This Threat Will Rather Put The ePAS Project Under Some Stress. It Could Get Messy.

This appeared late last week:

SA Liberals would halt controversial EPAS electronic patient record system if elected

By Isabel Dayman

8^th November, 2017

South Australia's Opposition Leader would pull the plug on the rollout of the state's controversial electronic patient records system if elected next March.

Speaking at a breakfast hosted by the SA branch of the Australian Medical Association (AMA) today, Liberal leader Steven Marshall slammed the State Government's rollout of the EPAS software, describing it as "completely mishandled".

"This is a program which needs urgent review," he told the gathering of doctors, also attended by Premier Jay Weatherill and SA Best party leader Nick Xenophon.

"We will immediately stall the rollout of the system to any other sites in South Australia and, more than that, we will immediately undertake an independent review to see what the options are for South Australia."

Mr Marshall told the meeting the cost of the EPAS rollout had blown out from $422 million to around $471 million.

"It's an extraordinarily expensive system and we still don't have it in critical hospitals like the Lyell McEwin Hospital, Modbury Hospital [and] Flinders," he said.

The EPAS system has been plagued by problems, with doctors previously complaining it is slow and clunky, complex to use when ordering drugs and therefore potentially dangerous for patients.

But Mr Weatherill defended the system in front of senior doctors on Wednesday, describing it as a necessary part of "modernising" the state's health system.

"Its initial phases have been challenging but it will be an important part of ensuring that we provide the best possible care in the future," he said.

"It's almost staggering to believe that people would want us, in this day and age, to be confined to paper-based records."

Xenophon and AMA at odds on EPAS review

SA Best party leader and state election candidate Nick Xenophon said the rollout of EPAS had been "botched" by the Government.

He said he supported the Liberal Party's call for an independent review.

"I spoke with a clinician last night who described EPAS in these words — that it's slow and cumbersome, and that the parts that work are fine, but the bits that don't work don't fit in with the rest of the health system," he said.

More here:

http://www.abc.net.au/news/2017-11-08/sa-liberals-would-roll-back-epas-marshall-says/9130540

Additionally we have this going on as first noted last week

SA pours another $49m into troubled EPAS

By Justin Hendry on Nov 7, 2017 6:45AM

For a major system upgrade.

The South Australian government has funnelled another $49 million into the Department of Health’s troubled electronic patient administration system (EPAS) for a "major upgrade" intended to make the system run better.

It brings the total cost of the project to $471 million to date.

The state-wide system, underpinned by Allscripts technology, has long been a cause for concern, suffering numerous delays, usability issues and cost overruns since the project was initiated six years ago.

Although budgeted at $408 million at the time of cabinet approval in December 2011, the cost of the project quickly rose to $421 million shortly after.

That figure has since grown to $471 million.

According to SA Health’s deputy chief executive Don Frater the money will be used for a “major system upgrade”.

Lots more here:

https://www.itnews.com.au/news/sa-pours-another-49m-into-troubled-epas-476992

I really wonder if the Liberals have actually thought this through – given the ‘blood and treasure’ already expended.

David.

Final Submission - Secondary Use Of MyHR Data.

Submission  - Secondary Use Of My Health Record Data  - November 2017.

Background to Submission Author.

Dr. David G More MB, PhD, FACHI, the author of this submission, is a registered medical practitioner with an over 20 year background in Digital Health implementation and use.

Short Summary.

Overall I would just like to be sure that whatever Framework the Consultation comes up with we have strong public accountability as to who is doing what with whose data and that it is conducted under ethical supervision - assuming that we decide we agree to proceed with Secondary Use  - which I remain sceptical of - given the context of reduced public trust of institutions and other risks. If Secondary Use is to proceed I also offer what I believe is a sensible and pragmatic approach to implementation.

Background To Submission.

On behalf of the Commonwealth Department of Health HealthConsult has been tasked with assisting to develop a “Framework for the Secondary Use of My Health Record Data”

Conceptually this framework is to enable use of the data in this system (which is identified clinical and administrative data) of the purposes of extraction, analysis and reporting on any manner of data elements held in the record for health related purposes and for the ‘public good’.

Apparently specifically excluded is use of the data ‘exclusively’ for commercial or administrative purposed but ‘mixed’ use is apparently permitted.

An example of mixed use might be the use by a for-profit drug company of the data to assist in locating individuals for a clinical trial – as recently discussed on RN’s AM.

See here:

http://www.abc.net.au/radio/adelaide/programs/am/privacy-concerns-about-my-health-record-system/9049856  

It seems to me that all those who have a myHR should at the least be offered an opportunity to opt-out and any Secondary Use while retaining their myHR if so desired.

Issues That Will Need To Be Addressed In The Final Framework.

Individual Consent

There is a general privacy principle that indicates the personal information should, in general, only be used, by anyone, for the purposes it was collected. As far as the myHR is concerned this would suggest the information held in the system is to be used for the purpose of delivering or supporting the individuals health care. Clearly using this same information for research, management etc. is unrelated to the direct care of the individual and so on is not what the data was given to the myHR for.

Data Quality

The data held in the myHR is largely held in rather old fashioned data-bases in forms where the is very little quality control and where it is held in forms that makes it very problematic to actually search or use the data. This has been openly acknowledged by the ADHA.

History Of Government Attempts To Misuse Health Data.

It was public opinion in the UK that resulted in the cancellation of the so called care.data program and in Australia data releases have been withdrawn after issue with the quality of anonymization were discovered. At the very least these issues should result in extreme care and caution with the use of the data or maybe have some actual experts oversee what Government does.

If There Is Any ‘Social License’ For Unannounced Use Of Personal Health Data Held In The myHR

It can be, not unreasonably, argued that unless individuals are fully informed and provided consent for data use that use of their data is a violation of the ‘social contract’ between the individual and the Government and that it is this sort of retrospective change of ‘the rules’ that is a contributor to the current lack of trust is government as starkly revealed in my recent poll.

----- Dated 12 November, 2017:

Do You Trust Government To Keep Safe And Not Abuse Private Information You Share With It?

Yes 4% (4)

No 95% (99)

I Am Not Sure One Way Or The Other 1% (1)

Total votes: 104

There Is Internal Government Awareness Of Complexity In, and Risks Of, Allowing Access To The Data

Discussions with the ADHA have not only confirmed major data quality and accessibility issues but also significant issues with safely providing any form of individual data access or downloading.

Proposal For Ethical Use Of Data Held In The myHR If It Is To Proceed.

Given that it is important that health data be properly used (where ethically possible) for the benefit of everyone I recommend the following approach to secondary use of the data held in the myHR system.

The approach also permits linkage to other relevant data sources.

1. All use of the data be as a result of a written publicly available proposal. This can be developed with the analytic entity. (A possibility for this entity may be a unit of the Australian Institute Of Health And Welfare)

2. The secondary use proposal is formally reviewed by an independent appropriately qualified and diverse expert ethics committee, and only proceeds if approved. The details of the Ethics Committee discussion should be publicly released. There should be a clear set of guidelines developed to explain what, and what not, constitutes ethical use.

3. All data analysis and reporting done in house – at a small group or sole purpose entity expert in handling data extraction, linkage and analysis. NO raw data leaves the analytic entity.

4. Researchers are encouraged to work with the entity experts to conduct analysis and reporting – but no data actually leaves the Government controlled repositories.

5. All summary reports resulting from the research  / analytics  is made publicly available on a dedicated web-site which also has the research proposal and ethic committee comments.

6. The supervising analytic entity should be within Government and publicly accountable.

This approach provides maximum transparency, considerable assurance of proper use of the information, reasonable data access and high security. There can also be total public confidence in what is done being done due to mandated transparency and disclosure. Additionally since no data is actually released, except in summary report form, the need to consent is obviated.

The disadvantages may be that outcomes may take a little time and may be more costly than simply handing the data over for use (and potential misuse).

I am happy to provide more details as may be useful to assess the proposal.

It should be noted that this submission is based on the assumption that the myHR Program proceeds as presently intended by the ADHA.

To be clear, overall I do not see Secondary Use of myHR data as either inevitable or positive, especially given the fact that most of the data is held and can be used elsewhere within Government, is more accessible there, and use of those sources avoids many of the privacy concerns associated with the myHR.

David More 16/11/2017.

The COAG Health Council Addresses Some Issues Around The myHR.

This was released early last week:

https://www.coaghealthcouncil.gov.au/Portals/0/CHC%20Communique%203%20November%202017_Final.pdf

Communique 3 November 2017

Federal, state and territory Health Ministers met in Canberra today at the COAG Health Council chaired by Meegan Fitzharris MLA, ACT Minister of Health and Wellbeing to discuss a range of national health issues.

Health Ministers noted the Queensland Parliament is in caretaker mode and the Queensland Minister was not present.

The meeting made progress in protecting patients with items dealing with the health risks associated with cosmetic procedures.

Ministers also agreed to pursue a national approach to supporting the mental health of health professionals including progressing reform of mandatory reporting. Ministers noted a suite of resources to help improve the safety and security of health professionals working in remote locations and protecting our children and seniors with advanced influenza protection, including the importance of investigating the benefits of flu vaccinations for children 6 months to 5 years. Significant progress was also reported by the Commonwealth towards the early roll out of a new Meningococcal Quadrivalent vaccine.

Other items discussed included:

Long term health reform

Ministers agreed on directions for long term health reform in the upcoming National Health Agreement noting that sustainable funding is a critical factor and requires further consideration.

Commonwealth Activity Based Funding Determination for 2015–16

Health Ministers noted the desire of all parties to finalise the independent review of funding and activity growth for 2015-16 and work to the earliest possible resolution.

National Health Genomics Policy Framework

Health Ministers approved the National Health Genomics Policy Framework 2018–2021.

The Framework agrees a high-level national approach to policy, regulatory and investment decision-making for genomics. Advances in genomics have the potential to help people live longer and better lives by reshaping clinical practice to fundamentally change the way we prevent, diagnose, treat and monitor illness, providing the opportunity to have more precise and tailored treatments. The ability to respond to this change is dependent on further

developing Australia’s capacity, capability and infrastructure needed to support integration of genomic technology into the national health system.

Health Ministers also agreed to the development of an Implementation Plan for the National Health Genomics Policy Framework that will identify actions to support the strategic priority areas.

Framework on Mandatory Reporting under the Health Practitioner Regulation National Law

Health Ministers have made considerable progress towards consensus on a national approach to a Framework on Mandatory Reporting under the Health Practitioner Regulation National Law, including:

•  Agreeing to progress with a predisposition to a national system that supports the mental health of the health professions whilst protecting patients, for consideration by the COAG Health Council out of session as a matter of urgency and
• Agreeing to continue finalising the CHC position noting that Queensland is in caretaker mode and any national legislation will need to be passed by the Queensland Parliament.

Health Risks Associated with the use of Medicines in Cosmetic Procedures

Health Ministers noted the recent investigations undertaken by New South Wales into cosmetic clinics and acknowledged the need for jurisdictions to continue to monitor and review regulation in this area to help reduce the health risks associated with the use of medicines in cosmetic procedures.

Current and projected usage of the My Health Record and update on jurisdictional infrastructure scalability plans

Health Ministers noted the current state of connection of state and territory health IT systems to the My Health Record, which shows variations in hospital systems connected across different jurisdictions and the degree to which information in the My Health Record is viewed.

Ministers agreed that the expansion of the My Health Record for every Australian will require changes to jurisdictional health IT systems and that all jurisdictions should assess the readiness of their infrastructure to handle increased uploading and viewing.

The Australian Digital Health Agency is working with jurisdictions on their readiness for the My Health Record expansion, including educating healthcare providers and preparing for increased load.

Options to reduce pressure on private health insurance premiums – feedback from the public consultation process

Health Ministers noted the Commonwealth summary of feedback received as part of the public consultation process on the paper Options to reduce pressure on private health insurance premiums by addressing the growth of private patients in public hospitals.

Here is a direct link:

https://www.coaghealthcouncil.gov.au/Portals/0/CHC%20Communique%203%20November%202017_Final.pdf

The two discussions I fund interesting were the one on Genomics and the one on the myHR.

As far as Genomics is concerned this really seems to be rather late to the party and especially regarding how EMRs and the myHR will handle and preserve Genomic data. Will be interesting to see what commentary comes out as time passes.

On the ‘compulsory’ enrollment in the myHR it is clear from the report I cited on Tuesday that adoption and use of the myHRis limited and many are not connected.

On chart 8 we find that less than 5% specialists are even connected, a little over 20%  of Pharmacies and about 15%  of Aged Care facilities are connected. Even in GP land there is just over 60% are connected.

Given the switch to opt-out is due next year one wonders how this will play out, and just what will be ready.

David.

Health Affairs Puts The Place Of Technology In Health Care In A Larger Perspective.

This appeared last week:

How The Rise Of Medical Technology Is Worsening Death

• Jessica Nutik Zitter

November 6, 2017 10.1377/hblog20171101.612681

Our aging population is at risk from a most benign-appearing source—the medical technologies we trust to keep us healthy.

When they were first widely used in the 1930s and 1940s, breathing machines did what humans could never have imagined a generation earlier: They kept young polio victims alive until their bodies cleared the virus that had temporarily weakened their respiratory system. Thanks to these miraculous machines, tens of thousands of these patients recovered and went home to live out the rest of their lives. This bold new use of medical technology riveted the world and set the stage for a new era in medicine, in which an overriding faith in the curative powers of technology prevailed. Over the next several decades, doctors assumed that everyone wanted and deserved access to these treatments. The breathing machine, or mechanical ventilator, was the first of many life-prolonging technologies to come. Now, there are machines to substitute for a wide range of physiological functions, including the pumping of the heart and the oxygenation of the blood.

Ideally, life-support technology should serve as a bridge to recovery, in which the failing organ is supported until the underlying disorder improves. But when the underlying disease or failing organ will not recover adequately to resume independent living, the recipient is likely to remain dependent on the machine. Unlike the polio victims, whose young and otherwise healthy bodies were often able to spring back to life after their illness had passed, the frail elderly and terminally ill are much less likely to recover. And so they are attached surgically to machines, most commonly through a tracheostomy tube in the neck and a feeding tube in the stomach. These patients cannot live at home and must remain in facilities where they are cared for by trained personnel. Most will never get out of bed again, eat independently, or talk. Many will lie in hospital beds, their arms tied down to prevent dislodgment of tubes, until they die.

According to the Department of Health and Human Services, over the next 45 years, the population of people older than age 65 will double. From 46.2 million in 2014, the number will climb to 98.0 million in 2060. In 2030, one out of every five Americans will be older than age 65. If trends continue on the current path, this will translate into millions of elderly patients on life support.

The SUPPORT Trial of 1996 was the first wake-up call to the medical community on the state of dying in America. It reported astonishing rates of mechanized deaths, accompanied by significant patient pain and suffering. Often, patients or their families had little or no prior communication with physicians about decisions to use these treatments. The mechanical ventilator, cardiopulmonary resuscitation, and dialysis machines are familiar mainstays of intensive care, and unless patients opt out, they drive the treatment plan. Doctors reach for them. And most patients, educated on these topics by inaccurate media portrayals, expect them. Substantive conversations about prognosis and treatment plans rarely take place, and patients’ understanding of their condition and treatment options are poor. But despite subsequent efforts by the palliative care community and others to reverse this situation, in 2013, the Journal of the American Medical Association reported an increase in intensive care unit (ICU) stays for patients older than age 65 in their last month of life.

Today, there is a steadily expanding menu of technological treatments designed to support a multitude of failing organs. An example is extracorporeal membrane oxygenation (ECMO), a form of cardiopulmonary bypass (CPB). CPB was developed in the mid-twentieth century for use during heart surgery. Like hemodialysis, which compensates for failing kidneys, CPB can take over for hearts while under the surgeon’s knife. The blood circulates through the machine, transported in and out of the body through large cannulae. The CPB machine oxygenates the moving blood and then pushes it back into the body, maintaining pressure and circulation. ECMO is conceptually and mechanically similar but is intended for longer-term support in patients who will remain, for days, weeks, even months, in the ICU. It was initially conceived in the 1940s but was largely relegated to research purposes and then to the treatment of neonates. However, during the swine flu pandemic of 2009, survival rates for adults receiving ECMO for respiratory failure were found to be higher than seen in earlier studies of the technology. Following that, there was a substantial rise in the number of ECMO centers worldwide, going from 148 in 2008 to 298 in 2015.

The ECMO machine can serve to support diseased lungs, or hearts, or both. Large catheters bring poorly oxygenated blood from the body to the machine, where it is oxygenated and then sent back to feed the tissues of the body. The goal is to support the body until the lungs and/or heart recover, or are transplanted. In the meantime, the patient can live in the ICU on this machine. While some patients are able to move around in the ICU, with staff carefully carrying the machine and catheters behind them, others lie in beds, either too weak to move or dependent on the breathing machine.

Intended as a bridge to recovery or a bridge to transplant, for some, this technology becomes what is called a bridge to nowhere. If a patient’s organ will not recover and the patient is not a candidate for transplantation, the remaining options are bleak. Such patients will likely suffer many complications aside from their underlying condition, including increased risk of bleeding, profound fatigue, cognitive decline, deconditioning, and serious infections with drug-resistant organisms. But arguably more difficult is the decision they face about how to proceed. Unlike patients on breathing machines, these patients are often awake and able to communicate. And so they must answer an important question. Are they willing to live the rest of their life in an ICU? If not, when to disconnect the machine? Most, once disconnected, will die within a very short period of time. How do doctors ask patients, many of whom didn’t elect for this treatment but were placed on it while in extremis, to decide what day they want to die? And one cannot ignore the issue of resource allocation. If a person does not wish to end his or her life, he or she may be using a precious and scarce resource that could save another patient.

Lots more here:

http://www.healthaffairs.org/do/10.1377/hblog20171101.612681/full/

Health technology seems now like it may just be going a little too far in some areas and while I am sure it is not true for Digital Health just yet, we need to be alert to side effects and harm, risks and unintended consequences!

David.

The ADHA Minutes For October 2017 Show The Usage Of The myHR Has Essentially Died.

The ADHA published the Board Minutes last week:

Board Papers

The intent of the Board is to publish as many Board documents as is feasible. Information and attachments to Board documents that are draft, not finalised or sensitive will not be published. An exception is made for draft material already in the public domain (in this instance the Board Advisory Committee Charters released on 16 September 2016).

Board Meeting 11 October 2017 - Board Papers (Download)

• Item 5 - CEO Report - 11 October 2017 (Word, 117kB)
• Item 6.6 - National Collaborative Network (Word, 104kB)
• Item 6.6 - Attachment A - NCNCHI (Word, 341kB)
• Item 6.6 - Attachment B - NCNCHI (Word, 57kB)
• Item 6.6 - Attachment C - NCNCHI (Word, 83kB)
• Item 6.6 - Attachment D - NCNCHI (PDF, 291kB)
• Item 6.7 - Intergovernmental Agreement (Word, 156kB)
• Item 6.7 - Attachment A - Inter-Governmental Agreement on National Digital Health 2016-18 (PDF, 912kB)
• Item 6.11 - Annual Report 2016-17 (Word, 102kB)
• Item 8.1 - Performance Reports (Word, 110kB)
• Item 8.1 - Attachment A - Performance Report (PDF, 1.02MB)
• Item 8.2 - Delivery Highlight Report (Word 112kB)
• Item 8.2 - Attachment A - Delivery Highlight Report (PDF, 1.86MB)
• Item 8.3 - Agency Governance (Word, 112kB)
• Item 8.3 - Attachment A - Agency governance structures 17-18 (PDF, 222kB)
• Item 8.4 - Attachment A - Correspondence to Minister & CHC (PDF, 192kB)
• Item 8.4 - Attachment B - Human Services HI service Annual Report 2016-17 (PDF, 347kB)
• Item 8.4 - Attachment C - OAIC Digital health activities Annual Report 2016-17 (PDF, 551kB)
• Item 8.4 - Human Services & OAIC Annual Reports on digital health activities 2016-17 (Word, 99kB)

Here is the link to the page:

https://www.digitalhealth.gov.au/about-the-agency/australian-digital-health-agency-board/board-papers

On usage we have the following from the notes:

“BACKGROUND

The layout of the Dashboard remains unchanged from the previous Board meeting. However, as part of ongoing continuous improvement, a few minor changes have been made to a number of charts:

-          Chart 8 on page 2. Compared to the dashboard tabled at the August Board meeting, this shows more providers and the proportion connected to the My Health Record; and

-          Charts 9 (page 2) and 12 (page 3) have been changed to monthly to be consistent with the data in other charts in the Dashboard.

It should be noted that while it appears that participation has decreased substantially in September 2017, the data for this month only covers two weeks.

SUMMARY OF ISSUES

There are now more than 5.1 million Australians with a My Health Record. Based on current consumer registration rates, this is increasing by approximately 100,000 every six weeks.

Consumer Participation (refer to Attachment A)

In the four weeks to 10 September 2017, an average of 17,568 consumers were registered each week. The majority of registrations were conducted by healthcare providers.  Average registrations has decreased since the August Board meeting and is likely due to the date of this dashboard being part way through an ePIP quarter (ends 31 October 2017) as well as less consumers logging onto MyGov. 

The number of documents uploaded and viewed by consumers has dropped which is consistent with patterns seen after the end of ePIP quarters in the last 12 months.

Organisation Participation (refer to pages 2, 3 & 4 of Attachment A)

There has been a continuing trend of steady increase in registration of most types of healthcare provider organisations over the past 12 months (Chart 6). However, in late August, there was a spike in the number of “Public Hospitals” and “Other” types registered. Western Australia and South Australia connected 24 hospitals between them and in Queensland, there were a significant number of public health centres connected (Chart 7).

The number of providers uploading the different clinical document types has slightly decreased (Chart 9), however Chart 10 shows that the volume of documents being uploaded overall still has peaks and troughs.

Chart 12 shows that the number of provider organisations viewing clinical documents has dropped slightly since July and the number of documents being viewed is also decreasing.

---

Despite the commentary that the data was only for 2 weeks in September all the graphs (Charts 12 – 17) show usage has unwound since July.

As an example of how unused the system is, is that in August only 200 or so Shared Health Summaries were accessed in the month by all hospitals.

Equally only a thousand Shared Summaries were looked up by GP practices in August and only about 3000 summaries were uploaded in August.

With 5,100,000 patients having a record this is just a joke. Even 100 times the use would be pretty wasteful.

All this data is in the Section 8.1 Attachment A pages 2 and 3 from the .pdf link above.

No wonder the ADHA is desperate to attract a great deal more use and so much of the data refers to cumulative data! It has to rise (sigh).
One is really forced to wonder just what difference forcing pretty much everyone is going to make if this is the usage ePIP payments and 5 million "users" generate. It really is already a failure I reckon!

David.

Weekly Australian Health IT Links – 13th November, 2017.

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

A huge week with a lot of very interesting opinions emerging and lots of private sector activity.

Many links to follow here.

-----

http://medicalrepublic.com.au/grahame-and-the-argonauts/11800

9 November 2017

Grahame and the Argonauts

Posted by Jeremy Knibbs

What does it say if the My Health Record project is not agile enough to pivot around a game changing and locally developed technology such as FHIR?

My favourite Saturday night movie as a kid was Jason and the Argonauts. It’s a story sourced from Greek mythology about a hero, Jason, who leads a band of intrepid outcast adventurers across the oceans and into battles with the likes of giant bronze statues that come to life, skeleton armies, and seven-headed snakes, in a quest to obtain the fabled golden fleece.

The fleece has magical healing powers and holds the key to Jason rallying the people of Thessaly to take back the throne and deliver his people from oppression. Unbeknown to Jason, he has been sent on his deadly fleece endeavour by the King of Thessaly who hopes Jason will perish on the mission.

-----

http://opengovasia.com/articles/how-the-australian-digital-health-agency-is-helping-create-a-seamlessly-connected-digital-healthcare-system-for-australia

How the Australian Digital Health Agency is helping create a seamlessly-connected digital healthcare system for Australia

Author: Priyankar Bhunia

6 Nov 2017

“Building an evidence base is one of the key priorities, to reassure clinicians and demonstrate to them how basic digital information-sharing services can really transform healthcare.” 

A major transformation is underway in the Australian healthcare system. The Australian government allocated AU$374.2 million in its 2017-18 Budget to be invested over two years, for the nationwide rollout of an opt-out model of My Health Record and to ensure every Australian is a part of it, unless they choose not to be.  

In June, the Australian Digital Health Agency (The Agency) released a Request for Tender (RFT) to develop a Strategic Interoperability Framework for Australia, with the objective of contributing to the deployment of a seamless digital health eco-system. 

-----

https://www.itnews.com.au/news/sa-pours-another-49m-into-troubled-epas-476992

SA pours another $49m into troubled EPAS

By Justin Hendry on Nov 7, 2017 6:45AM

For a major system upgrade.

The South Australian government has funnelled another $49 million into the Department of Health’s troubled electronic patient administration system (EPAS) for a "major upgrade" intended to make the system run better.

It brings the total cost of the project to $471 million to date.

The state-wide system, underpinned by Allscripts technology, has long been a cause for concern, suffering numerous delays, usability issues and cost overruns since the project was initiated six years ago.

-----

http://www.abc.net.au/news/2017-11-08/sa-liberals-would-roll-back-epas-marshall-says/9130540

SA Liberals would halt controversial EPAS electronic patient record system if elected

By Isabel Dayman

November 08, 2017

South Australia's Opposition Leader would pull the plug on the rollout of the state's controversial electronic patient records system if elected next March.

Speaking at a breakfast hosted by the SA branch of the Australian Medical Association (AMA) today, Liberal leader Steven Marshall slammed the State Government's rollout of the EPAS software, describing it as "completely mishandled".

"This is a program which needs urgent review," he told the gathering of doctors, also attended by Premier Jay Weatherill and SA Best party leader Nick Xenophon.

-----

https://www.medicalobserver.com.au/professional-news/technology-is-fine-but-the-gp-consultation-is-artform

Technology is fine, but the GP consultation is artform

Isis Maitland-Scott

6 November 2017

OPINION

We need to make sure that the pros of a technology revolution in primary care do not come at the cost of real communication.

The opening keynote address at the RACGP’s annual conference this year was delivered by Dr Jay Parkinson, CEO and founder of Sherpaa, an American digital health disruptor.

It was a very interesting choice for the opening address. Essentially, an American guy gets up and tells a room full of hard-working Australian GPs why their job will soon no longer be needed.

Sherpaa is a web-based medical service that offers 24/7 desktop, mobile and phone access to full-time doctors who reply swiftly to patient messages, to guide, or ‘Sherpa’ patients through the medical system. 

-----

https://www.6minutes.com.au/news/10-standards-communicating-within-health-system

10 standards for communicating within the health system

New AMA guide is designed to reduce duplication and waste

6th November 2017

The AMA has developed a guide outlining 10 minimum standards for communicating among health services, GPs and other treating doctors. 

It is hoped the guidance will improve quality of care for patients and also reduce duplication and waste in the health system.

-----

https://www.medicalobserver.com.au/professional-news/how-the-tabloids-made-secondary-use-of-data-sexy

How the tabloids made 'secondary use of data' sexy

Antony Scholefield

8 November 2017

TECH TALK

The concept of ‘secondary use of data’ does not sound like a salacious topic for tabloid journalism.

But a few years ago, it was all over the front pages of the UK’s notorious Daily Mail and other papers.

“NHS plans to harvest patient details” and “details being shared despite patients asking for them to be kept secret” were just a few of the headlines and teasers.

Secondary use of data refers to using millions of patient records to explore public health trends — in theory, without exposing any individual patient’s medical history. It can be a boon for health research because it shows links between different conditions and demographic factors.

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https://www.itwire.com/health/80731-pharmacists,-digital-health-agency-partner-on-my-health-record-initiative.html

Pharmacists, Digital Health Agency partner on My Health Record initiative

• 09 November 2017
• Written by  Peter Dinham

The peak national body representing pharmacists, the Pharmaceutical Society of Australia (PSA), is partnering with the Australian Digital Health Agency in a move designed to help increase the number of pharmacists using My Health Record - a digital system that enables healthcare providers to share secure health data and improve the safety and quality of patient care.

The Minister for Health Greg Hunt announced the partnership on Thursday and said the PSA represented 30,000 pharmacists working in all areas of pharmacy across the country, and is “ideally placed to develop and deliver education, training, information, and communications for the pharmacy profession”.

“This partnership will help PSA to increase the number of pharmacists working in all practice settings registered, able to view, and automatically upload medicines information to My Health Record.

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https://www.pharmacynews.com.au/news/how-government-plans-convince-pharmacists-use-my-health-record

How the government plans to convince pharmacists to use My Health Record

Shane Jackson says the benefits are safety and more effective care

Heather Saxena

10th November 2017

The Federal Government has given the PSA responsibility for improving pharmacist uptake of My Health Record.

Under a partnership deal with the Australian Digital Health Agency (ADHA), the PSA will deliver education and training to pharmacists.

Minister for Health Greg Hunt says the aim is increasing the number of pharmacists registered to use My Health Record.

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https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/my-health-record-what-you-can-do

My Health Record: what you can do!

Andrew Daniels shares his thoughts on how My Health Record can help pharmacies build digital health capabilities, as published in Post Script Australia on Monday 6 November 2017.

Pharmacies should understand why My Health Record is important and how their customers can participate, writes Andrew Daniels.

Already 5,160,000 Australians have a My Health Record and by the end of 2018, a My Health Record will be created for every Australian, unless they decide not to have one.

As more people get a My Health Record pharmacy staff are likely to be queried about it. So what is My Health Record?

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http://www.healthcareit.com.au/article/electronic-drug-management-systems-are-not-all-made-equal-new-guidelines-claim-bad

Electronic drug management systems are not all made equal: new guidelines claim bad implementations cause medication errors

Lynne Minion | 09 Nov 2017

Electronic medication management systems are not a panacea for unnecessary hospital drug deaths, with poorly implemented systems creating their own errors, according to an updated guide by the Australian Commission on Safety and Quality in Health Care.

Launched today as part of federal and state government efforts to reduce drug deaths caused by clinical error, the third edition of the Electronic Medication Management Systems: A guide to safe implementation has looked into Australian hospitals using EMM to see quality isn’t guaranteed.

Medication errors are the second most common
 type of medical incident reported in health organisations, and omission or overdose of a drug is the most frequent type of medication error, the guide claims.

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https://www.lexology.com/library/detail.aspx?g=f486fc67-8453-446d-ba6e-022accc6d968

Strategic Change: The Digitisation of Australian Healthcare

Baker McKenzie

Australia November 9 2017

With affordable, universal coverage and access, healthcare in Australia is amongst the world’s most advanced. Second only to the UK according to the Commonwealth Fund’s International Health Policy Survey, Australia’s health system ranks best on efficiency and healthcare outcomes. Yet at home, many Australians feel that healthcare should be more affordable and more efficient, citing high out-of-pocket costs and long hospital wait times as flaws in the current system.

Australia’s notable lack of technology in healthcare is a contributing factor to increased costs and lower standards of care. The industry is heavily regulated and expensive to innovate in, so the uptake of digital services has been slow and fragmented. Acknowledging the need for digital innovation, the Council of Australian Governments has recently endorsed the Australian Digital Health Agency’s (the ‘Agency’) Strategy. The Strategy is the product of consultation with consumers and healthcare industry professionals, and aims to deliver coordinated health information through digital channels to tailor and improve the quality of Australian healthcare. The Agency’s CEO Tim Kelsey stressed the need for this initiative, stating that Australia is facing rapidly rising demand for services, and that harnessing the power of technology will support high quality, sustainable healthcare for all Australians.

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https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/connecting-up-services-interoperability-revisited

Interoperability: a personal view

Created on Thursday 10 November 2017

By Bettina McMahon, Chief Operating Officer and Executive General Manager for Government and Industry Collaboration and Adoption.

Northcott is a not-for-profit organisation that provides services and innovation for people living with disability. Today Northcott is one of the largest not-for-profit disability service organisations in Australia and provides empowering, personalised services to over 13,500 people with disability, their families and carers each year.

Northcott CEO Kerry Stubbs recently invited me to visit Northcott’s offices to see how people with disability receive personalised services and how this lines up (or not) with health services.

As I meet with case managers, occupational therapists, speech therapists and accommodation managers, it becomes clear to me that an extraordinary amount of effort goes into creating seamless services for their customers. When it comes to interactions with the health sector, the head of operations Lee tells me there is great opportunity to share information between a person’s healthcare providers and Northcott’s service providers. “Right now, there are few formal information flows between all the people providing health and care services to a person with disability. Often it’s up to the customer or their family to pass this information along, and if they’re ill or under stress, this just adds to the pressure a family is facing.”

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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2017-wyatt113.htm

$2.8 Million Investment Towards Aged Care Evolution

The Australian Government will invest $2.8 million in detailed business case planning for a major project to further develop and improve My Aged Care, Australia’s aged care gateway.

Page last updated: 07 November 2017

PDF printable version of $2.8 Million Investment Towards Aged Care Evolution - PDF 282 KB

7 November 2017

The Turnbull Government will invest $2.8 million in detailed business case planning for a major project to further develop and improve My Aged Care, Australia’s aged care gateway.

Continuing modifications of MyAged Care aim to make it even more responsive and benefit the more than 1.2 million older people, their families and representatives who use it each year.

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https://www.medicalobserver.com.au/professional-news/individual-patient-billing-history-should-be-instantly-accessible

Individual patient billing history should be instantly accessible

Dr Oliver Frank

8 November 2017

PRACTICE SOFTWARE

THE ISSUE

In practices that do not universally bulk bill, a GP who sees a patient usually seen by someone else might want to have an idea of how much the patient is expecting to be charged, based on how much they have been charged in the past. 

Clinical and administrative systems marketed for general practice have no facilities to make accessing this information quick, easy and unobtrusive.

PROPOSED SOLUTIONS

On entry to the  software billing function — or when the GP has entered an item number — the system should automatically display the most recent billings for that patient, including date of service, doctor, item number and fee charged.

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https://theconversation.com/infections-complications-and-safety-breaches-why-patients-need-better-data-on-how-hospitals-compare-86748

Infections, complications and safety breaches: why patients need better data on how hospitals compare

November 8, 2017 6.27am AEDT

Authors

1. Stephen Duckett

Director, Health Program, Grattan Institute

2. Christine Jorm

Associate professor, University of Sydney

Australia’s health system is an information industry – it is awash with data. Tragically, though, the data is not well collated, not put into the hands of the people responsible for acting on it. Nor is it shared with patients.

Multiple “data sets” measure the safety of hospital care in Australia, but they are rarely linked, sometimes incomplete, and almost always delayed. We have lots of data about hospital safety, but it’s not used to make us safer when we have to go to hospital.

Information on patients’ experiences with their hospital care are often not reported back to public hospitals at unit or ward level, which makes working out where to start on improving care that much harder. Information about patients’ experiences in private hospitals is rarely reported publicly at all.

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https://www.lexology.com/library/detail.aspx?g=bfba7c41-3a08-4005-9f91-feb8cf5cb5a9

Online medical certificates: genuine fake, genuine, or just fake?

Lander & Rogers

Australia November 8 2017

“Why risk your job and your career? There’s no longer any need for a fake medical certificate when you can get a genuine medical certificate in 5 minutes online or from your mobile phone.”

So reads the advertisement from one online medical certificate provider.

Online medical certificate platforms claim that their value is in freeing-up an under-resourced health care system by providing a faster and easier service to patients with “minor” ailments and sickness.

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www.chf.org.au

Time to take patient safety records out of the data black hole

MEDIA RELEASE WEDNESDAY, 8 NOVEMBER

Australian hospitals need to release more records on patient safety and treatment outcomes in the interests of driving better care, the Consumers Health Forum says.

A new report issued today (Wednesday) by the Grattan Institute, finds that while hospitals routinely collect large amounts of data on patients, little ever reaches the public or doctors outside hospitals.

“Given modern day expectations of transparency and accountability, hospitals and governments should be enabling the orderly release of these data to doctors and patients,” the CEO of the Consumers Health Forum, Leanne Wells, said.

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https://theconversation.com/you-may-be-sick-of-worrying-about-online-privacy-but-surveillance-apathy-is-also-a-problem-86474

You may be sick of worrying about online privacy, but ‘surveillance apathy’ is also a problem

November 8, 2017 12.49pm AEDT

Author

1. Siobhan Lyons

Scholar in Media and Cultural Studies, Macquarie University

We all seem worried about privacy. Though it’s not only privacy itself we should be concerned about: it’s also our attitudes towards privacy that are important.

When we stop caring about our digital privacy, we witness surveillance apathy.

And it’s something that may be particularly significant for marginalised communities, who feel they hold no power to navigate or negotiate fair use of digital technologies.

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https://www.computerworld.com.au/article/629850/serious-concerns-businesses-prepare-mandatory-data-breach-notification/

Serious concerns as businesses prepare for the mandatory data breach notification

Some businesses appear ill-prepared for the Notifiable Data Breaches regime, which begins in February

Tony Heywood, AGC Networks (Computerworld) 10 November, 2017 16:43

In February of this year, the Notifiable Data Breaches (NDB) legislation was passed, with the new regime coming into effect on 22 February 2018. This means businesses need to start preparing now to comply with this amendment to the Privacy Act.

The NDB scheme requires businesses to notify both the Office of the Australian Information Commissioner (OAIC) and any affected individuals if the company experiences any unauthorised access, disclosure, or loss of personal information, if a reasonable person would conclude that this access, disclosure, or loss would be likely to result in serious harm.

The act makes it clear that serious harm isn’t necessarily only related to financial losses but could also include the public disclosure of private information such as a medical condition, for example.

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http://medicalrepublic.com.au/data-democracy-will-reshape-healthcare/11763

6 November 2017

How data democracy will reshape healthcare

Posted by Julie Lambert

Australia will need to make “a dramatic shift” in thinking on digital health to maintain its world-leading quality of healthcare, according to a new report from Harvard Business Review (HBR) Analytic Services.  

The HBR briefing paper, sponsored by Microsoft, stemmed from an international survey of 783 business decision makers on digital transformation, including 9% employed in the health sector, as well as qualitative interviews with Australian digital health experts.  

In Australia, an unsustainable spending trajectory, the rise of digitally literate consumers, the burden of chronic disease and demographic factors made the take-up digital technologies a crucial need, it said. 

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http://www.anu.edu.au/news/all-news/wearable-sensor-technologies-to-help-revolutionise-personalised-medicine

Wearable sensor technologies to help revolutionise personalised medicine

3 November 2017

Video of Grand Challenge: Your health in your hands

This is an outstanding project that will help doctors treat disease earlier and more effectively with precision therapies.

A research project, which aims to revolutionise personalised medicine through wearable sensor technologies such as bracelets, will receive up to $10 million as the inaugural winner of The Australian National University (ANU) Grand Challenge Scheme.

The five-year project promises to help clinicians detect diseases in people much earlier than is currently possible, and better manage their conditions.

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https://www.doctorportal.com.au/mjainsight/2017/43/genetic-privacy-v-duty-to-disclose-who-wins/

6 November 2017

Genetic privacy v duty to disclose: who wins?

Authored by Jane McCredie

Issue 43 / 6 November 2017

AS WE delve ever further into the human genome, ethical and legal frameworks are struggling to keep up.

Given the potential of genetic information to affect people’s employment prospects, or ability to get insurance, there’s been an understandable focus on protecting genetic privacy.

But what of situations where a patient refuses to share information that might give relatives the opportunity to identify their own genetic risk and seek early prevention or treatment?

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http://www.theaustralian.com.au/business/technology/smartphones-a-friend-for-g-medical/news-story/5cd6840366cc146d919f7f139546661d

Smartphones a friend for G Medical

• The Australian
• 12:00AM November 7, 2017

Supratim Adhikari

ASX-listed mobile health outfit G Medical Innovations’ bet on turning your smartphone into a bona fide health monitor looks set to play out, one way or the other in 2018, as the company edges closer to a couple of crucial milestones.

The first big one is winning approval for its product, Prizma — a medical-grade smartphone sleeve — from Chinese regulators, a move that will open the door to the biggest smartphone market in the world.

The second is to start ramping up production on Prizma and get the products into the hands of consumers.

Prizma’s goal, according to G Medical chief executive Yacov Geva, is to put a “doctor in the pocket” of everyday smartphone users. In practical terms, the Prizma sleeve fits over a smartphone and once there continuously collects, consolidates and analyses medical data. It’s powered by an independent battery that only becomes active when needed and ­allows patients to share the data with medical specialists.

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http://www.proactiveinvestors.com.au/companies/news/186759/g-medical-innovations-holdings-expands-into-india-and-taiwan-186759.html

G Medical Innovations Holdings expands into India and Taiwan

10:53 06 Nov 2017

The halt will remain in place until Wednesday 8th November 2017.

The company's shares are in pre-open

G Medical Innovations Holdings Ltd (ASX:GMV) has two binding Memorandum of Understanding's on the table for distribution of G Medical Devices in both India and Taiwan.

The company specialises in next generation mobile and e-health solutions.

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https://www.ibm.com/blogs/ibm-anz/icon-australias-treatment-cancer/

Enabling Iconic Figures in Australia’s Treatment of Cancer

June 1, 2017

Categorized: Health | Watson

Written by Terry Sweeney, IBM Watson Health, Asia Pacific

One in two Australians will be diagnosed with cancer in their lifetime[1]. That’s the latest alarming cancer statistic from the Australian Institute of Health and Welfare. Its findings show a sharp increase in incidence from previous reports. It’s our nation’s leading cause of death, and has touched the lives of almost everyone in some way.

Cancer is a global challenge, driving researchers and oncologists in their quest for a cure. In fact, 8,000 medical research papers are published every single day with new treatment options, genetic factors and patient studies, opening new possibilities in the fight against this terrible disease. That sheer volume of information is simply too much for one doctor to digest, and it’s only going to increase.

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http://www.theaustralian.com.au/business/technology/sydney-startup-episoft-closes-1m-capital-raising/news-story/b6bb944698ab9857b6eb4dc0162fa78a

Sydney start-up EpiSoft closes $1m capital raising

• The Australian
• 12:00AM November 7, 2017

David Swan

Sydney medtech start-up EpiSoft has closed a $1 million capital raising, backed by four private investors, as the Springboard Enterprises alumnus looks to scale-up its offering.

EpiSoft is a cloud-based medical record SaaS business, catering to hospitals and clinics with software that supports care co-ordination, management and treatment planning.

Company founder Jenny O’Neill, a health IT executive and the first female president of the Medical Software Industry Association, told The Australian she believed there was a gap in the investment market in Australia. She also felt there was a reluctance from investors to pour money into the digital health space, given a lack of knowledge.

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https://www.itwire.com/strategy/80707-episoft-raises-$1-million-to-fund-global-expansion.html

EpiSoft raises $1 million to fund global expansion

• 08 November 2017
• Written by  Peter Dinham

Australian start-up EpiSoft has closed a $1 million capital raising as it prepares to further develop its digital health platform and expand globally.

The capital raising was backed by private investors and is EpiSoft’s first investor raise, and follows a previous $250,000 government grant in 2013.

Founder of EpiSoft, Jenny O’Neill, a health IT executive with 20-plus years’ experience in senior roles and the first female president of the Medical Software Industry Association, says she believes there is a gap in the current investment market in Australia, and investors have an appetite for companies raising $500,000 or $3 million.

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http://www.afr.com/technology/gp-tech-platform-healthkit-raises-25-million-to-take-on-europe-20171027-gz9qw9

• Updated Nov 6 2017 at 11:05 AM

GP tech platform HealthKit raises $2.5 million to take on Europe

by Yolanda Redrup

A tech start-up founded by two former ANZ bank employees claims it has become the most popular health practice management software in Australia, as it closes a $2.5 million capital raising before international expansion.

HealthKit founders Alison Hardacre and Lachlan Wheeler say the company has more than doubled its market size this year, going from 10,000 practitioners using its platform to more than 22,000 worldwide, 19,000 of which are in Australia.  

The company plans to use the funds it has raised to set up a European headquarters in Ireland. It would not reveal who had led the $2.5 million raise, beyond saying it came from existing investors. 

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http://www.theaustralian.com.au/business/technology/learning-to-live-with-and-control-intelligent-machines/news-story/a8ed746a05f74cee45239fb11ffd0a2b

Learning to live with, and control, intelligent machines

• The Australian
• 12:00AM November 7, 2017

Supratim Adhikari

Artificial intelligence and automation may or may not be the death knell of society as we know it, but there’s a growing chorus of voices calling for us to re-evaluate our relationship with technology.

It’s pretty hard to deny the profound benefits delivered by technology over the course of the past decade; however, they haven’t come without consequences.

Some of the benefits have come at the expense of traditional business models and have laid down the foundation for new ­hegemons.

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http://www.smh.com.au/national/public-service/how-the-ancient-romans-would-build-the-national-broadband-network-20171103-gzeflz.html

How Ancient Romans would build the national broadband network

Clive Williams

Published: November 7 2017 - 12:15AM

Australian leaders could learn much from this 2000-year-old approach to management.

Australian governments in general seem to have problems managing major infrastructure projects. This seems particularly the case with the federal government and the 10-year-old national broadband network. (That is not to say the opposition, in government, would do any better.)

I recently had reason to consider the Roman approach to management, and there are a few lessons that can still be learned from what worked for them for several hundred years.

One of their major projects was building Hadrian's Wall in northern England, starting in AD122. At the time, it would have compared in scale to today's NBN project. The Romans completed the massive task in six years.

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http://www.smh.com.au/technology/web-culture/tweet-longer-twitter-officially-moves-to-a-280-character-limit-20171107-gzgvnh.html

Tweet longer: Twitter officially moves to a 280 character limit

Tim Biggs

Published: November 8 2017 - 8:00AM

Twitter's iconic 140 character limit for tweets is no more. In a move that could affect which ideas you can express on the platform, the amount of scrolling you have to do on your Twitter app and the political policies set by the President of the United States, the company has today announced that 280 characters is the new standard for all users.

The change, which will roll out to all users tweeting in English and most other languages, doubles the maximum length of every tweet, but Twitter says a recent test of the new limit showed the platform will maintain its brevity.

"We — and many of you — were concerned that timelines may fill up with 280 character Tweets, and people with the new limit would always use up the whole space", said Twitter product manager Aliza Rosen in a blog post. "But that didn't happen".

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Enjoy!

David.