!
David.

Monday, December 15, 2014

Weekly Australian Health IT Links – 15th December, 2014.

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

Well we are approaching the ‘silly season’ so we can all start relaxing and planning for an excellent Christmas and an even better 2015.
Interesting there is still some interesting material being reported so a browse through the headlines is worth the time spent I reckon.
CU in the New Year.
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NSW Ambulance losing revenue from billing system issues: Auditor

eHealth NSW also chastised in new report.

The Ambulance Service of NSW is losing millions in annual revenue as a result of ongoing problems with its new patient billing system, the state’s Auditor-General revealed today.
The service has experienced continuing issues since implementing its new patient billing system in 2012-13, following initial functionality and data migration issues.
In his annual report to parliament on the Health cluster [pdf], NSW Auditor-General Grant Hehir today revealed that because ambulance transport records did not completely transfer from the dispatch system to the billing system, the NSW ambulance service failed to collect $3.9 million in revenue for the 2013-14 year.
The agency was owed $99.4 million by patients at the end of June this year, of which $86.2 million is unlikely to be paid, the auditor found.
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RACGP leads efforts to curb prescription drug-related deaths

8 December 2014
The Royal Australian College of General Practitioners (RACGP) is leading efforts to curb the alarming number of overdoses involving prescription drugs which contribute to more deaths in some states each year than car accidents.
The RACGP recently released its Electronic assistance with managing abuse of prescription drugs discussion paper calling for a national implementation of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system for prescription drug management.
RACGP President, Dr Frank R Jones said a large number of prescription drug-related deaths in Australia could be avoided if GPs had access to a national electronic recording and reporting system for controlled drugs.
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Should you bet on Telstra Corporation Ltd for 2015?

By Darryl Daté-Shappard - December 9, 2014 | More on: TLS
It looks like some stocks can keep climbing and ignore the relatively flat gains of the S&P/ASX 200 Index (ASX: XJO) (Index: ^AXJO).
Telstra Corporation Ltd (ASX: TLS) is near new 52-week highs. The telecom giant is coming off of solid earnings growth in FY 2014, but what can investors expect from it in 2015?
Investors should be looking for growth catalysts that can propel the company and its stock to higher levels. Telstra has three parts in its growth story.
Asian expansion
Australia’s population is about 23 million people, yet just on our doorstep are many times more people in South East Asia. The growth opportunities are big for a technologically advanced telecom company like Telstra. In its recent investor day presentation, the company showed that many emerging countries in Asia still are only up to 2G mobile networks. It plans to put its multi-billion dollar war chest towards acquisitions and development in the region to expand its footprint and work with locally established telecoms.  The company projects that as much as a third of revenue will come from its growing Asian business by 2020.
e-health development
Combining healthcare and data management, the company has created a new division called Telstra Health. It sees great growth potential for this business which allows medical professionals and patients to work together online to monitor, test and analyse health and fitness. Health tests and results can be managed in real-time, improving the quality of medical services. Telstra thinks that this could be one of its top revenue generators within five years.
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John Durie’s CEO survey 2014: David Thodey, Telstra

John Durie

1: Has the corporate outlook improved and if so what are your investment plans?
The operating and economic environment for many businesses across a diverse range of industry sectors remains soft, reflected in the fact that business confidence has lost ground according to the latest business surveys. This vindicates the RBA’s current position of sustaining monetary stimulus by keeping the cash rate lower for longer to shore up growth prospects. Domestic GDP growth forecasts below-trend with generally sluggish demand conditions and soft earnings weighing on the growth outlook. This is despite well-documented strength in the housing market. On the global front growth outlook is now more uncertain which is also weighing on domestic growth prospects. While the outlook for the US, Britain and some emerging market economies such as India remain favourable; this is largely offset by weak eurozone and Japanese growth, while China is expected to continue to grow on a slower trajectory. Having said that our position on growth remains positive – we continue to look at ways we can grow through investing in new businesses and growing in new geographic markets. Our aim is to continue to build on the good progress we have made in the areas of software, e-health, network applications and media, and our growth into the ever-important Asian region.
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Older Australians: Care must be integrated through PCEHR

By admin Aged Care Dec 11, 2014
The National E- Health Translation Authority (NEHTA) yesterday announced that it will offer funding to private hospitals in order to integrate their systems to the Personally Controlled Electronic Health Record (PCEHR).
While this is welcome news it is essential that aged service providers are also included. Integration between the acute setting and home/residential aged care brings with it great opportunity and the real promise of better care and a significant reduction in costs.
“Peak body for age service providers, Leading Age Services Australia (LASA) has strongly advocated that age services be recognised, considering age service providers come second only to the state health system in volume.
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Heath Ledger style prescription drug overdose deaths could be stopped by new software alerting doctors to prescription drug abusers

  • Sue Dunlevy National Health Reporter
  • News Corp Australia Network
  • December 13, 2014 9:30PM
A POTENT mix of six prescription medications slayed Batman star Heath Ledger, now new medical software aims to save others from that fate.
The Academy award winning actor died accidentally from a prescription drug overdose in his Manhattan apartment in 2008 after taking a mix of medicines for insomnia, anxiety, pain, and the common cold.
Between 1,300 and 2,500 Australians a year are estimated to die from similar prescription drug misuse, more than those who die on our roads.
The medicines monitoring body NPS Medicinewise reports the number of opioid prescriptions subsidised by the Pharmaceutical Benefits Scheme (PBS) surged from 2.4 million in 1992 to 7 million in 2007.
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10 December 2014, 1.02am AEDT

To deal with chronic disease, patients will need better mobile health apps

David Glance
Of all the potential calamities facing humanity, the one that few people can argue about is that of the global population that is growing in numbers, age, size and incidence of chronic disease. In Australia, 3.6 million people have diabetes or pre-diabetes. In the US, that number was 29.1 million in 2012, or 9.3% of the population. The number of people with pre-diabetes in 2012 however was a staggering 86 million.
Diabetes is the 6th leading cause of death in Australia and the 7th in the US.

More doctors won’t work

It is no wonder then that 8% of all consultations that GPs deal with in Australia concern diabetes. GPs spend on average twice as long with diabetes patients and they visit twice as many times. The incidence of diabetes is rapidly outpacing the health services’ ability to deal with it. Diabetes in Australia is growing at 7% per year, whilst the number of GPs is only growing at 3%.
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NetComm Wireless Launches the n-Hub to Transform Healthcare

2014-12-10 09:00
SYDNEY, Dec. 10, 2014 /PRNewswire/ -- NetComm Wireless Limited (ASX: NTC), a leading developer of wireless Machine-to-Machine (M2M) devices, will today enter the health industry with the launch of its NetComm Wireless n-Hub (NTC-20) at the 2014 mHealth Summit in Washington, DC . Designed to meet rising global demand for M2M healthcare solutions, the n-Hub connects diverse Bluetooth and WiFi enabled mHealth devices to the speed and coverage of cellular networks.
The n-Hub will facilitate healthcare sector innovation as the global ecosystem of mHealth devices grows to exceed 650 million by 2020. The device enables secure data to be sent from the remote patient or client to their practitioner.
"The n-Hub is a game-changer for the global healthcare sector. It combines simplicity with open system flexibility to improve efficiencies, reduce costs and ultimately improve patient outcomes. The n-Hub has the capacity to drive innovation across a wide range of applications such as monitoring the health of elderly relatives, post surgery patient care and keeping tabs on personal health, to name a few," said David Stewart , Managing Director and CEO, NetComm Wireless.
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Privacy fears keeping doctors offline

5 December, 2014 Kate Aubusson
Australian doctors are avoiding social media and online communications with patients for fear of privacy breaches and overstepping doctor–patient boundaries, a new survey shows.
Doctors were yet to immerse themselves online, with many feeling they were unable to protect their personal and private information online, found the survey of 187 Australian doctors from all specialties.
The findings pointed to a "surprising reluctance to engage with new media despite the demands of the community", reported the researchers at the University of Sydney.
Three in five doctors reported being uncomfortable about interacting with patients who had accessed their personal information, according to findings in the Journal of Medical Internet Research.
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Medicare - Australian Organ Donor Register and Pharmaceutical Benefits Report December 2014 Release now available for download

Created on Thursday, 11 December 2014
NEHTA has released the specifications for the Medicare - Australian Organ Donor Register and Medicare - Pharmaceutical Benefits Report for December 2014.
These specifications can be downloaded from the NEHTA website via the following links:
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Federal Health Minister officially opens St Stephen's

8th Dec 2014 10:38 AM
UPDATE: Australia's first fully integrated digital hospital has been officially opened by Federal Health Minister Peter Dutton.
More than 100 guests attended the ceremony at St Stephen's Private Hospital which Mr Dutton described as "world class".
"St Stephen's has raised the bar for all healthcare providers by embracing technology literally before the foundations were laid," he said
"It will be a showcase for the improvements that eHealth information technology can make for health care and patient outcomes.
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Australia’s First Digital Hospital

Australia’s first hospital with fully integrated, digital eHealth capability has been officially opened.
Page last updated: 08 December 2014

Joint Media Release

The Hon Peter Dutton MP
Minister for Health
Minister for Sport

Keith Pitt MP
Federal Member for Hinkler

8 December 2014
Australia’s first hospital with fully integrated, digital eHealth capability was officially opened today.
St Stephen’s Private Hospital, operated by UnitingCare Health in Hervey Bay, has been created by expanding the regional hospital with a new, three storey inpatient hospital with 96 acute care inpatient beds and three additional operating theatres.
Health Minister Peter Dutton said St Stephen’s was a world class hospital which showcased the future of health care.
“St Stephen’s has raised the bar for all healthcare providers by embracing the technology literally before the foundations were laid,” Mr Dutton said.
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UnitingCare opens Australia’s first digital hospital in Queensland

Chris Griffith

AUSTRALIA’S first fully integrated digital hospital officially opened yesterday in Queensland with expectations that it will transform healthcare across the nation.
Run by UnitingCare Health, the $96 million St Stephen’s Hospital at Hervey Bay is the first local hospital to computerise everything from diet to dialysis and integrate its operations, equipment and services. It includes more than 300km of fibre-optic cable.
Director of medical services Monica Trujillo said machines fed data into patients’ records directly when they underwent a test. Food was ordered and managed electronically, and medication dispensed in a paperless environment.
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Medical history right alongside TV shows and lunch menu

Jessica Grewal | 9th Dec 2014 5:00 AM
AS A PATIENT at Hervey Bay's digital hospital, Beverly Kersnovske's entire medical history is at her fingertips - right alongside her favourite television shows and today's lunch menu.
The 86-year-old, who recently returned to St Stephen's Private Hospital after a stay last month, is quickly learning what it's like to be cared for in a touch screen environment.
Her expert navigation of the online entertainment system came in handy yesterday as she showed Federal Health Minister Peter Dutton the ropes ahead of the hospital's official opening.
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St Stephens fully digital hospital lead by clinical transformation

The first fully integrated digital hospital in Australia officially opened today in Hervey Bay, Queensland. St Stephens Private Hospital is a 96 bed UnitingCare Health facility, costing $96 million and partly funded by a $47 million Australian government grant.
Health minister Peter Dutton opened the new facility, describing it as the future of healthcare. 
“St Stephen’s has raised the bar for all healthcare providers by embracing the technology literally before the foundations were laid,” Dutton said.“It will be a showcase for the improvements that eHealth information technology can make for health care and patient outcomes. Digital technology can make health care far more efficient and more effective for patients and providers."
The key to the new facility is its digital integration, based around 28 Cerner applications with the Cerner Millennium EMR at the core of operations.
During the opening, UnitingCare Health's executive director, Richard Royle, was presented with a certificate confirming that the hospital was the first in Australia to have been accredited with Stage 6 EMRAM certification from HIMSS, an international measure of the hospital’s digitisation and integration.
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Government relaunches food rating site

8 December, 2014 Gemma Najem
The federal government has relaunched its food rating website 10 months after its controversial removal from the internet.
And the Heart Foundation has given a tick of approval to the system, which will award higher star ratings to products low in saturated fat, sugars, sodium and energy.
The website was initially launched by Assistant Health Minister Fiona Nash in February but was pulled down, leading to the resignation former chief of staff Alastair Furnival.
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#FHIR Updates

Posted on December 12, 2014 by Grahame Grieve
A round of links and news about progess with FHIR
Draft For Comment Posted
I have just finished posting the final version on which the current draft for comment is based: http://hl7.org/implement/standards/FHIR-Develop/.
This version of FHIR is our first serious look at what we plan to release as DSTU2 for FHIR. From here, this candidate will undergo a round of comment and testing, including the HL7 “draft for comment”, where HL7 members can comment on the content of the ballot, and also will be tested through several connectathons and other implementation projects. Following that, we will gather all the feedback, and prepare the second candidate, which will be published around the start of April. This will get another cycle of testing, and then we’ll make further changes in response. We’re planning to publish the final version of DSTU 2 around the end of June.
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Wearable electronic fitness devices market still poised for strong growth

December 8, 2014
Wearable electronic devices for fitness shipments are forecast to reach 68.1 million units in 2015, down from 70 million units in 2014, according to Gartner. This temporary dip in sales will be driven by an overlap in functionality between smart wristbands, other wearable fitness monitors and smartwatches. However, the market for smart wristbands and other fitness monitors will rebound in 2016 because of versatile designs and models with lower-cost displays.
“Fitness wearables are used for tracking health, which goes hand-in-hand with fitness and wellness,” said Angela McIntyre, research director at Gartner. “Consumers will be able to integrate the data from most wearables into a single account where their data can be analysed using cognizant computing to provide useful insights to wearers. Funding initiatives from Qualcomm, Apple (HealthKit), Google (Google Fit), Samsung (S.A.M.I.), Microsoft, Nike and Intel, among others, will build on early innovation in wearable fitness and health monitoring and create the infrastructure for merging data relevant to health and fitness”.
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Doctor rating sites ‘fundamentally flawed’

10 December, 2014 Tessa Hoffman
The rise of rate-your-doctor websites has spawned questions about how doctors should deal with negative, false or potentially defamatory reviews.
While not every bad review will be grounds for a defamation case, MDA National medicolegal expert Dr Sara Bird said it was important doctors knew where they stood.
Doctor can be rated on websites such as RateMDs, Yelp, and TrueLocal.
Rate-your-doctor sites were not only problematic, they were also "fundamentally flawed", Dr Bird wrote in the latest edition of Australian Family Physician.
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Labor's NBN is no more

Labor’s NBN – the idea of a publicly owned and funded, all fibre, wholesale broadband network, is now officially dead.
It has been ill for some time, and recently terminally so, but now the high priests of the competitive market have pronounced the last rites. The new NBN has not only new (well, old actually) technologies, but a new regulatory regime that will see competition introduced and prices raised. Building a new house or buying one just built? You will have to pay.
The Government has announced the biggest changes to telecommunications regulations since the NBN was announced, with major changes to broadband policy. Communications Minister Malcolm Turnbull and Finance Minister Matthias Cormann have released a new policy document which they say “sets out a roadmap for reform in the telecommunications sector which will see several restrictive aspects of existing market regulation gradually replaced with more competition-friendly settings.”
The document sets a radically different course for the NBN. It outlines a number of proposed reforms based on the Government's response to the 53 recommendations for regulatory changes proposed earlier this year following a review carried out by an independent panel of experts chaired by Dr Michael Vertigan. The paper is here.
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Jane McCredie: Machines in charge

Jane McCredie
Monday, 8 December, 2014
THE development of full artificial intelligence could spell the end of the human race, physicist Stephen Hawking warned last week.
“It would take off on its own, and redesign itself at an ever increasing rate”, he said. “Humans, who are limited by slow biological evolution, couldn’t compete, and would be superseded.”
Professor Hawking, who has motor neurone disease, was commenting on new machine learning technology applied to his computer-generated voice that analyses the scientist’s words to predict what he is likely to say next.
Fears that machines might take over the world have long been the stuff of science fiction.
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The Big Bang may have created a mirror universe where time runs backwards

  • 3 hours ago December 11, 2014 8:30AM
  • BY KATE SCHNEIDER news.com.au
IT’S of the greatest scientific puzzles persisting to this day: how and why does time move forward?
In their bid to finally solve this mystery, researchers have come up with a new theory. They now believe that the Big Bang some 14 billion years ago may have actually created two universes, one a “mirror” of the other, the Scientific American reports.
Yep, the universe (sorry — universes!) as we know it may have just gotten a whole lot bigger!
So if time moves forward in our universe, it makes sense that it may run backwards in the other “mirror” universe, right?
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Enjoy!
David.

Sunday, December 14, 2014

The Department Of Health Is Called For Not Evaluating Their E-Health Program. They Really Are Just Hopeless!

As a special for the last week of the year the blog provides two takes on this issue.
We both review a Capability Review of the Department of Health From the Australian Public Service Commission. Link to full report is found below. 
First from Karen Dearne we have her view which picks out all sorts of issues at DOH!
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“The Australian Public Service Commission's findings of serious inefficiencies and dysfunctional culture within the federal Health Department will not come as a surprise to those who have had dealings with senior executives and their middle managers.
The Sydney Morning Herald's Canberra workplace writer, Noel Towell, has today painted a bleak picture of "80 hour weeks, bullying, command and control" management following a Capability Review conducted by the APSC.
The report also warns there is an "urgent need to address inadequate governance arrangements and delivery frameworks".
"Decision-making has been largely centralised at senior levels, with a number of leaders being described by employees and stakeholders as exercising a command-and-control leadership style," the APSC report says.
"While this approach may be appropriate in responding to a crisis or national emergency, its application in day-to-day management has resulted in the disempowerment and poor use of its workforce, reinforced vertical silos, limited corporate ownership and potentially hampered innovation.
"The department's governance arrangements appear disconnected, which may be a function of their design."
Reviewers found additional financial investment is required to "modernise and ensure the department's ICT environment is secure and fit for purpose. While the department is acutely aware of the shortcomings and associated risks of its ICT systems, resolving this to an appropriate standard will likely require accelerated, concerted and sustained focus".
The review team "regularly heard" examples of risk aversion, tight control of information, micro-management, elevated decision-making and an excessive focus on issues management.
"Employees provided the team with examples where red traffic lights were not placed on management reports until risks were quite advanced, as they thought bad news would not be welcome," the report says.
"Employees regularly commented on personal fears of making a mistake, with some saying the 'department does not make mistakes'."
The report says the department should lead "more purposeful engagement and partnership" with external organisations.
"A majority of external stakeholders, including other (government) agencies, reported they have experienced the department as increasingly insular and often outwardly defensive," it notes.
"Stakeholders often commented on the difficulty in interacting with the department compared to other policy departments which were seen as much more open, though still professional and able to manage competing interests.
"In an increasingly contested policy environment, the department needs to ensure it adequately captures the views of stakeholder groups who often hold positions of authority and influence within the community.
"Incorporating a broad range of external policy perspectives into the department's advice remains crucial to its continued position as a trusted and key policy adviser to the Government."
The review team says the department's former secretary, Jane Halton, was recognised "for setting clear expectations for the department’s performance and she was respected for her intellectual and results-focused leadership".
But employees reported "a need for an overarching narrative that communicates a clear and coherent direction for the future".
And, "despite the efforts of the former secretary to break down silos, most employees and stakeholders described the department as hierarchical and siloed".
The new Enterprise Data Warehouse and the Personally Controlled E-Health Record system have been singled out as evidence of the department's "many highly capable employees, with deep subject matter expertise and a well-educated workforce".
Health employs "highly credentialed medical officers and other professionals with relevant qualifications to help inform internal policy and program decisions. It has access to rich data repositories, is developing an Enterprise Data Warehouse and is working on a broad e-health program which has the potential to strengthen the department’s platform for evidence-based approaches" to policy development.
The EDW, in particular, is seen as an opportunity for opening access to public health data for broad reporting and research purposes.
"The objective of the warehouse is to enable shared health information, greater accountability and unprecedented data transparency so future generations of Australians can be confident of a sustainable, nationally unified, locally-controlled health system," the report says.
"A work in progress, the EDW requires ongoing investment to realise its potential by the department and others, as well as solve data storage and privacy obligations in legislative requirements.
"There is an opportunity to underpin strategy development and policy formulation through greater analysis of data, within, across and beyond the (commonwealth) public service.
"Rich repositories of data exist at policy and program levels, particularly in the Pharmaceutical Benefits Scheme and Medical Benefits Scheme. These data sets have the ability to help shape the strategic agenda."
And the PCEHR? The department is awaiting the Government's decision on the Deloitte "Refresh" Review of the program, undertaken in May 2014.
"The review has the potential to influence e-health system design, implementation schedule, and planning for communication, education and risk management," the report says.
"The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda."
In response, the new Health Secretary, Martin Bowles, has welcomed the report, saying it "provides an opportunity to take the department forward, build our capability for the future and make the department the best organisation it can be".
"A review of existing arrangements is currently underway to ensure the department’s governance and delivery systems are aligned and sustainable to face future challenges," Mr Bowles says.
"One key area I plan to focus on is to ensure decision making is not centralised and that decisions are being made at the right level.
"As acknowledged in the report, the department has commenced work to break down silos. Our focus moving forward is to ensure we work across internal boundaries and limit potential duplication while fully utilising our highly capable workforce."
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Second, here is my view which looks more closely at e-Health issues!
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A little while ago the Australian Public Service Commission produced a Capability Review of the Department of Health.
There is some interesting material contained therein - with a number of areas of the Department definitely not receiving a glowing assessment.
Here is the link to the report:
The report is dated October 2014.
There were two of three areas that interested me:
P12.
First I was interested to discover that 229 people work in the section of the Department described as Information Technology and e-Health.
P37.
Second I found this section revealing.

e-Health

The Government has indicated it remains committed to an e-Health system that delivers real benefits. It has made a further $140.6 million available in 2014–15 for the operation of e-Health and the PCEHR system while it considers the recommendations of a review undertaken in May 2014. The review has the potential to influence e-Health system design, implementation schedule, and planning for communication, education and risk management. The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda.
----- End Extract.
These are weasel word of the first water!
“The Government has indicated it remains committed to an e-Health system that delivers real benefits. ”I wonder what this system is and how the Department knows what benefits it is delivering?
“The review has the potential to influence e-Health system design, implementation schedule, and planning for communication, education and risk management.” And just what has anyone been told regarding all these matters? What options and what evidence is being used?
“The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda.” In other words this has not been done!
What an expensive and misguided  farce!
I think it is fair to say Karen and I agree on this!
David.

The Spinning And Partial Truths Are Ramping Up On The Medicare Co-Payment. I Don’t Think Complaining That The Commentators Don’t Like The Plan Will Help.

This has been released in the last hour.
Media Release

Hon. Peter Dutton MP - Minister For Health And Sport.

14 December 2014

Labor scaremongering on Medicare

The Labor Party must immediately stop scaremongering in regards the Government's sensible plan to strengthen Medicare.
Medicare was designed to provide quality healthcare to all Australians, yet its cost has ballooned by more than double over the past decade, from $8 billion in 2004 to $20 billion today. Without change, in ten years' time, it will cost the taxpayer $34 billion.
Without action, Medicare is at risk of collapsing under its own weight, undermining its ability to go on providing quality healthcare to those most in need.
Importantly, we've retained bulk billing and put in place a number of strong protections for vulnerable patients. Pensioners, veterans, aged care residents and children under the age of 16 will be exempt from the optional copayment. We estimate that these carve outs represent around eight million people. 
Additionally bulk billing incentives for GPs who provide services to concession card holders and children under 16 will remain.
Many doctors already charge a copayment and what doctors charge their patients is ultimately a matter for doctors and not government. However we unapologetically believe that bulk billing should be for those who truly need it and not for wealthy Australians.
The plan I unveiled with the Prime Minister just over a week ago has drawn praise from a wide cross section of the community and has responded to feedback from doctors, MPs, Senate crossbenchers and most importantly, our constituents.
There is currently a great deal of scaremongering by various interest groups around our optional copayment plan.
Bill Shorten should tell Australians whether he would be prepared to pay $5 to see the doctor.
Media contact:  Kay McNiece, Acting Media Adviser, 0412 132 585
I will leave it to you to decide just what you think of what is said here.
David.