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."

Sunday, May 24, 2015

It Seems My Concern About What Is Going On In Hospital IT In South Australia Is More Than Warranted! A Whistle Blower Strikes!

A couple of weeks ago I published a blog suggesting there was a need for a review of what was going on with the EPAS project.

Wednesday, May 06, 2015

It Looks Like The South Australian Implementation of EPAS Is Going Pretty Badly. An External Expert Review Is Really Needed and Egos Parked At The Door!

Here is the link:
The relevant paragraphs in the blog were:
“Oh dear. This all suggests that a fundamental re-think of what has gone on to date and just how progress can be made is vital. This project has been going on for years - you would have thought the rough edges would have been addressed long before this.
An independent, external and expert view is clearly vital here!”
While I was happily resting after the weekend an e-mail from an unknown person appeared and only just avoided the spam filter. What it said was just explosive.
Obviously the e-mail was anonymous and I can’t totally verify what is said but the background provided and what is said seem more than legitimate to me, and likely truthful to me.
Here are the points made by the e-mail to be place in the public domain (quoted):
“I offer the following information in the hope that maybe you can use it in some way:
- a comprehensive review of the EPAS program was done, often referred to internally as the 'Bearing Point Report' (Bearing Point was the name of the consultancy that did the work.)
- the review recommended a suite of changes to the program, Health were tasked with formally responding (to my knowledge they never did properly respond)
- the former CIO of health, David Johnston, was sacked (~August) last year as a direct result of EPAS' failure
- Health set up a multimillion $$$ deal, without any public tender, with Telstra to supply 'Bed Side Monitors' (that being the name of the project) ostensibly in order to support EPAS, the monitors have been rolled out at great expense but to very little utility
- the 'Oracle Corporate Systems' project has cost ~3X its projected budget and is still nowhere near completion (a review of the OCS at the same time as the EPAS review, predicted this outcome)
- the company behind EPAS (Allscripts) was previously in serious trouble, their share market price tumbling when 1/2 their board resigned and they reported serious other problems (I have not kept up with them for the past year or so, not sure of their current situation)”’
I have to say it is a long time since we have had a leak like this!
I have only two points to make:
1. There seems to be some cover-ups going on in SA and with a new Hospital coming that can’t be good for the future!
2. A new updated public review is even more urgent as is the release of all the material mentioned above.
What more can other insiders tell us do you think?
David.

AusHealthIT Poll Number 271 – Results – 24th May, 2015.

Here are the results of the poll.

Do You Agree With The Decision To Replace NEHTA With A New Australian E-Health Commission? (Updated)

Yes 27% (31)

No 47% (54)

I Want Neither Funded By Government 22% (25)

I Have No Idea 4% (5)

Total votes: 115

What an interesting outcome. Lots do not agree NEHTA should be replaced with a Commission but then also a lot want the Government out of the scene altogether.

I think I need a better poll to sort this out!

Good to see such a great number of responses!

Again, many, many thanks to all those that voted!

David.

Saturday, May 23, 2015

Weekly Overseas Health IT Links - 23th May, 2015.

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

May 15, 2015 | By Katie Dvorak
Vulnerabilities in computerized infusion pumps could allow unauthorized users to gain access to the devices and modify the doses they deliver, according to a warning from the U.S. Food and Drug Administration.
The Hospira LifeCare PCA3 and PCA5 Infusion Pump Systems deliver anesthetic or therapeutic drugs to patients and can be programmed through a hospital's wired or wireless network, according to the FDA.
Infusion pumps by Hospira also were part of an investigation in October 2014 of medical devices and hospital equipment by the U.S. Department of Homeland Security. DHS expressed concerns that the tools could be activated remotely and at the time said it was working with manufacturers to identify and repair software bugs and vulnerabilities.
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Researchers: Health application design must include target audience

May 15, 2015 | By Susan D. Hall
Health website designers need to critically evaluate their assumptions about usability, especially for older populations, according to research published at eGEMS (Generating Evidence and Methods to improve patient outcomes).
The study involves a project by Healthcentric Advisors, a Rhode Island Department of Health's contractor, and Brown University to create a Web application allowing consumers to compare home health agencies.
Though the application was specifically designed for older consumers with low literacy and low health literacy, the researchers found that some general Web design principles didn't work for these people. They created a prototype, then tested it with consumers and hospital case managers, both of whom recommended changes. The case managers, for instance, wanted a mobile version and the ability to email search results.
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Automated Tool Found Effective for Medication Reconciliation

MAY 14, 2015 7:33am ET
A computerized algorithm has achieved promising outcomes in reconciling medications between clinical notes (unstructured data) and discharge prescriptions (structured data).
“Free-text medication data is inaccessible to computerized reconciliation applications that rely on structured medication information,” according to researchers at the Cincinnati Children’s Hospital Medical Center. “As such, accurate and timely reconciliation during care transitions poses significant challenges to clinical care providers.”
The study assessed performance of a computerized algorithm on real-world medication reconciliation data—clinical notes and discharge prescription lists for 271 patients enrolled in the Complex Care Medical Home Program at Cincinnati Children’s Hospital Medical Center. Researchers developed state-of-the-art machine learning (ML) and natural language processing (NLP) technologies as well as a computerized algorithm for medication reconciliation.
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PHRs should undergo mixed-method testing to improve usability

May 11, 2015 | By Marla Durben Hirsch
Patient engagement through electronic personal health records (PHRs) should be evaluated in different ways to make them more useful for the intended consumers, according to a new study in eGEMs (Generating Evidence & Methods to improve patient outcomes).
Involving patients in their own care management with electronic tools is a major component of the Meaningful Use program, and in improving both individual and population health. However, PHRs still are not being used to a great extent.
The researchers, from Intel and the University of Florida, developed a self-assessment tool to prevent falls to be used with an electronic PHR by older adults (the SAPHeR System). They then tested the system for functionality and usability both in the laboratory via observational study and with 10 older adults in their homes using the systems. The system included features such as links to fall prevention videos located on different website, information on performing activities that improve balance, such as Tai Chi, and self-assessment questionnaires.
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EHR alert significantly boosts HPV vaccination rates

May 12, 2015 | By Marla Durben Hirsch
Simply turning on and using a reminder alert about the Human Papillomavirus (HPV) vaccine during a patient visit can greatly improve vaccination rates, according to a new study in the Journal of the American Board of Family Medicine.
HPV, according to the researchers, is "critical" in helping to prevent cervical cancer, but has the lowest vaccination rate at only 30 percent nationally. Moreover, nearly two-thirds of patients who start the vaccination series do not finish it.
The researchers, from the University of Michigan and elsewhere, studied whether an electronic health record's clinical decision support alert would improve vaccination uptake. They studied 6,010 female patients who received treatment at clinics that had the prompt for the vaccine vs. 9,096 patients who attended clinics without the prompt.
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Privacy advocates blast 21st Century Cures bill

Posted on May 14, 2015
By Bernie Monegain, Editor-at-Large
Developing new cures for the thousands of diseases for which there is none may seem all well and good -- but some patient advocates say the 21st Century Cures initiative launched by a House of Representatives panel is throwing privacy out the window.
After a year of testimony from various healthcare experts before a subcommittee of the House Energy and Commerce Committee, the bipartisan duo of Rep. Fred Upton, R-Mich, and Rep. Diana DeGette, D-Wash., were ready for prime time. On April 30, they held a hearing on legislation on their 21st Century Cures initiative. On May 12, they were ready for the bill's markup, a process in which committee members offer amendments on the proposed legislation.
The bill calls for $10 billion in extra funding for the National Institutes of Health over five years. It's the era of data analytics, and the idea is that NIH would collect patient data that could lead to the discovery of cures for the more than 6,000 diseases that are currently incurable
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BSI publishes apps development standard

14 May 2015   Thomas Meek
The British Standards Institution has published a set of standards to support developers creating health and wellness apps.
PAS 277 outlines a set of principles that app developers should follow, to make sure that their products and services can be trusted by healthcare professionals and the public.
Its main aim is to define the quality criteria for registries and repositories of healthcare apps, so that they meet the needs of users. However, the BSI suggested that it may also help doctors to select apps to recommend to patients or for organisations to commission bespoke apps.
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Next-generation health IT requires primary care input

May 14, 2015 | By Susan D. Hall
Practicing clinicians and patients have the clearest understanding of what they need from health IT and should be shaping the national HIT research agenda, according to an article published in the latest edition of the Journal of the American Board of Family Medicine.
Researchers and clinicians need to team up to fully describe the workflow, information needs and communication processes required for health IT to effectively support clinicians' needs, the authors write. This partnership should extend to the practice-level tasks of using data to optimize the care of whole panels of patients in order to redesign care to support population needs.
The HIT Working Group for the North American Primary Care Research Group has been involved in such work through practice-based research networks (PBRNs) to identify specific ways in which health IT could better meet users' documentation, information sharing, decision-making and care delivery needs.
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Cybercrime price tag to reach $2 trillion

Posted on May 13, 2015
By Erin McCann, Managing Editor
If you haven't gotten serious about data cyberattacks at your organization, now's the time to do so. Because they're about to hit companies worldwide with a $2.1 trillion price tag.
At least that's according to new research published by Juniper Research, which took a closer look at the costs associated with cybercrime and what they'll end up costing companies on a global scale. And the numbers are staggering.
Going digital will increase the cost of data breaches to almost four times the cost estimated for this year, reaching $2.1 trillion (yes, that's trillion with a "t") in 2019. Breaking that down to the average cost of one of the breaches? Corporations can count on paying more than $150 million per breach by 2020.
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Health IT stakeholders assess HITECH's legacy

Jeff Rowe
May 13, 2015
It may seem a bit counterintuitive to call a $30 billion investment “a good start,” but that’s one way to sum up the findings of a survey recently published in the online Journal of the American Informatics Association (JAMIA). Through interviews with 47 stakeholders across the country, researchers explored a number of topics concerning recent developments in health IT. 
They found, among other things, that while there is a widely shared belief that the 2006 HITECH Act (Health Information Technology for Economic and Clinical Health) “catalyzed the creation of a digital infrastructure,  . . . there were major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange.” And these issues, the interviewees note, are undermining efforts to deliver integrated patient-centered care.
The interviewees ran the gamut from academics to vendors to policymakers and physicians, and the topics discussed included strategies for optimizing the use of HIT, ideas for innovation in HIT and recommendations and priorities for HIT businesses, healthcare organizations and researchers.
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Scanning the horizon

Electronic document management is now a priority for many trusts, but they must decide how much scanning to do and what round to take. A model in which trusts ask specialists to take care of back-scanning while setting up bureaus for forward-scanning may be emerging. Paul Curran reports.
Health secretary Jeremy Hunt’s call for a ‘paperless’ NHS reflected the widespread acknowledgement that shunting tens of thousands of paper records around the system each day is no longer practicable.
But moving to an electronic patient record and electronic document management system raises many practical issues - not least what to scan and how to manage the process.
“Trusts operate independently and have their own boards, budgets and ways of doing things,” says Neil Murphy, regional director, UK and Nordics, at Kodak Alaris, specialists in digital scanners and imaging software.
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Care coordination software market poised for strong growth

May 13, 2015 | By Susan D. Hall
The market for care coordination software is expected to expand at a 26.1 percent compound annual growth rate between 2015 and 2020, according to a new analysis from Frost & Sullivan.
These are IT applications specifically designed for team-based patient care, particularly for at-risk patients with chronic conditions and for patients transitioning between care settings, according to an announcement.
There are an array of offerings in this area--from "rudimentary to robust"--which can create confusion among potential customers, Frost & Sullivan says. However, it predicts the best solutions will offer unified, secure and workflow-enabled platforms that can quickly identify and manage at-risk patients, allowing care teams to implement and track care plans, engage patients in self-management, and provide round-the-clock communication with patients and their families.
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Telemedicine is changing the health care industry

Evita Caldwell May 12, 2015
In recent years, advancing technology has changed the way we go about our daily lives. From reading books on tablet devices to video chatting with a friend from afar, technology has ushered in new eras in our way of life.
But, how is technology shaping the world of health care? Health care experts joined “St. Louis on the Air" host Don Marsh to discuss how telemedicine- virtual patient-doctor interaction- is changing the industry.
Dr. Tom Hale, executive medical director of Mercy Virtual in St. Louis, explained that Mercy plans to introduce The Virtual Care Center, a 120,000-square-foot center that will focus on providing telemedical support to patients. The center will service both hospital and at-home patients through virtual doctor interactions. For example, doctors will monitor intensive care unit patients across all Mercy hospitals through remote radiology, neurology and pathology teams, and provide online doctors for patients in rural areas that lack adequate access to health care providers.
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Argonaut Project for Interoperability Nears Completion of First Phase

MAY 12, 2015 7:17am ET
When it comes to accelerating development of Health Level Seven’s Fast Healthcare Interoperability Resources (FHIR) standard, the Argonaut Project is ground zero for building a first-generation application programming interface (API) and core data services specification to expand data sharing among electronic health records as well as other health IT systems.
Massachusetts eHealth Collaborative president and CEO Micky Tripathi has volunteered his organization to serve as the project manager for Argonaut, an initiative launched in December 2014 to advance the adoption of RESTful FHIR APIs and OAuth-based security in the healthcare industry. RESTful APIs are based on modern Internet conventions and widely used in other industries, while OAuth is an open protocol that allows secure authorizationin a simple, standard method from web, mobile and desktop applications.
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Delay to 700,000 patient opt-outs

12 May 2015   Rebecca McBeth
The Health and Social Care Information Centre is “extremely concerned” that 700,000 patient objections to having their identifiable data shared have yet to be enacted more than a year on from being registered with a GP.
The centre does not have the “resources or processes to handle such a significant level of objections” and is concerned that implementation could impact on patients’ access to health services.
In supplementary written evidence submitted by HSCIC chair Kingsley Manning to the Health Select Committee,  he identifies a number of issues which mean the centre has not yet extracted or implemented any ‘type 2’ objections registered by patients with GPs.
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Hunt back as health secretary

11 May 2015   Thomas Meek
Jeremy Hunt is to remain health secretary following the Conservative Party’s victory in last week’s general election, and the formation of the first all-Conservative cabinet in 18 years.
Prime Minister David Cameron today confirmed Hunt’s reappointment to the position he took over in September 2012, following a stint as secretary of state for culture, media and sport.
During his time as health secretary Hunt, who is MP for South West Surrey, has been an advocate for IT in healthcare, notably calling for a “paperless NHS” in a speech to Policy Exchange in 2013.
The paperless vision was supported by two technology funds to drive the implementation of new technologies in hospitals, and ‘integrated digital care records’ to share information around healthcare communities.
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CHIME: Patient identification the biggest challenge to safe health data exchange

May 12, 2015 | By Dan Bowman
Healthcare IT stakeholder groups in the last week have spoken out about changes they would like to see made they believe would improve the 21st Century Cures Initiative.
For instance, in a letter sent to Reps. Fred Upton (R-Mich.) and Diana DeGette (D-Colo.), College of Healthcare Information Management Executives President and CEO Russell Branzell and Board Chair Charles Christian mince no words when it comes to their stance on the need for better patient identification, calling it "the most significant challenge" to safe health information exchange.
"As data exchange increases among providers, patient data matching errors and mismatches will become exponentially more dangerous and costly," Branzell and Christian say. "CHIME calls on Congress to remove the prohibition baring federal regulators from developing standards to improve positive patient identification."
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How Hospitals Are Leveraging Social Media

by Lisa Zamosky, iHealthBeat Contributing Reporter Tuesday, May 12, 2015
The majority of hospitals throughout the U.S. have some kind of social media presence.
Today, at least 1,576 hospitals use social media outlets such as Facebook, Twitter, YouTube, LinkedIn, FourSquare and blogs, according to the Mayo Clinic Social Media Network's Health Care Social Media List, which tracks hospital social media presence by state and platform.
A recent study published in the Journal of Medical Internet Research found that nearly 95% of hospitals have a Facebook page, just over half are on Twitter and nearly all hospitals (99.41%) can be found on Yelp. Large, urban, private, not-for-profit and teaching hospitals are among those most likely to use social media, the study found.
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How Healthcare Innovation is Leading to a Post-EHR World

Scott Mace, for HealthLeaders Media , May 12, 2015

Sutter Health brings Silicon Valley to healthcare IT, to speed up development without an army of IT people. The result is applications that improve care processes and benefit patients.

I bristle when I hear that we live in a "post-EHR world" because, of course, EHRs aren't going anywhere. But in one sense, the moniker is coming true.
That is because EHRs are now exhibiting the classic characteristics of technology platforms: assumed infrastructure that allows anyone, including providers, to innovate on top of them to solve clinical problems, workflow problems, and beyond.
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Pediatric EHRs Need Special Features Tailored to Children

MAY 11, 2015 7:51am ET
Electronic health records used in the care of children require specific pediatric functionalities to support the work of providers and to assure the delivery of quality care for patients.
That is the finding of a new report from the Agency for Healthcare Research and Quality. The report, based on research conducted by the Vanderbilt University Evidence-based Practice Center under contract with AHRQ, searched scientific literature and gathered expert opinions on EHRs used for pediatrics.
 “We hope this report encourages all stakeholders to collaborate on this effort to improve electronic health records, ensuring we provide the best possible care for children,” states the report, which lays out the special features related to a child’s evolving physiology, maturity and associated conditions not found in EHRs used for adult patients. Specific pediatric EHR functionalities include: the ability to build and maintain vaccination records, record growth and development data, calculate weight and age-based medication dosing, manage pediatric diseases, identify pediatric norms such as developmental milestones, and document the relationship between pediatric patients and their parents and caregivers.
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Employees top cause of security mishaps

Posted on May 11, 2015
By Erin McCann, Managing Editor
When it comes to healthcare data security breaches, law firms can offer firsthand insight into what they see from their clients. A new report sheds light on the No. 1 cause of security incidents for which companies sought legal guidance.
The report, conducted by the BakerHostetler privacy and data protection team, is based on more than 200 security incidents the firm advised clients on during 2014. And what they found from working with their 160 clients that experienced data security events? The lion's share of them were caused not by cyberattacks or lost unencrypted devices but instead by good old-fashioned human error.
Working with a forensic firm, BakerHostetler officials found employee negligence topped the list of five biggest causes of security lapses, accounting for 37 percent of them. Device theft by outsiders placed No. 2 on the list at 22 percent, followed by employee theft at 16 percent; malware at 14 percent and phishing at 11 percent. 
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Telemedicine no more effective than phone counseling to help smokers quit

May 11, 2015 | By Susan D. Hall
A new study published in the Journal of Medical Internet Research has found little difference between sessions delivered by telemedicine or by phone in the effectiveness of counseling to help rural patients stop smoking.
The research involved 566 smokers from rural Kansas randomly assigned to receive either telemedicine counseling at their primary care clinics (Integrated Telemedicine--ITM) or counseling delivered by telephone at their homes. There was no difference in the duration or content of the four counseling sessions each participant received. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms.
Verified abstinence at 12 months did not significantly differ between the ITM or phone groups (9.8 percent vs. 12 percent). Phone participants completed somewhat more counseling sessions than ITM, however ITM participants were significantly more likely to use cessation medications than those counseled by phone.
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ISACs key to defending against healthcare cyberattacks

May 11, 2015 | By Katie Dvorak
Cyberattacks on healthcare entities are not a matter of if but when, and industry collaboration is one of the keys to lessening the impact of such attacks, writes Forbes contributor Dan Munro.
Chief security officers, he notes, are the defenders, and face much bigger hurdles than the attackers looking to steal health data.  
"The basic equation is heavily stacked against the defenders because the attackers need only to exploit a single vulnerability once. Defenders have to protect all attack surfaces--all the time," Munro writes.
That's where a national network of Information Sharing and Analysis Centers (ISACs) comes in--the network fosters a collaborative culture for professionals to fight against attacks, he writes.
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Enjoy!
David.

Friday, May 22, 2015

An Expert View Of Just How Off The Rails E-Health Seems To Be At Present And How It Might Be Fixed.

This appeared last week in response to the E-Health Announcements last week and seemed to me to put a sound view of what we are seeing and to be trying to suggest the level of thought being applied to e-Health globally my need to be improved. More people need to read it!

A modest e-health proposal to government

Enrico Coiera
May 12, 2015
Dear [insert country name] Government,
E-health is hard. I think we can all agree on that by now. You have spent [insert currency] [insert number] billion on e-health programs of one form or another over the last decade, and no one knows better than you how hard it is to demonstrate that you are making a difference to the quality, safety or efficiency of health care.
You also know that so much of e-health needs to happen in the public domain that, irrespective of your desire to privatise the problem, you will end up holding the can for much of what happens. E-health is your responsibility, and your citizens will, rightly or wrongly, hold you accountable.
It is so hard to get good strategic advice on e-health. You recently commissioned [insert large international consultancy firm] to prepare a new national e-health strategy, and it didn’t come cheap at [insert currency] [insert number] million. In the end it told you nothing you didn’t really already know, but at least you can say you tried.
You also commissioned [insert large international consultancy firm] to prepare a business case to back up that strategy, and it didn’t come cheaply either at [insert currency] [insert number] million. The numbers they came up with were big enough to convince Treasury to fund the national strategy, but deep in your heart of hearts you know you’ll never see a fraction of the [insert currency] promised.
It’s also really hard to find organisations that can deliver nation-scale e-health to time, to budget and of a quality that the professions and the voters all agree it’s a good thing. You want the IT folks who build these systems to understand health care, its needs and challenges, deeply. Just because they can build a great payroll system or website does not qualify them to jump in and manage an e-health project. Do you remember how [insert large IT company] ended up crashing and burning when they took on the [insert now legendary e-health project disaster]? We can all agree that didn’t go as planned, and that you didn’t exactly enjoy the coverage in the press and social media.
What you really want firstly is impartial, cheap and informed expert advice because you are in the end driven to do the right thing. Given the heated and partisan nature of politics, that advice needs to come from safe and trusted individuals. That often means the advice comes from within the tent of government, or from paid consultancies where legal contracts and the promise of future work secure your trust. You also want the IT folks who build your systems to be deeply trained in the complexities of implementing systems for e-health. The health professions, and indeed the voters, also need to be sophisticated enough to understand how to use these systems, and their limitations. That’s going to maximise your chances of success, as well as blunt the uninformed chatter that so often derails otherwise good policy.
Our proposal is a simple one. We suggest you set aside 10% of the E-health budget to train the next generation of e-health designers, builders, and users. Use the funds to resource training programs at the Masters level for future e-health policy leaders, as well as system designers, builders and implementers. Let us provide incentives to include e-health in health profession training both at primary degree and for continuing education. Let us also invest in training the public in the safe and effective use of e-health. Investing in creating a critical mass of skilled people over 5 years will be your best insurance that, when you are again faced with e-health, you have a real chance of doing the right thing.
Given how little outcome you have had for your e-health investments over the last decade, and the harsh reality that little will change over the next, this is a chance to rewrite the script. Invest in people and skills, and you might find that with time e-health isn’t so hard after all.
[insert name of concerned citizen, NGO, or professional association]
[insert date]
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Here is the link:
I like the idea - but we need to pause the spending and doing things until we get these experts in place!
David.