Friday, January 30, 2009

Report Watch – Week of 26 January, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Deloitte sees $530 bln in US health care savings

Thu Jan 15, 2009 2:05pm EST

By Will Dunham

WASHINGTON (Reuters) - U.S. health care spending could drop by half a trillion dollars over 10 years if policymakers make broad changes like adopting electronic prescriptions and relying on drugs and procedures proven to work best, consulting firm Deloitte LLP said on Thursday.

Deloitte issued its proposals and analysis of potential cost reductions less than a week before President-elect Barack Obama takes office promising a major overhaul of the U.S. health care system.

The details of Obama's health care plans have not yet been released. Deloitte offered its own approach that embraced several ideas that experts have considered.

Deloitte proposed $220 billion in new spending upfront over three years on efforts such as getting doctors to use e-prescribing and electronic medical records, as well as better coordination of patient care through primary-care doctors.

Deloitte sees net savings beginning in the sixth year and 10-year savings of $530 billion.

"We're including improving health status and improving quality and not just taking an ax to costs," Paul Keckley, executive director of the Deloitte Center for Health Solutions, said in a telephone interview.

Obama and Congress, in which his Democratic Party has the majority, are planning sweeping changes in a U.S. health care system that is the world's most expensive but lags other nations in many quality measures.

Access the full article here:

The report can be viewed here:

And downloaded here:

Second we have:

Report: Privacy Rule Hinders Research

The HIPAA privacy rule continues to have a negative affect on health research, according to a new report from the Association of Academic Health Centers in Washington, D.C.

The rule imposes barriers that slow the pace of research, reduce patient participation in studies and increase costs, according to results of a survey of 54 respondents from 27 institutions that accompanies the report.


The association also recommends revising the Common Rule to add more explicit standards for the privacy of health information and accommodate new technologies against new threats to safety and privacy.

For the complete 12-page report, "The HIPAA Privacy Rule: Lacks Patient Benefit, Impedes Research

Full article here:

Third we have:

AHRQ report shows how barcoding medication improves quality and safety

January 22, 2009 | Diana Manos, Senior Editor

ROCKVILLE, MD – The Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology has released a report that shows how barcode medication administration can improve the quality, safety, efficiency and effectiveness of healthcare.

The report, released Wednesday, focuses on lessons learned from AHRQ projects where barcode medication administration and electronic medication administration record technologies (eMAR) were used.

According to the AHRQ, medication errors are the most frequent cause of adverse medical events. The Institute of Medicine has estimated that more than one million injuries and almost 100,000 deaths can be attributed to medical errors every year. Adverse drug events are estimated to cost the industry $2 billion a year.

The full article is here:

The report can be found here:

These reports and associated materials are worth a close look.


Thursday, January 29, 2009

International News Extras For the Week (29/01/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Privacy Issue Complicates Push to Link Medical Data


WASHINGTON — President-elect Barack Obama’s plan to link up doctors and hospitals with new information technology, as part of an ambitious job-creation program, is imperiled by a bitter, seemingly intractable dispute over how to protect the privacy of electronic medical records.

Lawmakers, caught in a crossfire of lobbying by the health care industry and consumer groups, have been unable to agree on privacy safeguards that would allow patients to control the use of their medical records.

Congressional leaders plan to provide $20 billion for such technology in an economic stimulus bill whose cost could top $825 billion.

In a speech outlining his economic recovery plan, Mr. Obama said, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.” Digital medical records could prevent medical errors, save lives and create hundreds of thousands of jobs, Mr. Obama has said.

So far, the only jobs created have been for a small army of lobbyists trying to secure money for health information technology. They say doctors, hospitals, drugstores and insurance companies would be much more efficient if they could exchange data instantaneously through electronic health information networks. Consumer groups and some members of Congress insist that the new spending must be accompanied by stronger privacy protections in an era when digital data can be sent around the world or posted on the Web with the click of a mouse.

More here:

Just a reminder, this is a issue that unless addressed squarely will not go away!

This here just emphasises the issue!

Dutch nationwide EHR postponed. Are they in good company?

On January 22 after two months of serious discussion (see here) the Dutch health minister Dr. Ab Klink announced in the Dutch parliament that the implementation of a national EHR will be postponed. He did not mention a new target date.

On November 1 the minister sent a letter to all Dutch households announcing the rollout of an EHR. Initially the discussion focused on technical and financial issues. But the accompanying brochure made it clear that all healthcare providers would have access to the patient data. This caused a major “uproar” from citizens. Within 2 months over 330.000 persons opted-out of a system that not even was legally accepted. As a consequence privacy and access concerns are now some of the major arguments for the postponement.

But also doctors and hospitals had strong objections, although with different arguments. As I have written on the Dutch EHR discussion site, it is a missed chance for which the official organisations are to blame. They never organised an information campaign to explain the concept of an EHR to either clinicians or patients.

However, it does not seem to be a Dutch-only problem. In Germany the introduction of the smart card has been seriously delayed, due to technical and security reasons. In the UK, one of the more advanced countries in the EU for implementation of a nationwide EHR system, serious safety and privacy issues are arising and the implementation has already a delay of over 2 years. The fact that on an almost regular basis electronic information is lost or stolen, doesn’t help either.

Full blog here:

Second we have:

Majority of Americans oppose hiking HIT spending

By Rebecca Vesely / HITS staff writer

Posted: January 19, 2009 - 5:59 am EDT

Americans expressed little support for increased federal spending on health information technology, according to a survey released last week by the Kaiser Family Foundation and the Harvard School of Public Health.

Sixty percent of those surveyed said that, when considering the federal budget, the incoming president and Congress should keep spending on health IT the same. Just 20% said that spending for health IT should go up, while 17% said that spending should drop.

The survey, called “The Public’s Health Care Agenda for the New President and Congress,” involved telephone interviews with a random sampling of 1,628 adults in English and Spanish between Dec. 4 and Dec. 14, 2008.

More here:

Looks like a considerable sales job is required will be care with avoiding waste!

Third we have:

The Minnesota way

Blueprint can help nation achieve cost, quality goals

By Gov. Tim Pawlenty

Posted: January 19, 2009 - 5:59 am EDT

Our country faces a time of unprecedented challenges. In Minnesota, as in many states, the economic crisis means that difficult decisions confront us as we grapple with an imminent, extensive budget shortfall. But, this is also a time of great opportunity. As we weather this storm, we can improve the efficiency of our government and our systems so that we emerge stronger as a nation, and as individuals.

Nowhere is the need for improvement more evident—or more essential—than in our healthcare system. Spiraling healthcare costs must be contained, even as we strive to improve the quality of care and improve the health of our populations.

This time of crisis is precisely the moment to champion significant reforms. As the Obama administration sets its priorities for healthcare reform, it must address the challenge in a nonpartisan, comprehensive manner. In the long run, it will not work to simply pull more people into a broken system. We must fundamentally transform our healthcare system in order to make it sustainable.

Three core principles to accomplish this are the restructuring of the payment system to better align provider incentives and improve healthcare value, the modernization of the healthcare system to create more efficiency through the use of effective technologies, and the investment in public health to promote healthy behaviors among individuals and prevent future avoidable chronic health conditions.

As health reform is discussed in the coming months, Washington can look to states for innovation in these areas, and Minnesota sets an example. In May 2008, I signed into law a nation-leading, health-reform bill built on those same three principles. Although Minnesota has one of the nation’s healthiest populations and a historically strong and inclusive health insurance system—both through employers and public programs—we are not immune to the current healthcare system’s uneven quality and out-of-control costs.

Much more here:

Good to see at least one State Governor is actually putting into operation the health reform ideas that have been around for the last few years. We can only wish him luck. Of course Health IT underpins all his plans!

Fourth we have:

Heartlands rolls out JAC e-prescribing system

19 Jan 2009

Birmingham’s Heart of England NHS Foundation Trust has started to roll out a JAC e-prescribing system across all three of its acute-care sites.

The project, which JAC claims is the largest of its kind in the UK, will see company’s Electronic Prescribing and Medicines Administration (EPMA) system deployed to cover 1,800 beds and all the wards and theatres at Heartlands, Solihull and Good Hope hospitals.

The project will deliver tools for managing both inpatient and to-take-out medicines and will be integrated with the JAC Pharmacy Management System, which has been in use at the trust for a number of years.

It will also incorporate the Multilex Drug Data File from First Data Bank Europe to enable users to check for drug-drug interactions, duplicate therapies and drug allergies.

Trust electronic prescribing manager, Niall Poole, said: “E-prescribing minimises the risk of medication errors in many ways; from the very basic, such as producing legible prescriptions to the very advanced, such as drug interaction information at the point of prescribing.”

Heaps more here:

It is good to see such roll outs and all it can do is add to experience as to what works and what doesn’t while improving care at the affected organisations.

Fifth we have:

New in '09: You won't go in to see the doctor

  • Expert: We bank, make travel plans and buy houses differently; medicine is next
  • Ask-a-doc Web sites and virtual clinics are growing in popularity; so using Twitter
  • Neither eHealth nor telemedicine will replace seeing a doctor in person

By Elizabeth Cohen
CNN Senior Medical Correspondent

(CNN) -- In the midst of a frantic week in September filled with auditions and deadlines, New York casting director Michael Cassara had zero down time. So one day, when he felt a sore throat coming on, Cassara had his doctor beamed into his office.

Michael Cassara was too busy to visit his doctor's office, so he had his doctor come to him -- virtually.

Cassara didn't use lasers; he used his laptop. Logging into his account at, Cassara clicked on the link for video chats and made an appointment, and an hour later, Dr. Sean Khozin popped up on his screen.

Based on how Cassara was feeling and his propensity to get strep throat, Khozin diagnosed a strep infection, "and five minutes later I had a prescription phoned in to a nearby pharmacy," Cassara says.

The typical visit to the doctor -- call for an appointment, go to the doctor's office, wait in the waiting room -- has remained unchanged for a very long time, notes Meredith Abreu Ressi, vice president of research for Manhattan Research, a health care marketing research firm. But she says you should expect that to start to change in 2009.

"Because of the Internet, we bank differently than we used to, and we plan our trips differently, and we buy real estate differently," she says. "But we still see our doctor the same way our grandparents did. I think we're about to see big changes in this area."

Ressi says to expect to see more doctors close their traditional practices and open "telehealth" practices, where they deliver all or part of their services, in one form or another, over the Internet.

This means chatting with a doctor online via video, e-mailing your doctor with a question or perhaps going to a Web site where, for a small fee, a doctor will answer your medical questions instantly.

Here are five big changes to the classic doctor's visit to look for in 2009. The changes aren't necessarily for the better or for the worse, and we're not recommending you take part in them; they're just part of the trend towards more "eHealth."

Lots more here:

CNN has quite a substantial coverage of a few important trends with video etc. Well worth a browse!

Complete The Work On Health Information Technology

President-elect Barack Obama and President George W. Bush may disagree on many topics, but they clearly agree on one thing: information technology (IT) is essential to reforming our health care system. They see the evidence that IT prevents errors that kill tens of thousands of Americans each year, reduces waste and duplication that cost up to one hundred billion dollars per year, and helps consumers take better care of themselves. They are joined by physicians, hospitals, governors, members of Congress, the public, and even other countries that see health IT as a necessity in health care.

President Bush set the ambitious goal in 2004 of ubiquitous electronic health records (EHRs) across the nation within ten years. He asked me to lead this effort for our country. Since then, the United States has seen intense and sustained efforts to move us into the era of digital medicine. We are now the world’s leading health IT innovator, even if our hospitals and physicians still struggle to get these tools into daily use.

President-elect Obama recently placed health IT among the critical infrastructures that are essential in the 21st century. He rightly recognizes that health care is one of our few remaining economic sectors where IT has not taken root. His health reform plan relies upon health IT to reduce costs and improve efficiencies. He has pledged $50 billion to bring health information tools into widespread use (which is $49,950,000 more than President Bush gave me to spend).

Now that we are well into the transition, reasonable questions to ask are, What should the President-elect do to get health IT into widespread use? What should he do differently from President Bush? What should he not do?

More here:

A useful balanced summary of what should be the Health IT objectives of the Obama administration by the architect of the Bush Administration’s initial work in that direction.

Seventh we have:

IBM issues rosy 2009 outlook

William Bulkeley | January 21, 2009

BUCKING the trend of high-tech competitors, IBM posted a 12 per cent gain in fourth-quarter profit and gave an upbeat outlook for 2009.

Big Blue's fourth-quarter results contrast with other technology bellwethers

Although facing "an extremely difficult economic environment," IBM said it expects to continue to benefit from the increasing profitability of its software and services businesses. Despite the global slowdown, IBM said customers are continuing to sign up for outsourcing and other services contracts.

The company, which provides technology services, software and mainframe computers, is often seen as a proxy for world-wide capital spending by businesses and governments, but its fourth-quarter results contrast with other technology bellwethers.

Intel last week reported quarterly net income fell 90 per cent, while sales fell 23 per cent from a year earlier. Big tech companies, including Oracle and Google, made rare trims to their work forces last week.

Chairman and chief executive Samuel Palmisano said, "we are confident about 2009 and, based on our 2008 performance, we are ahead of pace on our roadmap for $US10 to $US11 per share," in 2010. The company said it expects full-year 2009 earnings of at least $US9.20 per share. Analysts had forecast about $US8.75 a share.

In the fourth quarter, IBM reported net income of $US4.42 billion, or $US3.28 a share, up from the year earlier's $US3.95 billion profit, or $US2.80 a share. The latest quarter benefited from credits that lowered IBM's tax rate.

Quarterly revenue was $US27 billion, down 6.4 per cent from a year ago's $US28.87 billion, party due to the strength of the dollar. IBM said at constant currency rates revenue would have declined 1 per cent.

David Bailey, an analyst at Goldman Sachs, said IBM's profit "handily" beat Wall Street's expectations, even after adjusting for special items such as the lower tax rate and higher patent-licensing income.

More here:,24897,24942518-5013040,00.html

This company really has come back from the dead in the last decade or two. It is worth remembering IBM’s revenue is about twice that of BHP Billiton with a profit of $US10B + per annum!

Microsoft must be wondering what it should do to get back its ‘mojo’ at this point – given the news of the last few days of it retrenching staff and its falling profits.

Eighth we have:

Accessing Healthcare Through The Internet
By Ozo Mordi

WHEN stakeholders in the healthcare sector came together at the Sheraton Hotels and Towers recently to rub minds together, it was on how to set the ball rolling to make it possible for all Nigerians to access healthcare through the Internet.

The gathering, drawn from medical practitioners and Information Technology (IT) experts pointed out that much as electronic healthcare was a laudable venture, certain wishes which include the standard of practice, electricity supply and cost would need to be addressed before Nigeria can think of connecting.

But Dr. Segun Ebitanmi, Managing Director, Synapses who is proposing the idea of a medical network where a doctor can have access to a patient's file from any part of the world by merely clicking the mouse in what he calls Medinet, says these issues have already been resolved, adding that on the question of standard, there are about 400 electronic health standards in the world.

According to him, the key problems have always been the exact number to adopt or which one to adopt in implementing the medical networks all over the world.

But Synapses, in implementing the Medinet, he revealed, would be using the 10th edition of the International Classification of Diseases (ICD-10), adding that "our documents can accept documents from other standards." "We just convert to ICD-10 and then transmit it," he stated. The technology his company is using, he claimed, would support multiple standards.

More here:

It is good to see progress in E-Health – even in Nigeria! I hope they can get a good return on some simple initial steps and not get bogged down in excessive complexity until they are ready. Just internet access of itself can help clinicians to share information and do a better job with the resources they have.

Ninth we have:

Targeting Consumer-Focused IT

Vol. 11 •Issue 9 • Page 25

The emergence of technology-savvy consumers has health care organizations developing solutions to meet increased expectations.

By Capt. William E. Sorrells, MSC, FACHE, CPHIMS

Associated table

Today's health care consumer is more sophisticated and discerning than ever. The growth of accessible and inexpensive sources of information about health insurance, physicians, hospitals and other aspects of the health care system has increased consumer expectations.

In a competitive marketplace, health care consumers gravitate to cost-efficient, high-quality services. And the Internet serves as the predominant source of information they will use to make those decisions.

A RAND Corp. survey conducted for the Blue Cross Blue Shield Association examined ways in which consumers search for health care information and use that data to determine value. Nearly 70 percent of the respondents used the Internet to find information.

With that in mind, it's no wonder many health care organizations have made investments in feature- and content-rich Web sites for consumers seeking information about medical services. Health care organizations can gain a competitive advantage by exploiting target markets using IT, data and the ubiquity of the Internet to meet the growing demands of the health care consumer.

Consumer-driven strategy shift

According to Michael O. Leavitt, Secretary of Health and Human Services, "Every American should have access to a full range of information about the quality and cost of their health care options."

A significant consumer-driven movement in health care demands more choices and more information to make decisions. Adjusting the health care business model to account for the strategic importance of information requires a significant shift in thinking.

The traditional strategic resources for health care, including financial and human services, data and information, should be considered equally critical in how strategies are developed, particularly in environments with fierce competition. Using IT to extract, mine, assemble and analyze the data is particularly important. But just as important is using IT to bring health care consumers and organizations closer together in the environment of care, even if it's a virtual setting.

The future of like-minded efforts relies on aggressive moves toward consumer-focused health care and health information technology. Some key components of a consumer-focused health information exchange include:

  • an easily managed flow of information;
  • real-time exchange among patients, providers and payers;
  • easy access to disease-related education and personal health information;
  • easy access to current services and related costs;
  • patient-centered orientation;
  • interoperability of IT and data; and
  • online tools and applications (e.g., appointments, risk assessments, continuing education).

Health care organizations no longer can afford to operate with stove piped business units and service lines. In fact, crafting consumer-focused IT strategies that deliver services that match the health care consumer's expectations and needs will require teamwork and synergy, with the aid of data, information and IT. Developing a competitive intelligence system will require the solid partnership of marketing, IT, finance, human resources and the service lines with special emphasis on governance and provider feedback.

Full article here:

This is a useful discussion of the ways Health IT can impact and assist the consumer.

Tenth we have:

New Zealand looks for wrap around IT

20 Jan 2009

Seven of New Zealand district health boards have formed a collaboration to procure an “individual-centric” health management system.

The seven health boards, which serve around 27% of the population, have issued a request for information (RFI) and are looking to attract interest from software suppliers in the UK.

The New Zealand/UK-based Simpl Group is managing the RFI process, and has set up a website for responses, which must be received by 16 February. A further three district health boards have indicated interest and may join at the request for proposal stage.

Paul Malcolm, Simpl regional director EMEA, told E-Health Insider it was possible that the move could become a national procurement and a national programme.

“Traditionally, New Zealand has been behind England in its use of IT, but in recent years it has caught up and it now wants to do something like what the national programme [in England] was originally set up to do,” he said. “They want to make a step change. And they want to make it patient centric.”

The seven district health boards – Canterbury, MidCentral, Nelson Marlborough, MidCentral, South Canterbury, Wairarapa, Whanganui and Northland – have been working on their own reform and IT procurement plans, but “it has become clear that the vision of the individual initiatives is similar.”

I hope they are careful with this procurement. The risks are not small!

Eleventh we have:

The Greatest Healthcare IT Generation

Monday, January 19, 2009

By John D. Halamka

In Washington, Healthcare Information Technology policy planning is accelerating at a pace that is faster than at any time in history (at least my 30 years in healthcare IT).

Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan.

At the same time, the House Appropriations Committee has completed a bill that is not meant to stand alone. It outlines $2 billion in funding for the programs authorized by section 4301 of the Ways and Means Committee bill.

Here are the high points of the Ways and Means Committee bill.

* It codifies the Office of the National Coordinator (ONC), ensuring its continued funding and authority. To date it has existed only because of executive order.

*It creates a Chief Privacy Officer within ONC.

*It establishes and funds an HIT Policy Committee (Federal Advisory Committee)

*It establishes and funds an HIT Standards Committee (Federal Advisory Committee)

*It specifically mentions that the AHIC Successor, now known as the National eHealth Collaborative (NeHC), can be modified to become either the HIT Policy or HIT Standards Committee.

*Interestingly, it notes that the National Coordinator shall support the development and implementation of a qualified electronic health records (EHR) platform (imagine an open source software as a service system for the country), unless the Secretary of HHS determines that the needs concerning EHRs are met in the private market.

*NIST is to coordinate with the HIT Standards Committee to test standards and establish a conformance testing infrastructure (NIST can contract with independent non-federal labs to conduct performance testing).

* NIST and NSF are to establish a program of assistance to Institutes of Higher Education to establish multidisciplinary centers for Healthcare Information Enterprise Integration (centers to conduct research on applications for HIT)

*It authorizes and appropriates $300 million in Grants and Loans for state based demonstration programs. Grants can focus on such areas as health IT and the underserved, HIEs, technical assistance, and medical informatics education.

*It establishes HIT Regional Extension Centers, non-profit, public/private partner organizations that can have up to 50% of operations funded for up to 4 years.

*It specifies $20 billion in incentives to support health IT through Medicare and Medicaid, beginning in 2011. It outlines Medicare reimbursement incentives to eligible professionals, eligible Medicare Advantage Organizations, and eligible hospitals that exhibit a meaningful use of certified EHR. It outlines Medicaid reimbursement incentives to eligible Medicaid providers that exhibit a meaningful use of certified EHR

*It addresses the Privacy and Security of protected healthcare information to include breach notifications, relationship of business associates, and accounting for disclosures.

The bill is very well written and includes significant input from all the stakeholders - payers, providers, patients, CCHIT, HITSP, vendors, and government.

More here:

Great reading on all the background work that has been done.

Last for this week we have:

eHealth 2009 - eHealth for Individuals, Society and Economy

Monday, 19 January 2009

From 18 to 20 February 2009 the Ministry of Health of the Czech Republic in cooperation with the European Commission is organizing a ministerial Conference "eHealth for Individuals, Society and Economy". High-level eHealth conferences organized by the presiding countries since 2003 represent important annual milestones in this specific field. The Czech Republic therefore plans to carry on the tradition and host this Conference in Prague as a part of its presidency in the first half of 2009.

The seventh in a series of annual conferences organized since 2003 aims to support dissemination of eHealth best practices. As the title itself implies, the Conference will mainly be focused on eHealth in relation to:

  • Individuals
  • Society
  • Economy.

For individuals, eHealth brings new possibilities in terms of increasing quality and effectiveness of services. eHealth provides completely new methods of treatment chronic or rare diseases. In the European context, it can facilitate implementation of cross-border healthcare and contribute to continuity of care.

More here:

This would be good place to get to for a deep briefing on European e-Health and Prague is nice in early spring I hear!

There is an amazing amount happening (lots of stuff left out) – Just not much in OZ!


Wednesday, January 28, 2009

It Is Time for NEHTA to Come Clean with its Plans - Right Now!

Unless I am the victim of a quite clever hoax it seems we have NEHTA’s attention on the blog.

That being the case the two NEHTA comments really provoke more questions than they answer.

Post 1 reads:

Anonymous said...

You seem to be mixing your messages somewhat when you say:-

(a) this time we have a budget to deliver some basic infrastructure

(b) we are to conduct pilots in the absence of any committed funding

(c) this is not NEHTA’s mandate

(d) a successor organisation to NEHTA needs to be funded as per the Deloittes plan.

We would comment thus:-

(a) We need to work with the budget we have and to work with industry to deliver as much basic infrastructure as possible within budget.

(b) Committed funding to conduct pilots has not been announced; that is true, but you are not privy to what plans may be in place to secure that funding.

(c) NEHTA’s mandate can be changed or extended at any time to accommodate the changing environment. NEHTA is not fixed and rigid, nor is it set in concrete. NEHTA has a job to do and whatever needs to be done, to achieve that end, will be done.

(d) The Deloitte plan is just that, a plan. It may need to be modified to fit with these difficult times. Your push for a successor organisation may not be the only option. It may be more appropriate to expand NEHTA to fill that need and to fund it accordingly.

Wednesday, January 28, 2009 9:55:00 AM

Post 2 reads:

Anonymous said...

It is wrong to insinuate NEHTA can just arbitrarily change its mandate. For our Constitution to be changed the changes must be proposed by the Board of Directors and put before the Members for approval.

Wednesday, January 28, 2009 12:02:00 PM

What I read here is that:

1. AHMAC have spent $1.3M on a well considered plan, but that NEHTA believes it knows better and is this choosing to follow alternative options – what they are being unstated. The evidence that NEHTA knows better than Deloittes I find severely lacking.

2. NEHTA by implication is satisfied with the governance of e-Health in Australia despite the fact there is no real input from the private sector and health industry other than through non-binding and un-representative Stakeholder Forums. Few would accept that.

3. That NEHTA thinks it can deliver substantial improvements to e-Health in Australia without explaining to stakeholders just what their role is to be in all this and who will pay for the components NEHTA is not funded for. This is a recipe for yet another e-Health disaster.

4. That NEHTA thinks it is not accountable to the public and stakeholders as similar organisations are in our Australian democracy, and that it can just ‘run amok’ with no appropriate checks and balances. That is just wrong and sooner or later those involved will be made to account.

NEHTA needs to wake up and properly disclose its plans so they can be subjected to appropriate scrutiny and, if warranted, criticism and modification. Just to announce it is a ‘year of delivery’ when all is being delivered is pilots and unfinished infrastructure is just joke.

This all feels like the ghost of the old regime coming back again!

If all this is being backed by DoHA and the Minister it is vital we hear from her/them very soon indeed. Additionally there needs to be a real review of NEHTA’s plans before they proceed or we can be sure it will be a total it has always been when DoHA has tried deliver outcomes over the last decade.

I had thought with the delivery of the Deloittes e-Health Strategy and the changes in NEHTA management we had entered a new era. Seems not!


(p.s. Sorry if this is a con! - Will be very impressed if it is - but I expect denials etc.)

Canada Health Infoway Allocated Half A Billion in 2009 Canadian Budget

This just arrived.


Canada Health Infoway (Infoway) is very pleased to inform you of our allocation of $500 million in the recently announced 2009 Federal Budget. There is no doubt the infusion of these funds will have a positive effect on Canada from both a health care and an economic perspective.

Over the next two years, Canadians can expect to see the positive impact of our efforts to modernize health care with information technology. Not only will this funding go a long way in supporting e-Health projects throughout Canada, but it will also create tens of thousands of jobs across various sectors, including but not limited to the health IT industry.

Continued collaboration with all of our partners will remain critical to Canada’s continued success in implementing electronic health record (EHR) systems. To this end, we look forward to working with our partners as we redouble our efforts to forge ahead to accelerate the implementation of EHR systems across Canada. We will continue to keep you informed of major developments as they occur.

On behalf of Infoway and its partners, I want thank you for your continued support and encouragement. Your ongoing interest and contributions have been important to Infoway and the future of health care in Canada.

To find out more about electronic health record systems and the progress across Canada, visit us at

Yours truly,

Richard Alvarez

President and CEO


We now have Australia as the hold out for delivering a major Health IT Investment plan among all the advanced democracies.

We also have NEHTA apparently thinking it can just arbitrarily change its mandate – despite having a written constitution that defines what it should do – and to be doing that in the absence of a published plan and any serious public consultation. This is public sector management of remarkably low responsibility and accountability. (See comments in previous blog).

As noted in the previous post we need to hear from the Federal Minister sooner rather than later as to just what is planned so industry and the public sector can plan how move on with some confidence.


Tuesday, January 27, 2009

E - Health In Australia is Behaving Like a ‘Headless Chook’!

OK, the first serious working day of the new year and we get this in the Australian today!

Uniform health system in the mill

Karen Dearne | January 27, 2009

LARGE-SCALE production pilots of a nationwide e-health system will start this year, with the National E-Health Transition Authority set the task of making this happen as quickly as possible.

NEHTA chief executive Peter Fleming has been given a mandate to create a uniform IT infrastructure, starting with an incremental build-out of existing clinical and communication platforms.

Federal and state government agreement on the urgent need for healthcare safety and efficiency gains - detailed in several recent reports - signals an end to years of under-investment and fragmentation as parties pursued their own technology agendas.

"Legislative changes are needed, but from a technical perspective we aim to be in a position this year to run some pilots," Mr Fleming said.

"We're in very close dialogue with a number of groups about trials of electronic medication management and hospital discharge summaries."

Late last year, the Council of Australian Governments approved $218 million in funds to extend NEHTA's operations.

Mr Fleming said the organisation was working with software vendors to assess their capabilities and move towards the goal.

More here:,24897,24966640-5013040,00.html

For another take we also have:

This is the year of delivery: NEHTA

Suzanne Tindal,

27 January 2009 03:34 PM

The standards and foundations for nation-wide e-health solutions in Australia have now mainly been completed, according to National E-Health Transition Authority (NEHTA) CEO Peter Fleming, leaving implementation on the agenda for 2009.

"I've actually been pleasantly surprised at a lot of the work that's been done in the background around foundation standards. We're actually starting from a very good position," Fleming told in an interview last week.

"The reality is, though, that we have to move very quickly into a delivery mode and that means implementing. In my expectation, well, this is the year of delivery for NEHTA."

NEHTA had an "absolute mandate" from the Council of Australian Governments (COAG) to deliver in individual healthcare identifiers (which link electronic medical records together), Fleming said, which the authority has been working together with Medicare on. "Medicare is extraordinarily well positioned to do this because of its history and very keen to make this work," he said.

Although creating the individual healthcare identifier for Australians meant a "fairly substantial database", Fleming said the difficulties were created by non-technical issues. There were privacy issues, work flow issues and overarching consumer and government requirements, he said. Legislative changes would also have to be made.

This year would also see a number of pilots, according to Fleming. "I am expecting that as the year progresses we will move very quickly around some fairly reasonable scale pilots around medication management and discharge referrals, and we are talking to a number of groups about that at the moment," he said.

Those waiting for an all-at-once implementation would go home disappointed, however. NEHTA would move ahead incrementally, Fleming said, with the authority consulting states, peak bodies and vendors along the way.

More detail here:,130061733,339294585,00.htm

So we are to have NEHTA stitch together a serious of pilots in areas where we already have the more advanced States with already operational systems and, as usual, not plan in advance for how the piloted systems will be scaled and operationalised at a wider scope.

Why is it that I have this sense of déjà vu? We were here ages ago (2003/4) as I recall before NEHTA was even conceived of.

Last time the plan was scuttled when it was realised by the Department of Health and Ageing (DoHA) how much an organised basic national system (then termed HealthConnect) might actually cost. This time we have a budget to deliver some basic infrastructure and we are to conduct pilots in the absence of any committed funding. You and I can both guess where all this is heading.

Of course this is also not NEHTA’s mandate – the implementation of a National E-Health Strategy is to be undertaken by a successor organisation to NEHTA – and needs to be funded and executed as per the Deloittes plan to have a chance of success.

Of course that implementation has also not been funded and no-one seems to know who is doing what with whom.

More confusion is shown by DoHA issuing decrepit documents on Clinical Decision Support developed by the now defunct Australian Health Information Council as news!

AHIC Electronic Decision Support Systems Report

The Electronic Decision Support Systems Report was developed by the Australian Health Information Council (AHIC) in consultation with several coopted experts. The report contains a number of key messages and guiding principles for the further development of electronic decision support systems in Australia.


Electronic Decision Support was identified as a key area of importance for the Australian Health Information Council (AHIC) and as a result was the focus for the Council during its second term.

AHIC members identified the use and accreditation of EDSS; and medicines as being two important areas of Electronic Decision Support Systems (EDSS) for discussion. Several experts in the field, including Professor Johanna Westbrook, Dr Joanne Callen, Dr John Aloizos, Mr Michael Fitzsimons and Dr James Reeve provided valuable input into this report and I thank them for their participation.

Barriers to the successful implementation of EDSS have been identified and overcoming these barriers to maximise the benefits for health consumers has been discussed.

On behalf of AHIC, I hope that the development of this paper assists with advancing Electronic Decision Support Systems in Australia and as such can contribute to the use of safe, efficient and effective tools to support the skills and knowledge of health professionals across Australia.

I would like to take this opportunity to thank the members of the Council and the AHIC Executive for their valuable work and support in formulating this advice to AHMAC.

Professor James A Angus

Chair of Australian Health Information Council

Dean of the Faculty of Medicine, Dentistry and Health Sciences

The University of Melbourne

The rest of this report – dated mid January 2009 (but actually written late in 2007 – early 2008) can be found here:$File/AHIC%20EDSS%20web%20version%2012%20January%202009.pdf

I wonder how embarrassed the authors of this are that this has suddenly appeared recommending the development of a National E-Health Strategy that has already been done?

What we have here is the following.

1. A totally silent Health Minister – and, in contrast, the new US President sponsoring major e-Health initiatives.

2. A developed and sensible National E-Health Strategy the Government apparently won’t fund to implement.

3. NEHTA – without any ongoing guidance and control – simply floundering about seeking relevance and to spend the funds it has.

4. NEHTA having no mandate to do more that they are already tasked with (ID, SNOMED CT, Secure Messaging, NASH and Supply Chain). Where are the funds coming from to do the extra?

5. NEHTA pretending the Standards work is done when it is not.

6. NEHTA not acting to properly support the National E-Health Strategy with a focus on messaging as recommended.

7. There being no policy framework or legislation in place under which any trials or pilots could be conducted – legislation is not quick as Mr Rudd is finding out!.

8. A totally unrealistic time line to do anything at any scale and evaluate it in less than 12 months – as suggested.

9. DoHA – as far as E-Health is concerned – lost in the wood, out to lunch or whatever other term you like.

10. Medicare Australia will not have the Identity Systems operational until 2010 so how can pilots happen in 2009?


This is all a travesty and bloody sad.

We need a Federal Ministerial Statement of Intent in the E-Health Space sooner rather than later so everyone can know where they stand and what is actually going on!

We also need the FULL Deloittes report made public! This Labor Government is as bad as the Howard crew on openness and transparency as far as I can tell.


Monday, January 26, 2009

The National Health and Hospital Reform Commission Hears about the Need for e-Health.

Over the silly season a few reports we are almost certainly missed. The following is one I had not caught up until now.

December 8, 2008

NHHRC Consultation Reports Now Available On Website

The reports of forums conducted by the National Health and Hospitals Reform Commission (NHHRC) with community members and frontline health workers in thirteen venues around the country are now available on the NHHRC website.

The reports cover both the frontline and community forums at the following locations:

  • Adelaide
  • Alice Springs
  • Brisbane
  • Cairns
  • Canberra
  • Darwin
  • Dubbo
  • Geraldton
  • Hobart
  • Melbourne
  • Perth
  • Shepparton
  • Sydney

There are also two consolidated reports – one bringing together all the frontline health worker consultations, and the second bringing together the community consultations.

All the reports can be viewed at under the heading ‘Consultation Reports’.

The views expressed in these reports are those of the consultation session participants and should not be taken to be the views of the National Health and Hospitals Reform Commission or the Australian Government.

See release here:

In the report gathering the views of a huge range of health professionals we have a heap of interesting ideas.

However, what is most interesting to me is the following section, under the first section heading Overarching Solutions, we find as one of the three the EHR. The first two were to create a single national health system and to adopt a multi-disciplinary approach to care delivery. Here is the third.

---- Begin Extract

1.3 Electronic health records

A national system of electronic health records for every individual in Australia was suggested as a solution to a broad range of issues and challenges within health service delivery. Different alternatives to implement the system include a central mega-Medicare database linked to people’s Medicare numbers, or a transferable patient record, based on an electronic swipe card or equivalent computer chip type system, to access health records.

The issues and challenges that a national system of electronic health records could address include:

· Many different parties have different pieces of information about each patient, but there is no ability to connect this information together, to track patients or identify those who need health services but are not accessing them (lost to follow-up).

· Patients lack medical knowledge and are often unable to inform practitioners of their medical history accurately.

· When people move interstate – for example, for work, holidays, or as ‘grey nomads’, their medical information is left behind and is difficult or impossible to access by future doctors. This problem is contributed to by the fact that confidentiality requirements across each State are different.

· Patients are sometimes transferred between health service districts for treatment, but their patient information does not follow them.

· There is often no follow-up with GPs once a patient leaves an acute setting – for example, discharge summaries are not received.

A system of electronic health records could work to:

· Improve health information to ensure accurate patient information.

· Improve communication between private and public sectors.

· Improve communication and access to shared clinical information between hospital and community-based providers

· Improve clinical decision making, planning and benchmarking by recording clinical outcome measures and quality of life measures, to support whole population trend planning, longer term planning, prospective analysis of health data from birth, and benchmarking of trends.

· Enable faster referrals to allied health, secondary, and tertiary care.

· Reduce incidences of lost referrals.

· Enable faster exchange of discharge summaries and faster patient transfers to and from hospital.

· Improve communication between different health workers treating the same patient, by allowing health workers to know what other treatments a patient is receiving.

· Help free up clinical staff from basic administrative tasks and support better measurement and monitoring of patient outcomes.

· Support prevention and early intervention by flagging risk factors early. For example, a patient’s records could be flagged to monitor falls and if a second or third fall is reported, appropriate staff could visit the patient to assess hazards at home or review medication use.

A national system of electronic health records should include the following features:

· A useful interface that allows records to be available across sectors so that information about a patient’s condition and treatment in hospital is accessible by the patient’s hospitals, private and public sectors, State and Federal governments, allied health workers and community health practitioners. However, some health workers raised the issue of privacy, pointing out that patients may not want every health practitioner to see their complete health and treatment history – for example, people may not want information on mental health, sexual health or drug and alcohol treatment to be available to other providers.

· A wireless, digital, system that reduces reliance on paper-based systems and improves communication flows.

· The ability for practitioners to update the record at the point of care.

· An alert function to care providers, such as GPs and community nurses – for example, when a patient is admitted or discharged from hospital.

· Shared, distributed, and centralised databases of pathology, imaging, and cardiology. This would

· lead to a massive reduction in the duplication of testing, and prevent disparate databases which do not integrate.

Challenges to the delivery of a national electronic health record include privacy issues and the question of ownership over the records. This poses doubt over what e-records should contain and who should have access to them. Addressing public concerns about privacy through secure systems and education of health workers and patients in their use, and legislative change, particularly of the Privacy Act, to enable shared records while protecting patients and workers, will be necessary. A further challenge will also be the transfer of paper records to the electronic system, especially in rural and remote areas where adequate internet provision cannot be guaranteed.

---- End Abstract.

The full report is here:$File/Consolidated%20frontline%20workers%20consultation%20report.pdf

Well, we now have the NHHRC saying e-Health is pretty important and a Deloittes strategy which shows how it should be done.

Must be close to time to get on with it!


Sunday, January 25, 2009

Useful and Interesting Health IT Links from the Last Week – 25/01/2009.

Again, in the last week, I have come across a few reports and news items which are worth passing on.

First we have:

E-health eye opener


COMPUTERS A Swedish experience shows the benefits of electronic health. By Noel Stewart

GPs often worry about switching from one clinical software package to another, but Dr Jean McMullin, a GP in Heidelberg, Victoria, has shown it’s not as difficult or intimidating as feared.

In 2007 Dr McMullin spent six months working as a GP in Sweden. She had to learn a new clinical software package as well as cope with a different language. One concession was that she was able to dictate her notes to a medical secretary who entered them in Swedish into the software.

Dr McMullin was working in Umeå, a city of 110,000 in northern Sweden, in a vårdcentral — a care centre that closely resembles a community health centre in Australia. Sweden has few private general practices.

The vårdcentral had 4.5 equivalent full-time GPs, six nurses, a psychologist, two occupational therapists, three physiotherapists, a social worker, three medical secretaries, two receptionists and two administrators.

Dr McMullin says nurses in Sweden have a greater and more complex clinical role than in Australia. One of the nurses she worked with was trained in heart health and could prescribe medication. There were also nurses specialising in diabetes education and asthma.

The nurses have a gatekeeper role with all patients, triaging them to either a nurse or GP.

The vårdcentral works on a paperless basis, although reports can be printed if needed. Dr McMullin says all encounters with clinical staff are recorded in the electronic file. There is a facility to easily send a message to other clinical staff (eg, a nurse who checks a patient's BP can inform the doctor of the result).

Like most Australian software, as you order investigations and prescriptions they are automatically entered into the progress notes. Once a patient is seen, the doctor dictates all other information such as the history, examination and conclusion, for the medical secretary to type into the notes. All diagnoses are coded. If a GP wants to check a patient’s hospital notes or follow up a referral, notes can be accessed easily and electronically.

Prescriptions are always electronic and are sent to the pharmacist electronically. Patients can nominate to fill the prescription at any pharmacy in Sweden.

More here: (if you have access)

This is a useful article and it really is a pity that the e-Health articles in Australian Doctor, Medical Observer and the MJA are not accessible generally. There is no real reason I can figure out to restrict this content – as opposed to some clinical content which may be more problematic.

We can just hope for change.

Second we have:

Obama writes e-health script


23/01/2009 8:58:00 AM

A key aspect of President Barack Obama's plan to overhaul the economy and reform health care services is an investment of $20 billion in health information technology, with the aim of having all health records stored and accessed electronically by 2014. He sees this investment as essential for saving jobs, money and lives by cutting red tape, preventing medical mistakes, and reducing health care costs by billions of dollars each year.

President Obama cites the predictions made by a RAND study in 2005 that the widespread adoption of electronic health records could save more than $81 billion (about five per cent of the total health budget) annually by improving health care efficiency and safety. This study also indicated that the use of health IT in the prevention and management of chronic disease could eventually double those savings, while increasing health and other social benefits.

Of course, the potential long-term savings come with a hefty initial price tag, estimated at $156 billion over five years, with an additional $48 billion in operating costs. The $20 billion included in the economic stimulus package therefore represents only a fraction of what will be needed to bring this aspect of Obama's plans to fruition.

By any standard the US health industry is a costly and inefficient enterprise and the US lags more than a decade behind countries such as Canada, Germany and Norway in its efforts to implement e-health systems. A comparative study of OECD countries showed that in 2005 the US was spending only 43 cents per capita on health IT, compared to $31.85 in Canada, a whopping $192.79 in the United Kingdom, and $4.93 in Australia.

This makes Australia look like a shining example of e-health efficiency and early adoption in comparison, when the truth is that, after eight years and several hundred million dollars, Australia is still without a national health IT strategy.

More here:

Good to see Australian commentary on the things that are happening in the US with the new administration. The discussion of the importance of governmental commitment and the need to interoperability and planning are right on indeed!

The point about Health IT’s role in Health Reform is also totally right – but somehow not grasped by the pollies. Blowed if I can work out why, other than just poor advice from those who should know much better.

Third we have:

Worm infects millions of computers

  • Glenn Chapman, San Francisco
  • January 22, 2009

A NASTY "worm" has wriggled into millions of computers and continues to spread, leaving security experts wondering whether the attack is a harbinger of evil deeds to come.

American software protection firm F-Secure says a worm known as "Conficker" or "Downadup" had infected more than 9 million computers by Tuesday and was spreading at a rate of 1 million machines daily.

The malicious software had yet to do noticeable damage, prompting debate as to whether it is impotent, waiting to detonate, or a test run by cyber-criminals intent on profiting from the weakness in future.

"This is enormous, possibly the biggest virus we have ever seen," said software security specialist David Perry of Trend Micro.

More here:

Again a reminder about the need to keep up with Windows Update if you don’t want a whole lot of grief.

More here also:

'Amazing' worm attack infects 9 million PCs

Biggest infection in years, says Finnish security firm

Gregg Keizer 19/01/2009 09:16:00

Calling the scope of the attack "amazing," security researchers at F-Secure Friday said that 6.5 million Windows PCs have been infected by the "Downadup" worm in the last four days, and that nearly nine million have been compromised in just over two weeks.

Early Friday, the Finnish firm revised its estimate of the number of computers that had fallen victim to the worm, and explained how it came to the figure. "The number of Downadup infections [is] skyrocketing," Toni Koivunen, an F-Secure researcher, said in an entry to the company's Security Lab blog . "From an estimated 2.4 million infected machines to over 8.9 million during the last four days. That's just amazing."

More here:

Good to know the MicroSoft tools will detect and clean this little nasty.

Fourth we have:

Tiny motor allows robots to swim through human body

Nanorobots to swim through your body

Monash University scientists are developing nanorobots to swim through blood vessels to previously unreachable parts of the brain to take pictures or unblock blood clots.

Deborah Smith Science Editor

January 21, 2009

IT HAS been dubbed the Proteus motor, after the miniature submarine that travelled through the human body in the science fiction movie, Fantastic Voyage.

And its Australian creators hope their tiny motor - which is less than the width of three human hairs - will soon power medical nanorobots that can swim through tiny blood vessels into the brain.

James Friend, of Monash University, said that such devices could enter previously unreachable brain areas, unblocking blood clots, cleaning vessels or sending back images to surgeons.

More here

This is amazing stuff. I was certain Fantastic Voyage would remain Sci-Fi for a much longer time than it seems to be.

Fifth we have:

Cut and thrust for e-doctors

Mitchell Bingemann | January 20, 2009

IT takes a certain constitution to be able to slice your fellow humans with a scalpel, let alone put up with the bloody mess. I guess that's why most people skip medical school for a nice, safe job in a bank.

As the world economy crumbles, however, now might be a good time to skip the economics degree and start looking for a career in medicine.

Enter Trauma Centre: New Blood on Nintendo's Wii platform. This is just the game to prepare you for life with the scalpel and surgical hacksaw.

Players slice, stitch, inject and disinfect patients as a new and deadly disease called Stigma devastates a small Alaskan region and threatens to reach plague proportions.

Players take the role of a male surgeon named Markus Vaughn or his female counterpart Valerie Blaylock as they battle to contain the outbreak.

The medical procedures in New Blood are intense and often difficult.

Not only do you have a limited amount of time to complete each procedure, but complications are common, adding an extra dose of urgency to each operation.

More here:,24897,24932504-15325,00.html

Sounds like an interesting game – I wonder how long it will before we see versions that will act as serious simulators etc?

Sixth we have:

Report: Australian broadband performance on the rise

New Epitiro report shows Australian broadband providers improved performance and service delivery during Q4 2008

Andrew Hendry (ARN) 19/01/2009 13:58:00

Australian Internet surfers enjoyed significant improvements in performance during the last quarter of 2008, according to new international research.

Global broadband benchmarking firm, Epitiro, found email delivery times, browsing speed, connection and gaming performance had all improved during Q4 compared with Q3 last year.

The company measures the performance of the premium services of eight Australian ISPs from the same locations in Sydney, Melbourne and Brisbane every 15 minutes, 24 hours a day, seven days a week.

“There were small but significant gains across most of the variables we measure. [In Q4 2008] Australians were able to browse, surf, game and download a little faster than they could in Q3 [2008],” Epitiro said.

Of the eight Australian ISPs measured for performance by Epitiro, Telstra sat in top spot, followed by TPG, iiNet, Netspace, AAPT, Internode, Westnet and Optus.

More here:

Minister Conroy is going to have to work harder. We are all still waiting for the NBN – but at least while we are waiting things seem to be getting slowly better. It is really bizarre it is taking so long – now 14 months to even decide who is going to actually get to do the network build – assuming it actually happens.

Last a slightly more technical article:

Don't Fear the Penguin: A Newbie's Guide to Linux

Linux has an undeserved reputation for being complex, cryptic, and difficult to use. With this simple guide, you can get started using Ubuntu Linux today.

Neil McAllister (PC World) 23/01/2009 09:00:00

Getting started with Linux can be an intimidating task, particularly for people who have never tried any operating system besides Windows. In truth, however, very little about Linux is actually difficult to use. It's simply a different OS, with its own approach to doing things. Once you learn your way around a Linux desktop, you're likely to find that it's no more challenging to work with than Windows or Mac OS.

In this guide I'll focus on Ubuntu, the most popular Linux distribution today. But Ubuntu is just one of many different flavors of Linux. Literally hundreds of distributions are out there, appealing to a broad range of users--from teachers and programmers to musicians and hackers. Ubuntu is the most popular distribution because it's easier to install and configure than most others; it even comes in a few different versions, including Edubuntu and Kubuntu. If you happen to be running a different distribution, such as Fedora or OpenSUSE, you'll likely find that much of this guide still pertains to you.

Much more here:

This is a useful starter guide for Linux – which is gradually becoming more widely used and which has an increasing range of useful tools. There is already discussion in the US about the use of open-source software in the Obama Health IT initiative.

For a more negative view try this one.

Living free with Linux: 2 weeks without Windows

Can a dedicated Windows user make it for two weeks using only Linux? Preston Gralla tried it and lived to tell this tale.

Preston Gralla 22/01/2009 08:33:00

It's one of those perennial age-old battles that can never be resolved. Coke or Pepsi? Chocolate or vanilla? Linux or Windows?

More next week.