This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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."
EXCLUSIVE, Katie Hampson | The West Australian
Wednesday, 4 April 2018 4:00AM
Babies are missing key developmental milestones because their parents are glued to digital devices at times when they should be interacting with their infants, a leading WA paediatrician says.
Joondalup Health Campus paediatrics head Desiree Silva said the $26 million Origins Project was investigating the impact of electronics on a child’s health as part of a decade-long study of how a child’s environment influenced their risk of chronic health problems.
“Social interaction from an early age is changing and we are finding that some babies at six weeks of age are not smiling ... and smiling at six weeks old is a key milestone,” Professor Silva said.
“What we’ve noticed is a lot of parents are holding their phone or iPad and not actually looking at their child. What worries us, as paediatricians, is that platform of the child’s brain might be affected.
“That early brain development could be affected by that lack of interaction, or reduced amount of interaction, because parents are distracted by their phone.
“These devices are very addictive. So what does it replace? Basically, interacting with your child, or looking at what your child’s needs are, or responding to what your child is doing.”
I have little to add rather than to suggest we focus on the nippers, and not devices, when they are nippers. After that they can use their own devices, associated with whatever issues that causes!
The
research examined participants in the Get with the
Guidelines—Heart Failure program who were admitted to the hospital with
heart failure in 2008. Get With the Guidelines is a national registry of
hospitalized patients with heart failure.
The
hospitals involved had differing degrees of EHR implementation, categorized as
“no EHR, partial EHR and full EHR.”
A
total of 21,222 patients were eligible for the study. Approximately 1,484
individuals went to a hospital with no EHR; 13,473 were admitted to a hospital
with a partial EHR; and 6,265 went to a hospital with a full EHR.
Many
of the patients had comorbidities, such as hypertension, diabetes mellitus and
hyperlipidemia. The majority of hospitals involved — 76 percent —
were teaching hospitals.
Overall,
the results show there isn’t an association between degrees of EHR
implementation and better care quality, 30-day post-discharge death or
readmission. The study only showed improvement in one area related to EHR use:
beta blocker at discharge.
The full article is available freely
on-line. Here is the Abstract:
Association of Electronic Health Record Use With Quality of Care and
Outcomes in Heart Failure: An Analysis of Get With The Guidelines—Heart Failure
Senthil Selvaraj, Gregg C. Fonarow, Shubin Sheng, Roland A. Matsouaka, Adam D. DeVore, Paul A. Heidenreich, Adrian F. Hernandez, Clyde W. Yancy, Deepak L. Bhatt
Journal of the American Heart Association.
2018;7:e008158
Originally published March 30, 2018
Abstract
Background Adoption of electronic health
record (EHR) systems has increased
significantly across the nation. Whether EHR
use has translated into improved quality of care and outcomes in heart failure
(HF) is not well studied.
Methods and Results We examined participants
from the Get With The Guidelines—HF registry
who were admitted with HF in 2008
(N=21 222), using various degrees of EHR
implementation (no EHR, partial EHR, and full EHR).
We performed multivariable logistic regression to determine the relation
between EHR status and several in‐hospital
quality metrics and outcomes. In a substudy of Medicare participants (N=8421),
we assessed the relation between EHR status
and rates of 30‐day mortality, readmission, and a composite outcome. In the
cohort, the mean age was 71±15 years, 49% were women, and 64% were white.
The mean ejection fraction was 39±17%. Participants were admitted to hospitals
with no EHR (N=1484), partial EHR (N=13 473), and full EHR (N=6265). There was no association between EHR status and several quality metrics (aside from
β blocker at discharge) or in‐hospital outcomes on multivariable adjusted
logistic regression (P>0.05 for all comparisons). In the Medicare
cohort, there was no association between EHR
status and 30‐day mortality, readmission, or the combined outcome.
Conclusions In a large registry of
hospitalized patients with HF, there was no association between degrees of EHR implementation and several quality metrics and
30‐day postdischarge death or readmission. Our results suggest that EHR may not be sufficient to improve HF quality or related outcomes.
---- End Abstract.
While the study happened a few years
the Hospitals that were in the active arm of the study where advanced EHR users
by our present standards so the implication that there is more work needed to
achieve clear beneficial outcomes is almost certainly valid.
I do which the Digital Health
spruikers would listen to incoming evidence more and maybe work to improve
things and design real world studies that show the technology is making a real
positive difference rather than just wishing it were so.
A father of two died in hospital following a routine knee reconstruction because his anaesthetist accidentally entered fentanyl into the wrong computer file, the NSW Coroner’s Court has found.
Paul Lau, 54, died from multiple drug toxicity after being mistakenly prescribed fentanyl intended for another more complex surgical patient at Sydney’s Macquarie University Hospital in June 2015.
The most likely explanation for the prescribing error was that the anaesthetist, Dr Orison Kim, left Mr Lau’s file open on a computer and then returned to theatre, the inquest heard.
He’d been using the hospital’s new electronic prescribing system, TrakCare, and came back to the computer at a later time to enter medication for another patient. However, he accidentally prescribed a fentanyl patch and patient-controlled analgesia for Mr Lau, whose file was still open.
Mr Lau had already been prescribed oxycodone tablets and paracetamol for an “uneventful” anterior cruciate ligament reconstruction.
Dr Kim overrode 22 alerts in three batches while entering the medications, selecting “consultant’s decisions” and entering his password each time.
“It is clear that Dr Kim failed to exercise proper care, diligence and caution whilst prescribing medication erroneously in Paul’s TrakCare record,” acting State Coroner Magistrate Teresa O’Sullivan said in her findings.
Following up here are the full recommendations to the Hospital:
To the Macquarie University Hospital
1.That a working party be established to consider lessons learned and possible reforms which could be implemented at Macquarie University Hospital (“the Hospital”) as a result of the death of Paul Lau on 19 June2015:
a.That the workingparty comprise a representative from at least Information Technology (“IT”), the Anaesthetics & Perioperative Services Department (“Anaesthetics Department”), the Nursing directorate, the Macquarie University Pharmacy (“the Pharmacy”) and the Patient Safety and QualityManager.
2.That the working party consider, or in the alternative, the Hospital considers, the most effective way to implement the following suggestedreforms:
Presentation of Paul Lau’s Case
a.A staff seminar or seminars be conducted with the participation of staff from at least the Anaesthetics Department, nursing staff and the Pharmacy about the missed opportunities to detect the prescribing error in Paul Lau’s case and the lessons learned from hisdeath;
That the nursing staff involved in Paul’s carebe consulted about how that seminar be presented and have theopportunityto address the seminar if they wish;and
c.That the seminar address, at a minimum, communication, handover, opioid policy, observation of patients on high-risk medication, Schedule 8 checks and responding to patient deterioration.
TrakCare Changes
d.Give ongoing consideration to a method of verifying patient identity before medical practitioners submit medication orders on TrakCare, including specific considerationof:
i.Urgent short term methods of ensuring patient identity verification if software changes are likely to be prolonged in implementation;and
ii.The manual entry of the patient’s name prior to submitting a medicationorder;
e.A field/box labelled “current medications” or “medications history” (as determined appropriate) be included in the pre-anaesthetic assessment (see Tab 36C, Annexure C of Exhibit 1);
f.A field labelled “post-operative pain plan” (or other description as determined appropriate) be added to the Recovery Progress Notes template (see Exhibit5);
g.That investigation be undertaken into the feasibility and efficacy of an alert when medications are added to a patient’s chart after the patient file is allocated toPACU/Recovery;
h.That representatives of at least IT and the Anaesthetics Department consider the most effective way of ensuring that TrakCare alerts enhance patient safety without unduly distracting or diverting anaesthetists;including
i.How to safely reduce the number of alerts;
ii.Removing the default ‘batch’ override system;
iii.Creating a hierarchy ofalerts;
Creating a distinct alert foridentical duplicate “one touch” prescribing;
v.The effective use, if any, of font, format, sound, colour and placement for alerts; and
vi.Known literature and clinical guidelines on safee-prescribing.
TrakCare Proficiency
i.That medical practitioner accreditation include a TrakCare assessment process whereby it is mandatory for a person separate from the user to confirm that theuser is proficientto safely use thesystem;
j.That consideration be given to the most appropriate person to conduct the assessment and if the assessment would be more effective in person or on-line;and
k.That TrakCare proficiency for anaesthetists be assessed by the use of simulations or scenarios designed in consultation with the Anaesthetics Department.
Handover Practices
l.That a staff seminar or seminars be held involving staff from nursing and the Anaesthetics Department about handover practices which would include simulations of handovers by staff, the provision of feedback and discussion of mechanisms to enhance the communication between nursing staff and anaestheticsstaff;
m.That an audit or audits be conducted in relation to safe handover practices at the Hospital with particular priority given to practices at PACU/Recovery;
n.That there be a minimum number of audits conducted annually at appropriate intervals;and
o.That the results of those audits be published on the Hospital intranet and be held by the Nursing Directorate.
Perioperative Management
p.That, at least, representatives ofthe Anaesthetics Department and the nursing staff consider mechanisms to provide safe and effective perioperative management for patients, including:
i.Monitoring of patients taking high risk medications;
ii.Postoperative review of patients by anaesthetists in PACU/Recovery and on theward;
iii.The introduction of a pain service;and
iv.Relevant existing clinical guidelines including Australian and New Zealand College of Anaesthetists guidelines, Clinical Excellence Commission guidelines and any known proposed upcomingreform.
I have to say this report seems very much to be a consensus co-operative finding where some very sensible approaches are recommended and are apparently being implemented.
To my mind it is a combination of inadequate user training and poor system design and screen layout that are at fault and that serious efforts are being made on both these fronts.
All that remains is to educate the whole of the profession of the risks and work to optimize design safety with the software.
Almost 14 million patients across England are now using online GP services to book appointments, order repeat prescriptions and view their records.
According latest figures from NHS England, there has been a 42% increase in the number of people who are signed up for online services compared to the same time last year.
This means 24 per cent of patients (13.9 million) in England are now registered, which NHS England hopes will ease pressure on GPs and their staff and save patients time.
NHS Digital figures from February 2018 show an average of one million appointments are being made or cancelled online every month and nearly 2.3 million prescriptions ordered online, as more practices and their patients increasingly use digital technology.
Juliet Bauer, chief digital officer for the NHS, said: “We’re delighted to see an almost doubling in the numbers of people accessing digital services in GP practices since last year.
Frankly these are just amazing figures that make it utterly clear as to what patients actually want. They want to be able to make appointments, ask for prescription repeats and view their ACTUAL LIVE health record (not some incomplete partial copy – which will never provide the functionality they want and need).
To me seeing the voluntary response you get to Digital Health when you provide patients with what they want, compared with having to dragoon them into having something they don’t want, is a pretty stark condemnation of the ADHA’s policy performance, direction incompetence and frankly evil intent.
It really is as simple as that.
Just what is causing this stubbornness to persist in the face of clear evidence is now becoming clear and the bottom line is that the ADHA and the DOH are playing the Doctors (AMA, RACGP etc.) and the public for mugs. The myHR is intending to be a giant health information data-base, contributed by patients and their doctors for free, to allow the Government to better monitor and ultimately control the medical profession and what they do for their patients and what mistakes they make in the Government's eyes.
Just ask yourself just why else would they spend what is now heading towards $2 Billion and move towards compulsory use of the system if that was not their goal? This is nothing to do with patient safely and quality of care and all about Government attempting to manage, by deceit, one of their largest cost centres.
We all understand the backlash against Facebook when their cunning plan was exposed. The same will be the medical and patient backlash when they realise they are just unpaid data collectors.
Spread the word and explain to your friends how they are being deceived - as seems to be more common than it used to be with Government these days (think robo-debt, data disclosures etc.)!
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 shortened week after Easter with not much really happening until you look a little more closely and see the first Australian 5G network use and increasing private e-Health activity and some sadness with technology use.
When serial entrepreneur Dean McEvoy looks for new investment opportunities he searches for someone who is in love with solving a problem. And that is what he found with Tyde creator Romain Bonjean.
French-born Bonjean and his co-founders Shamus Cooper and Sudeep Gohil (both are Tyde advisers) launched the health business two years ago. Tyde is the first consumer-focused app for the federal government's My Health Record platform that is being rolled out by the Australian Digital Health Agency.
It's a single point to access and manage records, appointments and prescriptions that has real-time treatment adherence data, and that allows multiple users to interact in real time. Users can join the entire family's health records together.
"We got a great team in health informatics," says the 40-year-old Bonjean. "It is quite a complex activity to get the right architecture, connect properly, and the security and safety and privacy measures put in place are second to none. It makes banking and stock broking look like child's play next to it.
Parents are snubbing their infants in favour of digital devices according to leading WA paediatrician
EXCLUSIVE, Katie Hampson | The West Australian Wednesday, 4 April 2018 4:00AM
Babies are missing keydevelopmental milestones because their parents are glued to digital devices at times when they should be interacting with their infants, a leading WA paediatrician says.
Joondalup Health Campus paediatrics head Desiree Silva said the $26 million Origins Project was investigating the impact of electronics on a child’s health as part of a decade-long study of how a child’s environment influenced their risk of chronic health problems.
“Social interaction from an early age is changing and we are finding that some babies at six weeks of age are not smiling ... and smiling at six weeks old is a key milestone,” Professor Silva said.
There are probably a handful of GPs working today who finished medical school before the launch of Space Invaders in 1978.
Since that time, video games have become so ubiquitous that in January the WHO prepared a draft proposal for entering “gaming disorder” in its International Classification of Diseases.
But several dozen experts, including some from Australia, have pushed back against the classification in a paper published in the Journal of Behavioural Addictions.
Their arguments basically fall into three parts. First, there’s no genuine agreement on what a gaming disorder is. Does it involve gambling games? Violent games? Is it just internet addiction that happens to involve online games?
A father of two died in hospital following a routine knee reconstruction because his anaesthetist accidentally entered fentanyl into the wrong computer file, the NSW Coroner’s Court has found.
Paul Lau, 54, died from multiple drug toxicity after being mistakenly prescribed fentanyl intended for another more complex surgical patient at Sydney’s Macquarie University Hospital in June 2015.
The most likely explanation for the prescribing error was that the anaesthetist, Dr Orison Kim, left Mr Lau’s file open on a computer and then returned to theatre, the inquest heard.
He’d been using the hospital’s new electronic prescribing system, TrakCare, and came back to the computer at a later time to enter medication for another patient. However, he accidentally prescribed a fentanyl patch and patient-controlled analgesia for Mr Lau, whose file was still open.
Electronic prescribing error in month-old EHR responsible for death of NSW man, State Coroner finds
Lynne Minion | 06 Apr 2018
An anaesthetist’s accidental misuse of a month-old electronic medical record at Macquarie University Hospital in 2015 was responsible for the death of a 54-year-old man following routine knee surgery, the NSW State Coroner has found.
Six hours after an uneventful knee reconstruction, Paul Lau died after being administered medication meant for another patient, Acting State Coroner Magistrate Teresa O’Sullivan said in her findings.
The February inquest heard from eight witnesses on the events leading up to Lau’s death in the early hours of June 19, despite attempts to resuscitate him.
According to the Coroner, the hospital’s recently implemented InterSystems TrakCare electronic system, which had gone live on May 2, had been used by anaesthetist Dr Orison Kim to prescribe Lau’s drugs.
Telepresence robot technology means doctors can virtually meet with patients in other locations for face-to-face consultations, improving the care experience for the consumer.
Waikato District Health Board is trialling the use of clinical robots within its hospitals.
Robots Dougie and Daphne allow Waikato DHB specialists to roam the wards of Waikato and Thames Hospitals from wherever they are based, giving them virtual access to patients elsewhere.
The DHB is trialling the clinical robots for six months and hopes they can help specialists to intervene earlier to improve patient care in rural areas. They are the first of their kind in New Zealand.
I AM from a generation that knows the world without computers, a Luddite who makes a distinction between the “offline” versus “online” world and real friends versus virtual friends.
Technology has fundamentally changed how we interact and transact. As a tool, it gives us choice, convenience and control. It affects every aspect of life and gives people autonomy to choose how they buy their books, shoes or real estate (Amazon, shoesofprey, realestate.com). I no longer need cash or a credit card to make a transaction (PayPal, squarepay). Technology changes the way we communicate and consume information (Facebook, Twitter and LinkedIn). We expect customised and curated entertainment (Spotify, Netflix), and, increasingly, “biometrics” are changing our behaviour (fitbit and Apple watch). This is no longer a “brave new world” or the “digital frontier” – it simply is the world in which we live.
In the context of everyday life, Australians are prolific users of technology. The Australian Bureau of Statistics reports 13.7 million internet subscribers at the end of June 2017 – a 2.1% increase from December 2016. Sensis reports that 79% of Australians use social media, 59% of them daily. While the younger generation accesses Instagram and Snapchat, Facebook is still the most popular global network with over 2.13 billion monthly active users for December 2017, spending 20 minutes online per visit.
The Department of Human Services has a new “chief citizen experience officer” who hopes digital transformation can bring relief to both disgruntled clients and frazzled frontline staff, but the government continues to send mixed messages about its priorities in the portfolio.
Mukul Agrawal, who moved into the challenging role from AMP in November, spoke about his hope that simple forms of artificial intelligence can make dealing with Medicare or Centrelink a quicker, easier and more personalised experience, at the Australian Information Industry Association’s recent conference on the future of work.
Australia’s e-health record operator has begun investigating whether a virtual assistant could help answer questions about the personal e-health record that will shortly be created for every Australian under the opt-out My Health Record scheme.
iTnews can reveal the Australian Digital Health Agency is in the early stages of developing the virtual assistant to help users navigate the My Health Record website.
It comes ahead of an opt-out period for My Health Record, which is expected to see increased traffic to the standalone portal the ADHA has built to allow citizens to opt out.
Older Australians are being urged to consider their ongoing health and the benefits of having a My Health Record during NSW Seniors Festival which is launching across NSW from 4-15 April.
Older Australians are being urged to consider their ongoing health and the benefits of having a My Health Record during NSW Seniors Festival which is launching across NSW from 4-15 April.
My Health Record is an individual’s safe and secure digital health information, easily accessible by healthcare providers involved in your care including GPs, pharmacists and hospitals. All Australians will have a My Health Record by the end of 2018 unless they choose not to.
Australian Digital Health Agency CEO Tim Kelsey said the expansion of My Health Record nationally this year will deliver a system that provides universal functionality, clear and concise content and, critically, a safe and secure clinical health service for all Australians.
Call for Medicare to catch up, as the momentum of telehealth uptake grows
Lynne Minion | 04 Apr 2018
A telehealth system developed by the CSIRO’s Data 61 is fast-tracking the uptake of video consultations in Australia, with the platform now connecting 20,000 Australians with their healthcare practitioners.
Through partnerships with Health Team Australia, HealthKit and Ramsay Healthcare, Coviu is breaking down healthcare access problems in rural and regional Australia, improving the at-home management of chronic conditions, and providing the healthcare system with cost savings.
Such is its momentum, Coviu has grown its base of paying users by 470 per cent in the last year and has been commercialised in China.
Accessed through web browsers, a mobile app or integrated into practice management software, the emerging start-up was developed by Data61 in consultation with healthcare providers to tailor the platform to their needs.
The Department of Human Services plans to incorporate ‘voice of customer analytics’ into its digital services to pinpoint design weaknesses that have made it into production.
Head of enterprise architecture Garrett McDonald told IBM’s Think 2018 conference that the department was trialling IBM’s Tealeaf software “over the coming months”.
Tealeaf is used to track customer behaviours in web and mobile channels, and particularly identify areas of friction in the way they are laid out. IBM bought Tealeaf in 2012.
A new report by the government’s privacy authority has found that the Department of Health breached the Privacy Act a number of times as part of a bungled release of medical data in 2016, but the department will not face any sanctions or punishment.
The report, completed by Australian Information Commissioner Timothy Pilgrim prior to his retirement last week, found the department’s processes for assessing risks around releasing health data was “inadequate”, and that the office broke privacy laws in publishing the information.
But the department has escaped any sanctions, instead entering into an enforceable undertaking that requires it to “review and enhance its data governance and release processes” with oversight from the Office of the Australian Information Commissioner (OAIC).
Concerns that drug companies are using codeine upschedule to market stronger painkillers reveal an urgent need for real-time recording, says Guild
Pharmaceutical companies have come under fire for allegedly using a crackdown on codeine sales as an opportunity to market stronger painkillers to doctors, according to a Fairfax investigation.
One of the main concerns about the codeine upschedule was that doctors could end up prescribing even stronger medication to pain sufferers.
This may be coming to fruition, as some doctors are saying this is now happening through advertising sent to GPs.
If you look at a standard display of the fields in the PID segment (this one, or this one), there’s no fax number, just home and work phone numbers … in spite of the healthcare system being obsessed with faxing. So where is it? (and, while we’re at it, there’s no field for email either…)
Well, HL7 finally did something about this in v2.7, in 2011:
PID-40 Patient Telecommunication Information (XTN)
CBA cites Facebook scandal in push for slower data-sharing
By Clancy Yeates
2 April 2018 — 12:15am
Commonwealth Bank has pointed to Facebook's data privacy scandal as it urged the federal government to slow down a plan to introduce a data-sharing regime in financial services.
In a move that could have far-reaching effects on banks and their customers, Treasurer Scott Morrison last year ordered a review into "open banking", a system allowing consumers to securely share their financial data in order to get a better deal.
The review, by King & Wood Mallesons partner Scott Farrell, was delivered in February, with Mr Morrison declaring at the time open banking would "revolutionise" the industry.
Microsoft looks to fix multi-cloud mess with Azure Australia Central
The tech giant now boasts four Azure regions in Australia, with its latest, Azure Australia Central, allowing organisations to collocate legacy and modern applications.
By Asha McLean | April 2, 2018 -- 14:01 GMT (00:01 AEST) | Topic: Cloud
Microsoft has announced the go-live of two new regions in Australia targeted towards government, financial services, and critical national infrastructure clients in Australia and New Zealand that are making the move to multi-cloud.
The new offering, Azure Australia Central, has been designed for mission-critical workloads, and comes after Microsoft achieved official accreditation from the Australian Signals Directorate (ASD) in June, allowing the company to offer 50 services on the ASD Certified Cloud Services List across Azure and Office 365.
Offered out of Canberra Data Centres (CDC), the two new Azure cloud regions will allow for the storing of unclassified and protected-level data.
When Bill Morrow took over as head of the NBN Co, the company tasked with building the national broadband network, he was fully aware with what he had to contend.
The Coalition Government had come to office with a changed policy, going from the all-fibre Labor model, to what was called a multi-technology mix with fibre-to-the-node taking pride of place.
The prime minister at the time, Tony Abbott, had handed the job to Malcolm Turnbull with the directive to "kill the NBN". Turnbull picked the technologies, with HFC being pushed as the saviour of the rollout.
The Australian Competition and Consumer Commission’s (ACCC) final report into the state of the nation’s communications market has called for the government to plan for the future disaggregation of the NBN into competing networks.
The ACCC has previously endorsed the potential break-up of NBN into separate entities, as has a major government-commissioned review of the National Broadband Network rollout.
Fresh from its victory in the 2013 federal election, the Coalition government commissioned a panel of experts led by Michael Vertigan to conduct a cost-benefit analysis of the NBN rollout.
