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."

Thursday, December 17, 2009

The Press Release You Put Out When You Have Essentially Nothing to Say.

This arrived via the NEHTA RSS yesterday.

Northern Territory pushes the button on new e-health messaging system

15 December 2009. A new e-health messaging system is now in operation in the Northern Territory.
A national consortium of health organisations this week pushed the button on an innovative secure messaging delivery system in the Northern Territory which aligns with emerging national e-health standards.

The system, known as the Web Services Messaging Application or WSMA, uses new web-services technologies to send health information between different clinical software systems. It is based on a first generation messaging specification, drafted by NEHTA earlier this year, which is the front-runner to a national specification for secure messaging delivery currently pending release.

Sponsored by the Northern Territory Department of Health and Families (DHF), with software developed by local IT firm Diverse Systems Consulting, the project has been a joint initiative of the National E-Health Transition Authority (NEHTA), General Practice Network NT, and commercial software vendors Communicare Systems Pty Ltd and PEN Computer Systems Pty Ltd. The new system is part of the Northern Territory’s ongoing program of e-health innovation aimed at improving clinical information exchange and service delivery, particularly for patients in remote areas.

The WSMA application is designed to securely and efficiently transfer thousands of electronic messages a day containing critical healthcare information used to update the records of approximately 40,000 people who have already registered for the Northern Territory’s eHealthNT Shared Electronic Health Record service.

Under a self-assessment process a Declaration of Conformance was issued to affirm WSMA’s compliance with NEHTA draft specifications. Future WSMA releases are expected to undergo formal testing under a new national software conformance assessment scheme, specifications for which will shortly be released by NEHTA for industry comment.

Integrated within the established clinical software packages offered by PEN and Communicare, WSMA will be used in most of the Territory’s Aboriginal community controlled health clinics, public hospitals and a growing number of urban general practices.

NT DHF Chief Information Officer Stephen Moo said that, through its eHealthNT program, the Territory was committed to building state-of-the-art e-health solutions in line with NEHTA standards.

Design work has already commenced for the next generation of WSMA to be commissioned once the final NEHTA specification has been released. Future plans include developing NEHTA compliant eReferrals and eDischarge Summaries, enabling clinical information exchange between healthcare providers in the Northern Territory and providers in South Australia and Western Australia.

Test messages have already been successfully sent from SA Health systems to NT DHF systems demonstrating the e-health vision in action with information flowing seamlessly between interoperable systems in conformance with a national standard.

Read the full release (with contact details) at the NEHTA site:

http://www.nehta.gov.au/media-centre/nehta-news/576-nt

This release is really a classic ‘red rag’ to a tired old bull!

What it tells us is that the NT Health Department have had some vendors build a system based on what is thought will be NEHTA Standards (Those are not yet done.) and that this has been given a great new acronym (WSMA).

We are then told WSMA has been designed to do something – not that it is not actually doing it yet.

Also we are told that this trial implementation has been integrated with some community service software providers and that WMSA will be used within them.

We are then told further design work is underway for the actual working and standardised WMSA.

We are then delighted to be told that with test messages already sent (content totally un-specified) they are “demonstrating the e-health vision in action with information flowing seamlessly between interoperable systems in conformance with a national standard”. Now that is grand and wonderful is it not?

The obvious thing that is required here is that this release should have happened when there were some actual runs on the board and that attached to the release were some concrete technical details as to what has actually been achieved, how well it is working, what issues and leanings etc have been achieved.

To date not one of the 40,000 souls mentioned seem to have benefited from all this. When that happens is the time for the release!

The bottom line is to ‘toot you horn’ when you actually have something real to toot about!

This blatant chase after good PR is both transparent and unseemly. Note this is not to at all diminish or discourage what NT, Health and its partners are trying to do, but rather to condemn the publicity seeking nonsense coming from NEHTA.

David.

Wednesday, December 16, 2009

Weekly Australian Health IT Links - 14-12-2009

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article.

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http://www.zdnet.com.au/news/hardware/soa/WA-Health-issues-4-million-Cisco-contract/0,130061702,339299989,00.htm

WA Health issues $4 million Cisco contract

By Josh Mehlman, ZDNet.com.au
10 December 2009 05:17 PM

The Western Australian Department of Health is upgrading its networks and has issued a two-year, $4 million tender for Cisco switches and systems integration services.

The request for tender seeks a single company to supply Cisco switch infrastructure and associated management systems, and systems integration services for the equipment supplied. The equipment supplied must be from Cisco for "interoperability and Standard Operating Environment reasons".

-----

http://www.itwire.com/content/view/29980/127/

NBN to drive critical mass for new apps: Conroy

by James Riley

Friday, 11 December 2009

Australia does not have the critical mass of connections that would allow for the natural development of emerging applications in areas like e-health, education and business productivity and required Government intervention, Communications Minister Stephen Conroy said.

The massive Government investment in the National Broadband Network was an enabling investment in the broader economy, and in social service delivery, Senator Conroy said.
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http://www.australiandoctor.com.au/articles/4F/0C06624F.asp

E-health system still short on detail

8-Dec-2009

By Sarah Colyer

FRUSTRATION is mounting at the Federal Government’s lack of detail on how an e-health system will work, after a vague announcement at yesterday’s Council of Australian Governments meeting.

In a communiqué from yesterday’s meeting, COAG “affirm[ed] its commitment to the introduction in 2010 of national healthcare identifier numbers”.

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http://www.theaustralian.com.au/australian-it/nbn-co-down-the-wrong-path-cisco/story-e6frgakx-1225809283038

NBN Co down the wrong path: Cisco

  • Andrew Colley
  • From: Australian IT
  • December 11, 2009 8:50AM

NETWORKING experts have discussed concerns that the national broadband network will put the nation on a $43 billion path "back to the future" by returning incumbent telcos to dominant market positions.

Cisco Australia chief technology officer Kevin Bloch said that the NBN Co's minimalist approach to building the network would place an additional investment burden on access seekers that only dominant market players could bear.

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http://www.zdnet.com.au/news/software/soa/iSoft-looking-to-create-500-Aussie-jobs/0,130061733,339299986,00.htm

iSoft looking to create 500 Aussie jobs

By Suzanne Tindal, ZDNet.com.au
10 December 2009 05:43 PM

Australian-listed e-health company iSoft is considering upping its headcount in Australia by 500 people, hoping to increase the percentage of research and development workers it fields down under.

"We are looking for investment and I've asked for a significant amount of investment to put back into Australia," iSoft managing director Australia and New Zealand Denis Tebbutt said today at an Australian Information Industry Association event in Sydney.

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http://www.theaustralian.com.au/australian-it/regional-it-projects-get-265m-boost/story-e6frgakx-1225808993365

Regional IT projects get $26.5m boost

  • Fran Foo
  • From: Australian IT
  • December 10, 2009 11:54AM

PRIME Minister Kevin Rudd today unveiled seven projects that would receive a total of $26.5m as part of the $60m Digital Regions initiative.

The purpose of the program is to deliver better health, education and emergency services to regional, rural and remote communities.

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http://www.news.com.au/breaking-news/bionic-fingers-lending-a-helping-hand/story-e6frfku0-1225808800904

Bionic fingers lending a helping hand

  • From correspondents in London
  • From: AAP
  • December 09, 2009 8:39PM

THE world's first set of bionic fingers have been unveiled by scientists in Britain.

The lightweight motorised fingers, which cost up to STG45,000 ($80,585), are made out of plastic and give people with damaged hands the ability to pick up objects, write, grip and point.

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http://www.computerworld.com.au/article/329008/tony_who_budde

Tony who?: Budde

New shadow communications minister needs to engage with the industry, then get some policies

Tim Lohman 08 December, 2009 13:09

The first priority of the new shadow communications ministers, Tony Smith, should be to consult with industry and develop positive, constructive policies on the National Broadband Network (NBN), according to telecommunications analyst, Paul Budde.

Speaking to Computerworld, Budde said that former shadow communications minister Nick Minchin term had been characterised by politicking and a lack of engagement with the industry.

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http://abnnewswire.net/press/en/61905/iSOFT_Group_Limited_ASX:ISF_Launches_New_Aged_And_Community_Care_IT_Solution.html

iSOFT Group Limited (ASX:ISF) Launches New Aged And Community Care IT Solution

Sydney, Dec 9, 2009 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the launch of iSOFT Aged Care - Enterprise Wide Health (EWH), an integrated management solution for aged and community care organisations.

iSOFT Aged Care is designed to support organisations of any size, including residential, long-term and community care, and retirement living. Enabling the delivery of improved and more efficient health care, the solution includes residential aged care and retirement components that manage care records, billing and financials, eBusiness and reporting requirements.

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http://www.computerworld.com.au/article/329210/isoft_won_t_take_hit_from_uk_contracts_ceo

iSoft won't take a hit from UK contracts: CEO

iSoft executive chairman and CEO Gary Cohen says little chance of NHS National Program for IT being scrapped

Trevor Clarke 09 December, 2009 16:49

ASX-listed healthcare software provider iSoft (ASX:ISF) has down played the possibility of taking a hit from possible changes to its lucrative UK contract for the NHS National Program for IT.

Comments from chancellor Alistair Darling ahead of the UK government's pre-Budget report this week suggested the 12.7 billion pound program could be scrapped.

Speaking to Boardroom Radio Australia iSoft executive chairman and CEO Gary Cohen, said the government had since clarified the chancellor's statements and that there was little chance of the program being binned.

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http://www.theaustralian.com.au/australian-it/three-way-struggle-for-bionic-eye-development/story-e6frgakx-1225807909793

Three-way struggle for bionic eye development

COMPETITION for a $50.7 million fund to develop a bionic eye has become a three-way tussle between Bionic Vision Australia, Swinburne University of Technology and a mystery suitor.

It is understood the Australian Research Council has short-listed a joint bid by Swinburne University and La Trobe University's Graeme Clark Hearing and Neuroscience Unit, and a second bid by Bionic Vision Australia backed by National ICT Australia and the University of Melbourne.

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http://www.computerworld.com.au/article/328860/consensus_reached_e-health_software_standards?eid=-255

Consensus reached on e-health software standards

National E-Health Transition Authority announces standards agreement

Georgina Swan 07 December, 2009 17:50

The move towards e-health standards has taken a significant step forward as industry groups join with the National E-health Transition Authority (NEHTA) to develop an approach for the standard assessment of medical software.

The four industry groups — the Medical Software Industry Association (MSIA), the Australian Information Industry Association (AIIA), the National Association of Testing Authorities (NATA) and the Joint Accreditation Scheme of Australia and New Zealand (JAS-ANZ) — have been working with NEHTA to define how software will be certified and the principles around compliance and conformance.

Note: Covered in earlier blog.

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http://www.newsmaker.com.au/news/2013

Australia’s Fragmented E-Health System in Limbo

Monday, December 07, 2009 - IQPC Australia

Sydney, Australia – Australia’s fragmented e-Health system has hit another barrier with reports claiming the governments have ‘changed direction’ on a national e-Health scheme.

NEHTA’s Chief Executive Peter Flemming said the original vision of having a single e-health record for each Australian had been abandoned by the Council of Australian Governments in favour of a ‘more commercial approach’.

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http://www.media.tas.gov.au/release.php?id=28578

Lara Giddings, MP

Minister for Health

Tuesday, 1 December 2009

NW Patients Linked to New Medical Records System

North West patients will soon be able to access health services across Tasmania without the need to repeat personal details every step of the way.

The North West Area Health Service has replaced its 20-year-old patient administration system with an up-to-date integrated statewide system.

The new system, launched at the Mersey Community Hospital today by Health Minister Lara Giddings, allocates each patient a single identification number which will apply across the State and lays the foundation for the introduction of the electronic patient record.

Note: iSoft are the software provider.

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http://www.nehta.gov.au/media-centre/nehta-news/571-snomed-ct

Health terminology for the Australian health sector launched

7 December 2009. NEHTA today launched the first release of SNOMED CT-AU®* to Australian licence holders.

SNOMED CT-AU is the Australian release of SNOMED CT (Systematized Nomenclature of Medicine-Clinical Terms) with additional customised content for the Australian healthcare market.

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http://www.theaustralian.com.au/australian-it/warning-on-self-diagnosis-via-the-net/story-e6frgakx-1225807584107

Warning on self-diagnosis via the net

RESEARCHERS have warned Australians risk becoming a "nation of cyberchondriacs", as doctors urge consumers against using the internet to diagnose and treat themselves rather than consulting a health professional.

According to a new study, more than one in four Australians who search online for health information believe they can use it to diagnose and treat themselves without the need for a doctor.

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http://www.theaustralian.com.au/australian-it/gov-20-unveils-draft-report/story-e6frgakx-1225807627091

Gov 2.0 unveils draft report

  • Fran Foo
  • From: Australian IT
  • December 07, 2009 10:01AM

THE public has been invited to comment on how federal government departments and agencies can utilise web 2.0 to their benefit.

They will have until December 16 to air their views on a 129-page draft report on web 2.0, including social networking tools and websites like Facebook and Twitter.

Also here:

http://www.smh.com.au/national/challenge-is-for-public-servants-to-shrug-off-their-instinct-for-secrecy-20091207-kffh.html

Challenge is for public servants to shrug off their instinct for secrecy

MATTHEW MOORE

December 8, 2009

THERE are two main recommendations in this report on how government should adapt to the internet era and one obstacle threatens both of them: public service culture.

Unless that culture changes, the report says, secrecy will remain the default position of government.

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http://www.smh.com.au/digital-life/mobiles/no-tumour-link-to-mobile-phones-says-study-20091204-kaqs.html

No tumour link to mobile phones, says study

December 4, 2009

A very large, 30-year study of just about everyone in Scandinavia shows no link between mobile phone use and brain tumours, researchers reported on Thursday.

Even though mobile telephone use soared in the 1990s and afterward, brain tumours did not become any more common during this time, the researchers reported in the Journal of the National Cancer Institute.

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http://www.smh.com.au/technology/technology-news/the-future-before-your-eyes-20091205-kc04.html

The future before your eyes

KELSEY MUNRO

December 6, 2009

IMAGINE a world where your contact lenses double as a personal computer display, superimposing information in front of you.

That virtual-reality dream, a staple of sci-fi movies, is a step closer thanks to the work of Seattle scientists who have been developing a prototype to generate images inside a contact lens. The information would appear about 50 centimetres from the user's eye.

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http://www.zdnet.com.au/news/business/soa/NSW-Health-CIO-leaves-role/0,139023166,339299849,00.htm

NSW Health CIO leaves role

By Suzanne Tindal, ZDNet.com.au
04 December 2009 12:58 PM

in brief: NSW Health chief information officer Mike Rillstone has made permanent his secondment as the chief executive of NSW Health's shared services area.

A spokesperson for NSW Health told ZDNet.com.au that Rillstone has now been appointed to the role of CEO Health Support Services. He stepped into that role in June as a six-month secondment while the department sought an executive to fill the position, which was vacant after the former chief executive John Roach became NSW Health's chief financial officer.

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http://www.techworld.com.au/article/329227/mozilla_thunderbird_e-mail_client_comes_tabs

Mozilla's Thunderbird e-mail client comes with tabs

Mozilla hopes to lure users away from Outlook with new search features

Mikael Ricknäs (IDG News Service) 10/12/2009 06:25:00

Mozilla Thunderbird 3 now has message archiving

Mozilla Messaging on Tuesday released version 3 of its Thunderbird e-mail client, which comes with a tabbed user interface and improved search features.

The support for tabs is inspired by the same tabs that have become a standard feature in web browsers and function in the same manner. For example, hitting enter or double-clicking a message opens it in a new tab.

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Enjoy!

David.

Medicare and Centrelink are to be Merged. Health Information Said Not to Be Involved.

The following, as a result of a National Press Club Speech today, was reported a few hours ago.

Medicare, Centrelink to be merged

By Online parliamentary correspondent Emma Rodgers

Agencies that have direct contact with the public, such as Medicare and Centrelink, will be merged into a "one-stop" shop under changes to the sector announced by the Government today.

In a major overhaul to the way health rebates and welfare payments are delivered, the Government will begin establishing offices around the country that will incorporate Medicare, Centrelink, the Child Support Agency and disability service organisation CRS Australia under the one roof.

Medicare and Centrelink will also be moved into the Human Services portfolio.

Announcing the reforms at the National Press Club today, Human Services Minister Chris Bowen said the changes will improve service delivery and reduce bureaucratic processes and duplication.

"The time has come to reassess whether we, the Government and the nation, are getting enough out of the Department of Human Services," he said.

"There is not enough coordination between our service delivery agencies.

.....

Mr Bowen has also been quick to reassure people that the changes are not about the collection of personal information in one central location.

"It is not a central database," he said.

"We will not house an individual's personal, sensitive information in one place, vesting all control with one body or one card."

The Department will work with the Privacy Commissioner over the reforms and Mr Bowen says health information will not be included in the shake up.

.....

Read the full report here:

http://www.abc.net.au/news/stories/2009/12/16/2773480.htm

If ever there was a set of changes where the devil will be in the detail this is it! Inevitably in a merged organisation there will be information flows that no one is aware of – some of which may, or may not, be seen as appropriate by those who are subjects of that information

I am sure these changes will suit some, but I wonder just how those with some of the more stigmatizing health issues will feel about Centre link employees also being in the same loop. Time will tell I guess.

David.

Tuesday, December 15, 2009

If This is True, And One Would Hope Not, I Wonder Does NEHTA Know About It?

The following appeared today in the West Australian.

ID plan to curb welfare cheats

ANDREW PROBYN and SHANE WRIGHT, EXCLUSIVE, The West Australian December 15, 2009, 2:45 am

The private details of every Australian will be held on a giant national database under a Federal Government plan for "virtual" national identity cards designed to crack down on welfare and medical fraud.

The West Australian understands Human Services Minister Chris Bowen will use a speech tomorrow to claim the idea will save Australians from the paperwork involved in applying for employment benefits, seeing a doctor or collecting child support payments.

But the concept, expected to anger privacy advocates, is effectively a re-birth of the Howard Government's controversial Access Card proposal that was killed by the Rudd Government as a $1.2 billion saving measure in its first weeks of taking office.

However, instead of issuing all Australians with new identity cards - as envisaged under the trouble-plagued Access Card and its earlier incarnation, the Australia Card - the Government will create "virtual" ID cards by centralising vast amounts of information already held by various human services agencies.

These include Medicare, Centrelink, the Child Support Agency, Australian Hearing and CRS Australia, which coordinates rehabilitation services for people with disabilities, injuries or other health conditions.

.....

Coupled with the proposed national electronic health records, which would allow the sharing of patient details between healthcare providers, the new e-identity database will be a powerful Government tool to track down welfare cheats and deadbeat parents attempting to avoid child support payments.

Consolidating Government information would also aid the fight against so-called "doctor shoppers" who move between bulk-billing GPs to get multiple prescriptions for pain-killers and other addictive drugs.

.....

Full Article Here:

http://au.news.yahoo.com/thewest/a/-/newshome/6585637/id-plan-to-curb-welfare-cheats/

There is some more coverage here:

Bowen to announce Government data reforms

By Brett Winterford

Dec 15, 2009 12:18 PM

Feds deny plans for another Access Card.

The Federal Minister for Human Services, Chris Bowen, will tomorrow make a speech that outlines reforms to Australia's welfare system expected to be underpinned by a major IT refresh.

While details are still scant, it is widely expected to include an announcement of some level of data sharing between Human Services departments - which includes Centrelink, Medicare, the Child Support Agency, Australian Hearing and CRS Australia.

An article in the West Australian today linked the pending announcement to scuttlebutt suggesting that the Rudd Government plans to implement a "virtual ID" card by centralising the databases across these departments.

.....

"That [West Australian] article is incorrect," the spokesman said. "There will be no Virtual ID card. The Government has no plans to create one central database across Government or store all data in one location."

The spokesman did not deny, however, that the announcement will involve some sharing of data between departments within the Human Services portfolio.

More here:

http://www.itnews.com.au/News/162925,bowen-to-announce-government-data-reforms.aspx

The possibilities are I think quite high there is the plan to use some sort of data matching approaches to improve services and reduce fraud – and that this will be without a card. It will be all “virtual”.

Amazingly one of the key systems – Medicare Australia’s Customer Data System is one of the 4 systems targeted and also the source of NEHTA’s IHI.

Of course the IHI is meant to have legislated protection – but the source for its information and for updates etc is now to be used for more general ID management – hardly a good look – and all too cute as well! I have a feeling this is a very bad case of the right and left hand not having a clue about what the other is up to.

Confusion about what is going on with all this has the real potential to derail the HI Service plans I suspect and someone needs – real quickly – to start getting a coherent overall plan together.

This has all the feel of the same sort of silliness and lack of communication that derailed the Access Card and the Australia Card.

The truth of the general thrust of these reports is somewhat confirmed by the fact that a 3AW host in Melbourne sought comments on what all this means from a colleague.

I await the speech tomorrow with considerable curiosity.

David.

Response From CeH to Blog Comments

I write in response to the blog comments following release of the letter to the PM.

In regard to whether or not to make the letter to the PM public – We certainly were of two minds. The BCA letter had been made public and it was the view of the last meeting of the CeH (referred to in the letter) that our support for the BCA position should be made widely known. We did delay its release and sought advice from participants prior to release. The view was that it must be made known to the members of the organisations involved. With so many of those we thought it was tantamount to being made public and so we did that. If there had been some indication from the PM’s office that they would prefer to enter into private discussions then we certainly would have respected that and in any event meant no disrespect by its release. We believe it is about building political support from the broader community which surely is helpful for such an important issue and when so much money is involved.

In regard to the reference to NEHTA: There is now a published NEHTA plan with measureable milestones. This is what has been asked for by David and contributors to the blog for a long time. There is also evidence of the Jurisdictions talking together and aligning better than they have in the past. These are worthy steps forward which deserve recognition – which is what the letter did. I do accept there is a level of frustration around the pace of progress.

In response to questions about the constitution and authority of the Coalition: As described in the letter to the PM, the Coalition formed to improve the strength and coherence of the health system’s voice on e-health issues. It is a loose coalition and is not legally constituted. To do so would have precluded a number of the organisations from participating. There is no elected spokesperson that can speak on behalf of all those organisations. More information is provided at www.ceh.net.au

What happened in relation to the letter was that at the last meeting of the Coalition (held 1st December) which was convened by HISA and well attended, there was consensus that a letter should be sent to the PM prior to the COAG meeting which was to be held on the 7th of December. A small group undertook to write the letter based on the discussions that had taken place at the meeting, to distribute it for comment and then to allow organisations to withdraw from the list for the letter if they felt they were not in a position to support it for whatever reason (one did).

This is what was done and why the letter talks about the consensus at the meeting. Because of the time frame there was not a lot of time for a different approach. It should be said however that there was strong support for both the action and the letter from the many that did respond on behalf of their organisations.

Michael Legg,

President HISA


Monday, December 14, 2009

Specific Disclaimer of CeH Views on NEHTA.

On Sunday I posted a blog suggesting the CeH letter to the Prime Minister was an unalloyed good.

I have learnt a lesson here. I had seen a range of circulated drafts but had not actually seen, and carefully reviewed, the final letter before posting.

This paragraph appeared late in the drafting and I did not notice it before I put the file up for downloading.

“We believe that the National E-Health Transition Authority (NEHTA) has shaped a coherent vision and roadmap and has defined several “Foundation Projects” that must be funded and implemented to provide a shared basis for success. The States and Territories are also progressively aligning with the NEHTA roadmap and its foundation projects. We also note growing support of the private sector; the Business Council of Australia has strongly supported action on e-health in their letter to you dated 21 October 2009, the content of which we endorse. Finally, there is widespread consumer acceptance of and desire for a health system transformed by e-health – an independent public opinion poll commissioned by NEHTA found that 82% of consumers say they would use an e-health record.”

For the record I totally support the CeH thrust in getting more attention on e-Health and supporting the funded implementation of the National E-Health Strategy.

I do not believe NEHTA has shaped a ‘coherent vision’ and I do not believe they understand what their role is in supporting health system reform and improvement. I have no idea just how many of the CeH members agree with this sentiment. As far as I can tell I was not asked but I could have missed it!

My view is that NEHTA is a dysfunctional disaster that has slowed e-Health progress in Australia a great deal – but all regular readers know that and the reasons why I feel this way.

I have posted earlier on the issue of NEHTA’s claim of total public support. See here:

http://aushealthit.blogspot.com/2009/12/more-evidence-regarding-silliness-of.html

I am sorry I did not check more carefully before putting this final version up for download. Excluding that paragraph the letter is good – with it – not so!

Sorry again! Running a blog like this is a learning experience!

David.

The NEHTA / Medicare Australia Health Identifiers Still have A Few Serious Issues To Address.

Late last week we had the release of the draft legislation for the National Health Identifier Service.

I have provided the links here to the documentation.

http://aushealthit.blogspot.com/2009/12/e-health-news-from-doha-new-draft.html

First of let me say that if what is proposed actually provides a robust, reliable and trustworthy, privacy protective identifier to permit the correct linkage of the various information components that may make up a lifelong patient electronic record and provide clinicians and consumers with certainty as to the provenance and ownership of the health documentation they are authorised appropriately to access, and essentially nothing else, then that outcome is almost certainly a very good thing.

Indeed right at the beginning the proposed legislation says (as its objective):

“3. Purpose of this Act

(1) The purpose of this Act is to provide a way of ensuring that a person who provides or receives healthcare is correctly matched to health information that is created when healthcare is provided.

(2) This purpose is to be achieved by assigning a unique identifying number to each healthcare provider and healthcare recipient.

The essence is that all this is to ensure ‘correct’ matching of records by allocation of a unique identification number.”

This, of course, brings us to the first set of issues.

First where is the practical evidence that the approach being adopted will work ‘correctly’? I assume by the use of the word correct we are talking of vanishingly small error levels.

Well, we all know the Medicare Australia databases have measurable error rates and we also know there are more Medicare Numbers out there than there are people entitled to have them so how can we know the system will be essentially error free?

My view is that we can’t. Without a large scale pilot of say 500,000 people we are only guessing. How many mismatched records does it take to cause a problem? I don’t know but it is not many.

Second to conduct a pilot of this scale all the systems that may need to embed the identifier will need to be modified, tested and operational so exchange accuracy can be confirmed. It’s a bit late to discover we have used a ‘trusted’ data source which turns out not to be quite trustworthy enough after the event!

Put bluntly this is a potentially expensive leap of faith that may turn out to not be quite ‘good enough’.

In the COAG explanatory document we have the following (Building the Foundations – Page 7):

“A Healthcare Identifiers Service (HI Service) is being designed and developed by the National E-Health Transition Authority (NEHTA) on behalf of all governments.

The HI Service will provide a national capability to consistently identify individuals and healthcare providers to facilitate reliable healthcare-related communication.

In 2007, NEHTA contracted Medicare Australia to scope, design, build and test the HI Service. The design of the HI Service draws on existing elements of Medicare Australia infrastructure including trusted personal information about individuals, consumer Medicare cards, information policies, and customer services such as shop front and online services. For these reasons it is proposed that Medicare Australia will be the initial operator for the HI Service for the first two years of operation.”

I can’t find a single word that suggests a feasibility study has proven all this will actually work as intended. It seems just to be assumed.

The planned time lines are explained in this article

NEHTA to test health ID this year

By Suzanne Tindal, ZDNet.com.au
02 October 2009 04:54 PM

The National E-Health and Transition Authority (NEHTA) has today released its strategy for 2009 to 2012, listing priorities and timelines to enable e-health, including developing an "office" model for health identifiers by December.

The strategy was formed considering the National E-Health Strategy written by Deloitte last year and the recent National Health and Hospital Reform Commission recommendations. NEHTA admitted that there had been a gap between what stakeholders expected of it and where the authority was heading. "As the organisation evolves it is important to ensure a foundation exists for 'what' the organisation has been put in place to deliver," it said.

There are four parts to the strategy: "urgently" developing the foundations to enable e-health, coordinating the progress of priority e-health solutions and progresses, accelerating adoption, and leading the progression of e-health in Australia.

The strategy will see an "office model" for the healthcare identifiers released by December this year. An early adopters release will follow in April 2010, followed by a later adopters release in July 2010.

NEHTA CEO said earlier this year that legislation to enable the use of individual health identifiers was unlikely to be passed until next year.

Lots more here

http://www.zdnet.com.au/news/software/soa/NEHTA-to-test-health-ID-this-year/0,130061733,339298878,00.htm

I don’t see any large scale validation or software modification phases – I wonder why?

This must also be a worry

COAG commits to health IDs in 2010

By Suzanne Tindal, ZDNet.com.au
08 December 2009 03:43 PM

The Council of Australian Governments yesterday confirmed the goal of introducing individual healthcare identifiers within the next year and vowed to put draft legislation on the table for consultation.

.....

However, the overall framework for e-health records remains unfunded. NEHTA's business case for the combination of the health identifiers into personally owned individual electronic health records was again not considered by COAG. NEHTA has been trying to get its business case considered since October last year.

Estimates say that the spend needs to be between $1.2 billion to $1.9 million to create a functioning e-health system.

More here:

http://www.zdnet.com.au/news/software/soa/COAG-commits-to-health-IDs-in-2010/0,130061733,339299911,00.htm

We might be creating all this and the big picture does not get proceeded with!

See here:

http://aushealthit.blogspot.com/2009/12/coalition-for-e-health-wrote-to-prime.html

The comments by experts reported here are also very interesting:

E-health identifiers ready

10-Dec-2009

By Sarah Colyer

BASIC privacy rules for Australia’s future e-health system have been laid out in draft legislation, but privacy experts are worried the Bill is too narrow in scope.

.....

Australian Doctor understands the identifiers are technically ready, and could come into use as soon as the Bill is passed.

But David Vaile, executive director of the University of NSW’s Cyberspace Law and Policy Centre, said the Bill was “contextless” and a “complete governance failure”.

“It’s almost as if they have deliberately tried to make the Bill impossible to comment on, because you can’t see the system it is a part of,” he told Australian Doctor.

The Bill did not answer whether the identifier could be used for financial monitoring, research or auditing, he said -– “things way beyond clinical care”.

He was also concerned that the legislation left some complaints to be dealt with in the Privacy Act, “which is encyclopaedic”.

Dr Juanita Fernando, chair of the health sub-committee of the Australian Privacy Foundation, raised concern that the Bill does not address incidental breaches of privacy; for instance, when doctors fail to log out of the e-health record properly.

More here (registration required):

http://www.australiandoctor.com.au/articles/3d/0c06633d.asp

The National Partnership for e-Health certainly is not reflective is quality governance in my view. See here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health.pdf

Lastly for interesting takes on the matter we have this:

Govt wants to establish e-health system

December 11, 2009 - 12:09AM

AAP

Every Australian should be assigned their own electronic health record number by the middle of next year, with the federal government releasing the draft legislation establishing the system.

Introducing personal e-health records will slash $627 million off the health budget every year, according to the Australian Institute of Health and Welfare.

Federal Health Minister Nicola Roxon says a national e-health system will allow health providers to share patient records and improve care.

"Mismatching of patient information has been an acknowledged problem in the health system," she said in a statement on Thursday.

More here:

http://news.smh.com.au/breaking-news-national/govt-wants-to-establish-ehealth-system-20091211-kmi2.html

One can only be glad that someone knows exactly how much personal records will save. I am sure the AIHW would be surprised at the apparent precision of the estimate!

Note this link provides a very useful summary of what is planned:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-nr-nr230.htm

Even if the HI Service does deliver something that is fit for purpose, scales as needed and so on there are still some major issues to be sorted I believe.

These seem to me to fall into the categories of Implementation and Cost Issues.

Among the implementation issues are things like:

1. Addressing the education of public and providers as to what all this is about, what it means and so on.

2. Addressing the present lack of clarity as to who does what in the maintenance and updating of the HI Service. With 20+ million souls enrolled and 300,000 new ones a year being added this is a major task.

3. The issuance of the NASH provided smartcards for provider identification to the 600,000 or so health providers. (The cost in materials and effort of this will be non-trivial).

4. The lack or a ‘real’ implementation plan – 22 million people are not going to be using this service come July 1, 2010 take it from me!

Cost issues also exist I think.

1. NEHTA has a total of $218M to spend on this and all its other operations until June 2012 (from July 2009). Given NEHTA’s base running costs are about $35M p.a. (excluding consultants) that does not leave all that much to get all this going and then operate!

2. Who will pay the software developers to modify their systems to suit these identifiers or is it just something they have to do.

3. How is the work done in practices around the country for initial and confirmatory look ups of HI’s the be compensated?

I am sure there are all sorts of other issues – like just how likely is the legislation when passed going to suit what has been built – and guess what I now see the whole student sector is about to get an identifier to – approved at the last COAG!. We are all going to be numbered to death!

I will leave it to the lawyers and privacy experts to assure us all this is all OK but I have a feeling – from Prof. David Vailes comments – which I agree with on my reading – there are some problems here also.

I am not at all comfortable with the use of identifiers for such areas as research, management and disease surveillance without some actual consent from the patient involved. As for the old ‘and whatever the law requires’ should just not be there.

I also wonder how making provider details available without specific consent (say as is done in Skype) might not be a better idea.

I really don’t have a good feeling about all this. Too secretive, too un-consultative and too unproven are my takes for openers.

David.

Sunday, December 13, 2009

Health Department Secretary Feels the Heat of e-Health Inaction. About Time!

There was a Government sponsored conference on the National Broadband Network last week for 2 days.

The meeting web site is here:

http://www.broadbandfuture.gov.au/index.html

You can catch up with all the action - in a landmark for Australian Government openness - here:

http://www.broadbandfuture.gov.au/conference-program.html

Links are there to audio and video of all the sessions.

There is a just wonderful report of one of the four e-Health sessions.

E-health future on NBN derailed by lack of basics

Ry Crozier | Dec 11, 2009 9:32 AM

Passions spill over at broadband futures forum.

Frustration at perceived delays in implementing a national e-health agenda boiled over at the Government’s broadband future forum yesterday where a discussion on NBN possibilities could not get past basic issues like funding availability.

In a session where imaginations were supposed to run wild and free on the e-health applications made possible by the National Broadband Network, the whiteboard and butcher’s paper went unused.

Dialogue instead took for granted applications made possible by the NBN, such as human genome mapping, as issues of financial sustainability and scalability of more basic e-health proposals currently on the table took centre stage.

That prompted at least two delegates - including a representative of the CSIRO e-Health Research Centre - to pass comments that they “thought the purpose of this session was to look into the future of what we could do with the NBN.

“We seem to be having a discussion on what the issues are today. We need to challenge ourselves a little bit more,” the representative said.

The observation drew support from some delegates and defensive responses from some of the assembled panel of experts.

“The reason this group is about barriers is because there’s an element of frustration from a technology point of view,” said Adam Powick, a Deloitte partner and primary author of the national e-health strategy.

“Now that the technology is available, how do we break through? Right now we can’t share information between a hospital and GP [general practitioner] 100 metres away for God’s sake. We have to put in place the basic building blocks.”

Powick was supported by Department of Health and Ageing secretary and National E-Health Transition Authority (NEHTA) board member Jane Halton.

“We have to deal with some of the barriers in a way that respects they are real,” she said. “We have to work through [them].”

Dr Mukesh Haikerwal, a GP and professor at Flinders University’s school of medicine, stopped short of labelling the attitude of the room as “negativity”. But he recognised there was “more we can do."

He believed initiatives such as the future forum were a positive. “[By] pulling together people I think we can make this happen,” he said.

Budde’s burst

Tensions were raised from the first opportunity for audience participation as telecommunications analyst Paul Budde criticised the Government over what he saw as a lack of “high-level strategic policy” and frameworks on their part to drive the e-health agenda forward.

“Jane, let’s be honest. The problem is we don’t have good Government policy on e-health going forward,” Budde said.

“We [need to] start with a high-level strategic policy on what we’re going to do with e-health and set a framework so individual silo's point in the same direction. I think we need some leadership from the Government in setting some high-level policy.”

The suggestion immediately appeared to put the panelists on the defensive.

Dr Haikerwal pointed Budde to the national e-health strategy released by the Federal Government last week, while Halton told the packed room, “I think you’ve seen a significant level of leadership from the Government on this.

“NEHTA has been relentlessly swotting away, with some controversy I acknowledge,” she said.

“The bottom line is we do have a strategy. You can’t expect a revolution on this in 20 seconds.

“It does require a bunch of software [and funding] which we don’t have. We all acknowledge we could do more which is why we’re here.”

Powick acknowledged the “absolutely critical” importance of policy but believed the “bigger issue has been the readiness of the [health] sector to take it up.

“The current situation is diabolical,” Powick said, referring to issues of care professionals not being able to share records such as x-rays between facilities.

Heaps more fun here:

http://www.securecomputing.net.au/News/162575,ehealth-future-on-nbn-derailed-by-lack-of-basics.aspx

Of course Paul Budde is right! (Thanks Paul!) All we have officially is an unfunded 20 page summary National e-Health Strategy and a lot of people who are sick and tired of the obfuscation and delay! As I keep reminding people NEHTA has now been in operation over 5 years and really should have got more done, that makes a difference, before now. Hence the frustration.

Remember it is August 2008 when the National E-Health Strategy was finalised! (16 months ago – not 20 seconds)

If you want some real amusement watch the wrap up session given by the NEHTA CEO with the purpose of dragging together the 2 days of e-Health discussions.

The direct link is here:

http://webcast.viostream.com/?viocast=2251&auth=2e531774-16c7-4122-8bc5-84f09c057b0d

I heard the same platitudes and excuses, and the same list of issues and claims of progress, as I have been hearing for the last decade. Just absolute ‘baby steps’ forward and what progress there has been made has been almost in spite of Government policy on many occasions.

It really is time to stop the excuses. If the NBN is going to justify itself an upfront and serious investment is required in the leadership, policy and governance of e-Health in this country. Remember the NBN is said to be an 8 year program – I hope we can make some serious progress well before then. (I am not likely to last that long!)

David.

The Coalition for E-Health Wrote to the Prime Minister A Week or So Ago. Letter Now Released.

Here is the release e-mail.

-----

Dear Colleagues,

There was only limited response from COAG around e-health and no feedback other than acknowledgement of receipt from the PM, despite the opportunity presented by being in the same place (broadband forum) last week and so it would seem sensible to make our letter public.

Although the PM did say supportive things in his speech and interestingly Jane Halton came out in the forum saying there were only two things she wanted to get up in her current tenure they were improvement in Aboriginal health and e-health! This is the strongest statement I have heard from the Department.

Please use whatever channels at your disposal to make the contents of the letter known (attached for convenience).

Regards,

Michael

-----

Dr Michael Legg, PhD FAICD FAIM FACHI MACS(PCP) ARCPA

President, Health Informatics Society of Australia

End e-mail

The letter can be downloaded from here:

http://moreassoc.com.au/downloads/CeH%20Letter%20to%20PM%20re%20COAG%207Dec09%20v1.0.pdf

Of course, Ms Halton then went on to say there was no money and she would have to rob Peter to pay Paul.

That perspective just reveals how 'detached from reality' Ms Halton and her Minister and PM are. Has no on pointed out to them investments in Health IT actually make money and improve quality and efficiency over the longer term.

Investment of this sort is a core Government function in my view! That's what her e-Health Strategy (that she has been spruiking) says at least!

The CeH letter is a good one and should be taken notice of.

The CeH can be found here:

http://www.ceh.net.au/

Bah Humbug! And so close to Christmas.

David.

Saturday, December 12, 2009

Why the US is Doing Health Information Technology – in Two Pages – Must Read!

For those who wonder why the US is spending near to $US40 Billion on E-Health, from the man who is doing it!

The Evidence for HIT

Monday, November 30th, 2009 | Posted by: Dr. David Blumenthal | Category: ONC

In February 2009, President Obama and the Congress launched a vast, ambitious program to improve the health of Americans, and the performance of their health system, by building a nationwide, interoperable, private and secure, electronic health information system. This vision – of health care empowered by a modern information system, serving each and every American according to their needs and preferences – reflects decades of study and thinking by health care experts, health professionals, and average citizens. Typical of the consensus underlying the nation’s new health information technology (HIT) program is this recommendation by the Institute of Medicine from its seminal 2001 report, Crossing the Quality Chasm:

“Congress, the executive branch, leaders of health care organizations, public and private purchasers…should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.”

Similar recommendations have come from many other non-partisan, independent authoritative sources such as the Commonwealth Fund, the Markle Foundation, and the Robert Wood Johnson Foundation. These recommendations reflect not only academic studies showing the benefits of HIT, but also experience and common sense. We live in a digital age. We have seen technology improve virtually every facet of our lives. But medicine still relies on cumbersome paper charts. We manage information the same way Hippocrates did 2400 years ago. It’s time to move medicine into the 21st century.

Many health care organizations, big and small, public and private, have installed electronic health record systems and are reaping their benefits daily. Examples include not only national systems like the Veterans Administration and Kaiser Permanente, but regional groups like Geisinger Health System, and individual hospitals like the Beth Israel Deaconess Hospital in Boston, and Lakeland Hospital, a 77-bed facility outside of Omaha Nebraska. These organizations show that the vision is feasible – health care can be made higher in quality and lower in cost through the best existing HIT.

From a common sense perspective, it is impossible to imagine a 21st century American health system deprived of the electronic methods of collecting, managing, and moving data that have revolutionized virtually every other area of human endeavor. Information is the lifeblood of medicine. HIT is its circulatory system. A health care system without an electronic health information system simply cannot achieve its potential, anymore than an Olympic athlete could compete with a failing heart. This is the vision that President Obama and the Congress embraced in February 2009.

Nevertheless, any bold new goal has to be reduced to practice, and skeptics are now asking appropriately whether the HIT program can succeed. A few recent studies have raised questions about whether health care organizations that have installed electronic health records are actually realizing the expected benefits. Perhaps existing examples of success are atypical, and can’t be reproduced in the rest of our health system? Perhaps we are moving too fast? Perhaps the risks are too great?

As a scientist myself, I take the academic literature very seriously. I believe that policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program. To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for: namely, that having an EHR alone is not sufficient. Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits. The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs. The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people. And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements. We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead.

Sometimes bold steps are required to improve the human condition. Among the most successful health and social programs in American history are Social Security, Medicare, Medicaid, the Community Health Center Program, and the State Children’s Health Insurance Program. It would have been a tragic mistake, costing untold thousands of lives and enormous suffering, if we had foregone or delayed these programs. I believe the HIT initiative will rank with these huge successes in the value it will bring to the American people over the years to come.

David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

Link to original is here:

http://healthit.hhs.gov/blog/onc/index.php/2009/11/30/the-evidence-for-hit/

Lots of comments follow the post.

As they say I could not have put it better myself! The central point that Dr Blumenthal makes is crucial – having an EHR is not of much use – actually having clinicians using it to deliver care in a better, more evidence based and safer way is!

The clumsy implementation efforts of Australian State and Commonwealth Governments, Medicare and the production of endless paper specifications by NEHTA is not the way we can actually make a difference. Following the US and thinking how we can incentivise ‘meaningful use’ of e-Health is a much better way I believe.

We deserve way better leadership in this space – as even the CEO of NEHTA said a few days ago at the NBN talkfest!

David.

Friday, December 11, 2009

Weekly Overseas Health IT Links 08-12-2009

Here are a few I have come across this week.

http://www.govhealthit.com/GuestColumnist.aspx?id=72673

Leverage today’s standards for meaningful use

· By Dr. Charles Jaffe

· Friday, December 04, 2009

By Dr. Charles Jaffe and John Quinn

Dr. David Blumenthal, director of the Office of the National Coordinator (ONC) for Health Information Technology, recently urged the healthcare industry to break down barriers to electronic exchange of healthcare information in order to improve the quality of care and better serve patients.

To reach that goal, we must develop a greater degree of interoperability among healthcare IT applications than we have today. To discard the existing data interchange standards and to replace them with something new and “simpler,” as some are proposing, would be counterproductive.

http://online.wsj.com/article/SB125944755514168145.html

Patient ID Theft Rises

By JILIAN MINCER

Medical identity theft is on the rise and expected to worsen.

The problem has grown during the recession as more uninsured people use the coverage of a friend, relative or even a stranger to get care. Of particular concern is the fact that most of the fraud is committed by people who pay medical workers for patients' information.

In one case, a front-desk clerk at a medical clinic in Weston, Fla., downloaded the personal information of more than 1,100 Medicare patients and gave it to a cousin, who made $2.8 million in false Medicare claims.

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http://www.forbes.com/2009/11/24/security-hackers-data-technology-cio-network-breaches.html

The Year Of The Mega Data Breach

Andy Greenberg, 11.24.09, 7:00 PM ET

Glance at 2009's data breach statistics, and you might think the IT world had scored a rare win in the endless struggle against cybercrime.

According to the Identity Theft Resource Center, government agencies and businesses reported 435 breaches as of Nov. 17, on track to show a 50% drop from the number of breaches reported in 2008. That would make 2009 the first year that the number of reported data breaches has dropped since 2005, when the ITRC started counting.

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http://www.modernhealthcare.com/article/20091204/REG/312049984

Ore. launches statewide emergency-care registry

By Associated Press

Posted: December 4, 2009 - 11:00 am EDT

Oregon has launched a computerized statewide registry to help make sure people's end-of-life medical wishes are easily available to doctors and paramedics.

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http://www.healthdatamanagement.com/news/CIOs_stimulus_meaningful_use-39462-1.html?ET=healthdatamanagement:e1103:100325a:&st=email

CIOs Worry About Stimulus Deadlines

HDM Breaking News, December 3, 2009

A survey of CIOs and other top information technology leaders at provider organizations finds most respondents worry to some degree about being able to implement standards recommended by the HIT Standards Committee to meet current deadlines for the meaningful use of electronic health records.

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http://govhealthit.com/newsitem.aspx?nid=72527

Blumenthal: Diverse HIE methods will emerge

By Mary Mosquera

Thursday, December 03, 2009

Health information exchange will spring from a variety of sources and methods beyond the federal government’s work to set-up a nationwide health information network (NHIN), Dr. David Blumenthal, national coordinator for health IT, said yesterday.

“We want to continue to make [NHIN] an option for the exchange of information and for aggregating enhanced uses of data, but we expect others to evolve,” he said at a panel discussion Dec. 2 sponsored by the Brookings Institution.

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http://blogs.wsj.com/health/2009/12/01/safety-guru-health-it-is-harder-than-it-looks/

December 1, 2009, 1:46 PM ET

Safety Guru: ‘Health IT Is Harder Than It Looks’

Yes, health IT systems done right can help improve patient safety. But health IT systems done wrong can actually create new safety risks, a doctor and patient-safety expert says in a new article published by the journal Health Affairs.

We heard something similar a few weeks back, when we chatted with a senior Kaiser doc who warned of “magical thinking” on health IT. Today’s commentary comes from Bob Wachter, a UC San Francisco hospitalist, who writes:

“recent experience has confirmed that health IT is harder than it looks … Several major installations of vendor-produced systems have failed, and many safety hazards caused by faulty health IT systems have been reported.”

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http://www.fiercehealthcare.com/press-releases/leapfrog-group-announces-its-2009-top-hospitals?utm_medium=nl&utm_source=internal

Leapfrog Goup announces its 2009 top hospitals

December 4, 2009

WASHINGTON, December 3, 2009 - While Congress debates whether health care reform would control health care costs, today employer purchasers point to 45 hospitals that lead through example-delivering the best quality care in the nation while attaining the highest levels of efficiency. Thirty-four urban, eight children's and three rural hospitals have been named 2009 Leapfrog Top Hospitals, based on results from The Leapfrog Hospital Survey. The survey (found at www.leapfroggroup.org) is the only national, public comparison of hospitals on key issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency.

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http://www.e-health-insider.com/news/5442/one_in_10_prescriptions_have_errors

One in 10 prescriptions have errors

03 Dec 2009

One in 10 written hospital prescriptions contain mistakes, most are minor and spotted but some are potentially lethal.

In many cases the errors result from poor or illegible handwriting, transcribing errors, ambiguous prescriptions or other communication breakdowns.

This is the finding of major new research commissioned by the General Medical Council, which says despite the prevalence of errors most are spotted and few lead to serious harm to patients. Unlike some previous studies the focuses just on prescribing rather than covering prescribing through to medicines administration.

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http://www.e-health-insider.com/news/5430/dr_foster_names_safety_underperformers

Dr Foster names safety underperformers

30 Nov 2009

The Dr Foster Hospital Guide 2009 names 12 NHS trusts which it says significantly underperformed on its new measure of patient safety.

The guide, published over the weekend, identifies patient safety as the single most important element of hospital care. For the first time the guide has introduced a Patient Safety Score which bands trusts with similar scores awarding scores of one to the poorest performers and five to the best.

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http://www.modernhealthcare.com/article/20091203/REG/312039985

Patient Privacy Rights unveils PHR report card

By Joseph Conn / HITS staff writer

Posted: December 3, 2009 - 11:00 am EDT

Are personal health records privacy risks? Most people are at a loss trying to figure that out, according to the Patient Privacy Rights Foundation, which is the premise behind its new report card on selected PHRs.

“They're pretty much an unregulated new product,” said Ashley Katz, executive director of the Austin, Texas-based not-for-profit.

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http://www.healthdatamanagement.com/news/HIEs_Internet_stimulus_EHRs-39457-1.html?ET=healthdatamanagement:e1102:100325a:&st=email

What's the Future of HIEs?

HDM Breaking News, December 3, 2009

The numbers are daunting. Nearly two decades after the advent of community health information networks and more than five years after the Bush Administration starting pushing for electronic health records and health information exchanges, only 28 states have one or more operational HIEs. And operational doesn't mean everyone in a region, much less a state, is active in the HIE.

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http://www.fierceemr.com/story/hit-progress-stunningly-slow-10-years-iom-report/2009-12-03?utm_medium=nl&utm_source=internal

HIT progress 'stunningly slow' in 10 years since IOM report

December 3, 2009 — 1:54pm ET | By Neil Versel

Tuesday marked the 10th anniversary of the publication of To Err Is Human, the eye-opening Institute of Medicine report with the now-familiar assertion that preventable medical errors in U.S. hospitals kill 44,000 to 98,000 people every year. The landmark tome, plus a follow-up report, Crossing the Quality Chasm (2001), and other subsequent IOM publications called for greater use of health information technology to help reduce the number of mistakes and assure greater care coordination.

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http://www.itworldcanada.com/news/canada-faces-widespread-e-health-skills-shortage/139502

Canada faces widespread e-health skills shortage

By: Shane Schick On: 03 Dec 2009 For: CIO Canada

The Information & Communications Technology Council releases a report that indicates the country could require thousands of IT professionals with health-specific skill sets. What we need to do to prepare

While the Ontario government is dealing with the political fallout of the eHealth Ontario scandal and Ottawa reviews its funding commitments to Canada Health Infoway, a new research report suggests Canada may need to fill approximately 12,000 IT-related health-care jobs within the next five years.

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http://www.ehealtheurope.net/news/5428/moray_helps_public_get_health-e

Moray helps public get Health-e

01 Dec 2009

A new website that provides a platform to enable people to take more responsibility for their health has been launched in Moray, Scotland.

The new Health-e-Space website, which went live earlier this month, provides local health information, links to recommended websites and suggestions on how to live with health conditions.

Community Health-e-Space, the websites sister site supplies a social networking platform for people to share their health concerns and experiences with others in the Moray area.

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http://www.modernhealthcare.com/article/20091202/REG/312029987

Blumenthal to review NCVHS' past recommendations

By Joseph Conn / HITS staff writer

Posted: December 2, 2009 - 11:00 am EDT

Part two of a two-part series (Access part one):

If the nation's top health information technology official makes good on a pledge he made recently to resurrect two key privacy policy papers, he will find that their recommendations are still relevant, according to a Kentucky lawyer who helped produce both documents.

David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology, said last month he would be looking into the papers produced by the National Committee on Vital and Health Statistics.

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http://www.modernhealthcare.com/article/20091202/FREE/312029948

Sebelius announces $235 million for HIT advancement

By Joseph Conn / HITS staff writer

Posted: December 2, 2009 - 11:30 am EDT

HHS Secretary Kathleen Sebelius announced a three-year, $235 million Beacon Community Cooperative Agreement Program, including $220 million to contract with up to 15 not-for-profit and government organizations that are leaders in health information technology to "generate and disseminate valuable lessons learned that will be applicable to the rest of the nation's communities."

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http://www.healthdatamanagement.com/news/stimulus_ARRA_EHR-39454-1.html?ET=healthdatamanagement:e1101:100325a:&st=email

Vendor Exec to Feds: Change Course

HDM Breaking News, December 2, 2009

Convinced the government is moving in the wrong direction to encourage adoption of electronic health records, Evan Steele, CEO of software vendor SRSsoft in Montvale, N.J., recently cautioned Aneesh Chopra, chief technology officer in the Obama Administration, that the federal approach won't work.

SRSsoft sells what it calls a "hybrid EMR" that includes extensive use of document imaging and management software. In a letter to Chopra, Steele speaks of the volume of skeptical physicians posting to the "FACA blog," which is the blog for the HIT Policy and HIT Standards federal advisory committees.

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http://govhealthit.com/newsitem.aspx?nid=72522

ONC reorganizes for push on EHR, HITECH goals

By Mary Mosquera
Tuesday, December 01, 2009

The Office of the National Coordinator for Health IT (ONC) announced it would reorganize the office to better reflect its role as a leading force in the adoption of electronic health records and other health IT, including closer oversight of privacy issues.

Appointing a chief privacy officer is one of the main moves detailed in a notice published in the Federal Register. The notice is dated Nov. 20, but the changes are effective as of Dec. 1.

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http://motorcycleguy.blogspot.com/2009/12/canadian-perspective-on-standards.html

Wednesday, December 2, 2009

A Canadian Perspective on Standards Harmonization

Today I have a special guest post from Mike Nusbaum. Mike's a great guy and knows quite a bit about participating in multiple standards organizations. He has been in leadership positions to my knowledge in ISO TC-215, HL7 and IHE, and also facilitates and writes for ANSI/HITSP here in the US. Mike helped establish the Canadian framework for standards harmonization, and I asked him to write a guest post on the topic. Here's Mike:

Guest contribution by: Michael Nusbaum, BASc, MHSA, FHIMSS

(a Canadian healthcare IT consultant who also works with HITSP in the US)

A Canadian Perspective on Standards Harmonization

As the US health reform freight train continues to roar down the tracks, the IT standards imperative becomes increasingly critical. The government's well-funded priority to stimulate reform through the establishment of an interoperable nationwide health information network (NHIN) has put incredible pressure on standards harmonization activities over the past 6 months. Clearly, interoperability is achieved through the implementation and use of standards, and funding directed towards state and regional health information exchange (HIE) initiatives is contingent upon the adoption of those standards within all stakeholder communities.

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http://www.ehiprimarycare.com/news/5426/fracture_risk_tool_built_using_qresearch

Fracture risk tool built using QResearch

30 Nov 2009

A score to predict the risk of patients suffering fractures due to osteoporosis has been developed using the QResearch database.

The fracture risk algorithm, QFractureScores, can be used by clinicians and patients to calculate an individual’s percentage risk of an osteoporotic fracture over the next ten years, allowing early interventions to take place according to researchers.

The tool is available as open source software www.qfracture.org and users are asked to enter details including age, sex, weight, height and illnesses to determine the risk of a fracture.

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http://www.ehiprimarycare.com/news/5431/time_savings_reported_on_gp2gp

Time savings reported on GP2GP

01 Dec 2009

GP practices report that receiving records via GP2GP saves time on the first consultation and time spent summarising records, according to GP2GP benefits survey developed as part of the national SHA benefits return.

CfH conducted two surveys earlier this year covering the clinical and administrative benefits of the GP2GP project which enables the almost instant transfer of patients’ electronic record between practices.

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http://www.govhealthit.com/Article.aspx?id=72297

Healthcare needs a security framework

By Lisa Gallagher

Today’s healthcare organizations are being urged to adopt electronic health records in the midst of complex legal and regulatory changes, especially in the areas of privacy and security. In this environment there is a clear need for a security framework specifically designed to help healthcare organizations build a security program that addresses all current data protection requirements.

For years, there has been considerable opinion in the healthcare industry that HIPAA does not adequately protect health data in today’s rapidly changing IT environment.

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http://www.healthdatamanagement.com/news/HIPAA_privacy_breach_hospital-39428-1.html?ET=healthdatamanagement:e1098:100325a:&st=email

Sixteen Fired for Records Snooping

HDM Breaking News, November 30, 2009

The Harris County Hospital District in Houston recently terminated 16 employees for violating the HIPAA privacy rule after improperly accessing patient information on a colleague who was shot during a robbery attempt, the Houston Chronicle reports.

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http://www.healthdatamanagement.com/news/home_health_acquisition_vendor_consumer-39448-1.html

GE Buy Expands Home Health Line

HDM Breaking News, December 1, 2009

GE Healthcare has acquired Living Independently Group Inc., which sells the QuietCare wireless, sensor-based passive patient monitoring system for use in assisted living facilities, senior communities and private homes. Terms of the acquisition were not disclosed.

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http://www.healthleadersmedia.com/content/242616/topic/WS_HLM2_TEC/HHS-Will-Spend-80M-to-Train-HIT-Support.html

HHS Will Spend $80M to Train HIT Support

John Commins, for HealthLeaders Media, November 24, 2009

Understanding that there is a lack of qualified technical workers, Health and Human Services said today it will make $80 million in grants available to develop the nation's healthcare information technology workforce. Community colleges will get $70 million of the grant money to develop training programs, and the remaining $10 million will be used to develop educational materials to support those programs, HHS said.

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Microsoft, Google Face Off On Healthcare

Microsoft HealthVault and Google Health want to be the repository of choice for millions of personal health records. Are they up to the task?

By Mitch Wagner, InformationWeek

Dec. 1, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=221901566

Microsoft and Google are taking their rivalry to the doctor's office, running competing services that allow people to store their medical records online for access by family members and healthcare providers.

Google Health and Microsoft HealthVault are similar approaches: They let patients input their own medical data either by typing it in or by giving permission for the vendor to get the information from a healthcare provider or insurer with which it's partnering. Google Health and Microsoft HealthVault then provide tools for those partners to give the patient personalized health advice and other services built around the person's records.

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Colorado Healthcare Providers Launch Information Exchange

"They've standardized the content so we can exchange and have interoperability with health records," explains the CIO of Children's Hospital.

By Mitch Wagner, InformationWeek

Dec. 1, 2009

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=221901513

Three Colorado hospitals have tied themselves in an information exchange, sharing medical records to improve patient care and reduce unnecessary redundant tests.

The program unites the Children's Hospital, Exempla Healthcare, and Kaiser Permanente Colorado, to share complete medical records, including medications, discharge results, lab results, radiology reports, and more. All three hospitals use EMR software from Epic Systems, which simplifies the process.

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http://www.ottawacitizen.com/health/Modern+medicine/2284323/story.html

Modern medicine

The Ottawa Citizen

November 30, 2009

It is good to see that the spending scandal at eHealth Ontario has not sabotaged plans to bring health records online in Eastern Ontario.

The eHealth scandal was about spending abuses and lack of oversight. Provincial auditor Jim McCarter concluded that Ontario taxpayers did not receive value for the $1 billion that had been invested in the project. The agency's mismanagement put Ontario behind most jurisdictions in the effort to set up a province-wide network of electronic health records.

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http://www.floridatoday.com/article/20091129/NEWS01/911290319/1006/news01/Hospitals+will+get+heart+data+via+Bluetooth

Hospitals will get heart data via Bluetooth

BY KAUSTUV BASU

FLORIDA TODAY

Trauma doctors in Brevard County will soon be armed with technology that makes life-saving care available to patients before they roll up to the emergency room door.

Brevard County Fire-Rescue is implementing Bluetooth technology to transmit electrocardiogram readings from cardiac patients in the field to hospitals so doctors are better prepared to treat them.

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http://www.modernhealthcare.com/article/20091130/REG/311309932

3-D diagnostic imaging cost issues hinder adoption

By Shawn Rhea / HITS staff writer

Posted: November 30, 2009 - 11:00 am EDT

In radiology, the availability of virtual technology has long been a reality. But questions over effectiveness and reimbursement have hindered widespread adoption of the cutting-edge technology.

It has been roughly three decades since doctors began using virtual imaging—CT, MRI or ultrasound scans converted into three-dimensional images—as a screening, diagnostic and surgical-assist tool, and a growing number of studies are finding the technology to be nearly as effective as more invasive surgical alternatives when it comes to detecting diseases and conditions.

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http://www.healthleadersmedia.com/content/242663/topic/WS_HLM2_TEC/BCBS-of-Tennessee-Notifying-Members-After-Patient-Information-Stolen.html

BCBS of Tennessee Notifying Members After Patient Information Stolen

John Commins, for HealthLeaders Media, November 25, 2009

BlueCross BlueShield of Tennessee is readying a Nov. 30 mass mailing to some of its 3.1 million customers in the Volunteer State who may have had their Social Security numbers and other private data compromised after an Oct. 2 hard drive theft at a remote training facility in Chattanooga.

"It's going to be a progression of mailings, with those who would be most at risk receiving the first mailings, depending upon how many people had a Social Security number compromised," says BCBST spokeswoman Mary Thompson.

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http://www.healthcareitnews.com/news/anesthesia-it-users-see-benefits-complain-about-functionality

Anesthesia IT users see benefits, complain about functionality

November 25, 2009 | Bernie Monegain, Editor

OREM, UT – The anesthesia information system (AIS) market is small and immature, but early adopters are seeing benefits, including better patient care, a reasonable return on investment and even decreased liability, according to KLAS.

In "The Growing Market for Anesthesia Software: Liability, Integration and the Benefits of Adoption," KLAS interviewed 100 organizations that use AIS, representing an estimated 75 percent of those doing anesthesia documentation in the United States.

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http://www.computerweekly.com/blogs/tony_collins/2009/11/claim-of-censorship-over-cerne.html

Claim of censorship over Cerner system

The Sydney Morning Herald and ZDNet in Australia report that the University of Sydney removed from its website - temporarily - a negative essay about a Cerner system which had been installed at hospitals in New South Wales.

The author of the essay is a medical IT professor, Jon Patrick, who is reported to have claimed that NSW Health, which is part of the government of New South Wales, put pressure on the university to take down the paper.

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http://www.ehiprimarycare.com/news/5433/kingston_hits_go-live_date_with_cerner

Kingston hits go-live date with Cerner

01 Dec 2009

Kingston Hospital NHS Trust has confirmed that it has gone live with its Cerner Millennium Care Records Service (CRS) programme.

E-Health Insider can exclusively reveal that the trust switched from its iSoft CliniCom Patient Administration System (PAS) to the new Cerner system at the weekend with “different areas coming up on stream” over Friday, Saturday and Sunday. The final functionality went live yesterday morning in the outpatients department.

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http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/11NOV2009/091123HHN_Online_Pelletier&domain=HHNMAG

What the Health Care Industry Really Needs

By Jeff Pelletier

The most crucial component of going digital is connectivity.

The economic stimulus package signed earlier this year earmarks $19 billion for health information technology (HIT) improvements that demonstrate "meaningful use" to improve patient safety and outcomes. While HIT covers a range of technological tools and advancements, much of the discussion has focused on electronic health records (EHRs) and computerized provider order entry.

Investment in these key systems will bode well for patient care, but it is only scratching the surface of the technological advances needed to make the U.S. health care system a seamless, error-free entity. Connecting EHRs to other medical technologies used in patient care and ensuring those technologies work together—for example, to automatically document medical procedures in patient records—is where health care systems will see the biggest return. It is also where the stimulus package goals (improvements in quality of care, care coordination, and reductions in medical errors and duplicative care) will be fully realized.

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http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm?chan=top+news_top+news+index+-+temp_top+story

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

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Enjoy!

David.