Tuesday, August 31, 2010

It Looks Like It Will be a While Before iSoft Recovers from This Mess!

iSoft released its annual 2010 Full Year results just on market open today.

You can read the gruesome details here:

http://media.corporate-ir.net/media_files/irol/16/161325/investorpack.pdf

and for the real details here:

http://media.corporate-ir.net/media_files/irol/16/161325/4e.pdf

The result has already be covered here:

iSoft CEO steps down after poor result

ISOFT Group chief Gary Cohen has stepped down as part of a review after a horror full-year result.

Shares in the Sydney health information technology company slumped more than 20 per cent to 12.5 cents, after it reported a $382.9 million loss, following $34.7m profit last year.

The company's shares have now fallen about 83 per cent this year.

The result included a $341m one-off impairment charge, primarily related to goodwill. Total revenue fell 20 per cent to $431 million and earnings before interest tax depreciation and amortisation tumbled 77 per cent to $30m.

Chairman Robert Moran, who described the result as "disappointing", said iSOFT's board has commenced an in-depth review of the company's business operations.

A number of aspects of the review are already being implemented, including the departure of Mr Cohen who will remain with the company to assist with its transition and strategic development.

iSOFT has engaged an executive search firm to assist in finding a new CEO, with chief operating officer Andrea Fiumicelli to serve as acting chief.

The company has also commenced a "board renewal" process to identify candidates from both Britain and Australia to join the board.

On the result, Mr Moran said: "A difficult economic environment, adverse currency impact, delays to the implementation of the National Program for IT in the UK and an increased cost structure all contributed to this result."

iSOFT changed its name back to iSOFT last year after IBA Health acquired the group in 2007.

Mr Moran said the review has already targeted annualised operational cost savings of $50m by end of June 2011, with more than half of this to come through headcount reductions.

More here:

http://www.theaustralian.com.au/business/city-beat/isoft-ceo-steps-down-after-poor-result/story-fn4xq4zx-1225912302486

There is also some additional information here:

STOCKS ON THE MOVE

* Health information company iSoft (ISF.AX)

ISOFT

31 August,2010

ISF.AX, (0.135, -0.030, -18.180%), the market's most active stock, lost a quarter of its value to hit a 6-½ year low of A$0.125 after it reported a loss of A$383 million due to a hefty writedown of goodwill.

It said it needed to restructure its senior debt facilities, review its capital structure and was considering asset sales. Its chief executive stepped aside to work with the board on strategic options for the company.

Full article is here:

http://money.ninemsn.com.au/article.aspx?id=7953645

Clearly all this is pretty bad news for iSoft investors – to say nothing about how the ex-CEO (Gary Cohen) must feel to essentially lose his job.

While it is hard to be sure it does seem we are in part seeing in the figures the effects of the takeover transaction from a year or so ago impacting – as well as all the issues around the UK National Program for Health IT which have harmed cash flow and the need to recognise that there has been a major reduction in the value of the company’s intangible assets.

The 2009 annual report reveals there was over a billion dollars of intangible assets on the company and with the write down in these results this amount has been essentially halved but it is still a rather large $480 million.

Given that the company has a very substantial amount of ongoing legacy and maintenance revenue and many customers all over the world as well as a very newly developed and apparently quite good product in Lorenzo we can only hope the steps planned will turn the ship around!

For all concerned it would be sad if this can’t be achieved, but I doubt it will be quick!

David.

Monday, August 30, 2010

Weekly Australian Health IT Links – 29 August, 2010.

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. Note also that full access to some links may require site registration or subscription payment.

General Comment:

Well, it seems we remain in political limbo, with uncertainty surrounding all sorts of policy directions.

It has been pleasing to see health and general and e-Health seems firmly back on the agenda.

As an example we see here:

http://www.smh.com.au/federal-election/rural-services-now-in-spotlight-20100823-13in1.html

Rural services now in spotlight

Mark Metherell

August 24, 2010

Country people are more likely to die from cancer, may wait four weeks to see a doctor and get a lower share of Medicare spending.

Despite their plight, their needs failed to draw national attention during the election campaign.

That changed dramatically on Saturday night, says rural health spokesman Gordon Gregory. He said yesterday he had heard more about rural health as a political issue in the preceding 40 hours than in the previous 40 weeks.

That is thanks to the elevation of three country independent MPs who have bemoaned the lack of rural health services and who may now choose the next prime minister.

----- end quote.

The risk, in these rather fraught times, is that we will see less than considered policy emerge. I suggest we be alert to that outcome – but not be alarmed just yet!

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http://www.theaustralian.com.au/australian-it/greens-back-e-health-with-strong-data-security-and-privacy/story-e6frgakx-1225909093831

Greens back e-health, with strong data security and privacy

THE Greens will support government initiatives on e-health, as long as strong data security and privacy protections are in place.

"If you talk to people in aged care, in Aboriginal and regional health, they are very strongly supportive of e-health," WA Greens Senator Rachel Siewert said yesterday.

"So are we. But we do want to make sure that sensitive medical information is protected, and that individuals have control over decision-making (about access).

"We will work with whoever's in government on e-health, to ensure those safeguards are there. And that's very definitely about negotiation, not obstruction."

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http://www.computerworld.com.au/article/358524/politicians_bad_each_other_e-health_/?eid=-255

Politicians as bad as each other on e-health

Round table event hears there is too much focus on the technology, and not enough on healthcare

THE e-health capabilities of the major political parties are “as bad as each other” according to the former chief of the South Australian department of health.

The comments were made at the health informatics conference on Tuesday, when ABC's Tony Jones moderated a roundtable of industry veterans, who discussed a number of issues about e-health including the qualities required to lead a successful project implementation.

The panel comprised of the head of the National e-health transition authority, Peter Fleming, Ernst &Young health and human services lead (former CEO South Australia Department of Health) Jim Birch, author of the independent evaluation report of the NHS summary care record, UK professor Trish Greenhalgh, health informatics society of Australia president professor Michael Legg and technology vendor Intersystems's CEO Professor Stan Capp.

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http://blog.healthbase.info/?p=67

evolution, revolution and NEHTA

2010-August-26 | 08:19 By: Filed in:

There is a wide spectrum of opinion in Australia regarding how e-health should be progressed. At one end of this spectrum we have the proponents of national-scale, top-down architected and developed infrastructure, such as exemplified by HealthConnect and by the NEHTA work program. At the other end, we have those who believe that such national-scale, government-run projects are doomed to fail, have been shown to fail around the world, take forever, and cost an order (or several orders) of magnitude more than organically evolving, bottom-up, industry-led alternatives. Where does the truth lie?

Many cite “the internet”, as an example of a successful, complex, evolving ecosystem that was not designed top-down by a government. However, some parts of it were. What is clear, is that the internet’s success is based on many soundly engineered components. These components are based on standards, modularity, clear separation of concerns, ease of implementability, relatively simple conformance requirements, and well tested implementations. This notion of soundly engineered components is one that is poorly understood or acknowledged in e-health, but one that needs to be if substantial progress is to be made.

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http://www.ehealtheurope.net/news/6183/orion_health_launches_rhapsody_4

Orion Health launches Rhapsody 4

24 Aug 2010

New Zealand's Orion Health has announced the launch of the latest version of its integration engine, Rhapsody 4.

Orion says the latest version of Rhapsody focuses on providing greater support for the latest industry trends, technologies and standards, including secure web services, already adopted by groups such as HL7 and Integrating the Healthcare Enterprise.

Paul de Bazin, Rhapsody product manager said the solution now provides greater support and features for organisations using service oriented architecture (SOA) to solve their integration challenges.

“Healthcare institutions are recognising the value of using integration tools to provide simple, reusable components – but they also require those components to be healthcare specific.”

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http://www.medicalobserver.com.au/news/online-consults-cautious-welcome

Online consults: cautious welcome

24th Aug 2010

Caroline Brettingham-Moore

DOCTORS say appropriate guidelines and rebate amounts for online consultations are crucial if Labor’s promised $392 million e-consults investment is to avoid creating perverse incentives for GPs.

Under its pre-election pledge, Labor would provide rebates of up to $100 for GPs treating rural and regional patients via online consultations and video-­conferencing, according to News Ltd reports. This is almost three times the current $34.30 rebate for a level B consult.

However, Labor had not confirmed these rebate amounts as MO went to press.

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http://www.theaustralian.com.au/news/health-science/low-tech-road-to-crisis-e-health-reform/story-e6frg8y6-1225910648546

Low-tech road to crisis: e-health reform

  • AT THE COALFACE: Terry J. Hannan
  • From: The Australian
  • August 28, 2010 12:00AM

CRITICAL e-health reform is being interrupted by the Coalition.

The rest of the world has confirmed that healthcare technologies are essential for reform work.

The Coalition's anti-National Broadband Network stance indicates lack of comprehension of the capability of modern technologies to improve care delivery. And Labor is in an impossible situation caused by technological limitations to its e-health projects. Add to this the non-election. It all brings to mind the 1977 Tenerife air disaster in which two airliners collided on a runway. Investigators found that loss of cognitive efficiency, high autonomic arousal and loss of communication accuracy led to multiple small errors, culminating in the disaster.

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http://www.medicalobserver.com.au/news/concerns-held-for-funding-of-ehealth-trials

Concerns held for funding of e-health trials

24th Aug 2010

Caroline Brettingham-Moore

A QUEENSLAND division charged with trialling national standards for electronic health records in collaboration with NEHTA has expressed fears the funding could dry up before development work is complete.

Brisbane-based GPpartners – one of three divisions last week charged with trialling the standards – originally established a Health Records Exchange (HRX) system funded by the Howard government’s Cooperative Research Centres program in 2005.

But its deputy chief executive Brett Silvester said he “lives in fear” of short-sighted approaches, having previously seen federal funding for the development of the HRX axed in 2007.

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http://www.computerworld.com.au/article/358577/nbn_speeds_necessary_healthcare_identifier_service/?eid=-6787\

NBN speeds not necessary for healthcare identifier service

But healthcare experts say a more reliable infrastructure would help fast-track healthcare applications

The Labor government's proposed $43 billion national broadband network (NBN) isn't necessary for the rollout of the health record identifiers, according to the head of the National eHealth Transition Authority (NEHTA).

The comments were made at the health informatics conference on Tuesday, when ABC's Tony Jones moderated an e-health discussion with five industry representatives.

When Jones quizzed the panel about the need for the NBN, NEHTA CEO Peter Fleming said a reliable internet connection – not faster speeds - was the most significant requirement for the implementation of the healthcare identifier service (a system where a unique 16-digit number will be used to electronically link a patient's health records).

In this context, he said it didn't matter whether the reliability was delivered as part of the Labor government's proposed NBN or another project.

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http://www.theaustralian.com.au/australian-it/queenslands-mater-hospital-leads-way-on-e-health/story-e6frgakx-1225910776754

Queensland's Mater Hospital leads way on e-health

  • From: AAP
  • August 27, 2010 9:47AM

A PAPERLESS computer monitoring system will help doctors care for premature babies at a Brisbane hospital, in an Australian first.

The Mater Hospital's Neonatal Critical Care Unit has introduced the new BadgerNet system to give medical staff real time access to health records.

It is the first Australian neonatal clinic to use the technology. Director of neonatology Dr David Knight said the system will save time and lives. "Staff have access to electronic prescribing and drug administration systems,'' he said.

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http://www.medicalobserver.com.au/news/independents-push-ehealth-centre-stage

Independents push e-health centre stage

27th Aug 2010

Caroline Brettingham-Moore

THE rollout of the National Broadband Network (NBN) and e-health now lie at the heart of negotiations between three Independent MPs, Labor and the Coalition as the two parties jostle to form a minority Government.

As MO went to press the Coalition had won 73 seats, while Labor was just behind on 72 seats – however an additional seat is looking likely for Labor after Greens MP Adam Bandt said he would be inclined to support the party in a hung parliament.

And WA National MP Tony Crook has not yet pledged his support for the Coalition.

Independent MPs Tony Windsor, Rob Oakeshott and Bob Katter last week continued negotiations with the two major parties as they worked to broker a deal that would benefit their rural and regional constituents.

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http://www.healthinvestor.co.uk/%28X%281%29A%288nbGQtd6ywEkAAAAZmM1NzdiYWMtZjU3NC00NTg2LThhMzAtZTZiNTEwYjhmZTA0rgPYG4SxbZPw6cPcxsTWo9DJb9s1%29S%283f3qwi55ywwj1nyr1irgd145%29%29/ShowArticle.aspx?ID=1278

iSoft targets telehealth market

NHS software supplier iSoft has won a place on the telehealth assistive technologies framework agreement, which should allow the firm to expand its fledgling telehealth division.

The framework agreement is with Buying Solutions, the national procurement organisation for all UK public services, and will facilitate the buying of a wide range of products for public sector contracting authorities.

The agreement is for two years, with the option of two further one-year extensions, and will cover the areas of telecare, telehealth and telecoaching.

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http://www.hospitaliteurope.com/default.asp?title=iSOFTawardednationaltelehealthsupplieragreement&page=article.display&article.id=22777

iSOFT awarded national telehealth supplier agreement

Wednesday 25th August 2010

The framework agreements facilitate the buying process across a broad range of services and products for UK public sector contracting authorities, saving time, resources and avoiding duplication of effort.

The Telecare, Telehealth and Telecoaching framework agreement is for two years (with the option of two further one year extensions) and covers the purchase, installation, maintenance, monitoring and coaching of telecare and telehealth solutions.

iSOFT entered for tender applications in the areas of telehealth products, telehealth services, telecoaching products and services, and managed services – and the company was successful in all four areas. iSOFT has partnered with Bupa Health Dialog for the category of telecoaching.

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http://www.computerworld.com.au/article/358082/qld_health_adopts_warehouse_management_system/?eid=-255

Qld Health adopts warehouse management system

New system expected to result in less goods returns and decreased potential for delays to patient care

Queensland Health (QH) is to implement a new warehouse management system at its Central Pharmacy (CP) business unit to improve the efficiency of delivering pharmaceuticals and dental products to all QH hospitals and clinics.

The agency currently uses the enterprise-wide pharmacy software system iPharmacy, supplied and maintained by iSoft to connect all QH pharmacy departments with CP.

According to Queensland Health, all processes within the CP warehouse are completely paper-based where automation ends at the release of a picking list. Dental products also rely on the Pronto application for managing stock order processes.

QH’s Shared Services Partner (SSP) agency, which supplies clinical consumables and as part of QH’s Supply Chain Management Integration Strategy (SCMIS) Project, will also benefit from the new system.

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http://www.theaustralian.com.au/australian-it/trial-for-stroke-victims-telemedical-services/story-e6frgakx-1225909043923

Trial for stroke victims: telemedical services

Stroke patients will be next to benefit from the expansion of acute telemedical services in a Victorian trial.

The plan is to give doctors in Bendigo Hospital immediate access to Melbourne-based neurologists using wireless videoconferencing, so patients who would benefit from a life-saving drug can be identified quickly.

Project leader and head of neurology for Eastern Health Christopher Bladin says stroke victims in rural and regional hospitals who need the blood-clot buster tPA generally miss out.

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http://www.theaustralian.com.au/australian-it/net-value-adds-to-medical-education-surgery-over-the-web/story-e6frgakx-1225909046325

Net value adds to medical education: surgery over the web

A SIMPLE idea to broadcast surgery live over the internet has sparked a medical education revolution.

It will benefit specialists conducting rare or complex operations as well as under-resourced doctors in remote locations.

Surgeon and internet entrepreneur Andrew Renaut says his videosurgery live and on-demand webcasts, accessible to medical professionals only via a secure site, are just the start.

"For the first time, surgeons and surgical trainees can watch a whole range of rare or advanced procedures," he says.

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http://www.computerworld.com.au/article/357876/opinion_filter_dead_it_ll_back/?eid=-6787

Opinion: The Filter is dead, but it'll be back

National security imperatives will ensure some kind of net filter will be on the agenda in future

The Greens' success over the weekend in cementing their hold on the balance of power in the Senate has sounded the death knell for the government’s controversial ISP-level internet content filter.

While the plan had been delayed in July with the Federal Attorney-General‘s office to review the filter blacklist - or refused classification content - to be administered by the Australian Communications and Media Authority (ACMA), the weekend’s election result means for the next few years the filter will not get legislative approval as the Greens have committed to blocking it.

The drowning of the much-hated filter could be cemented further should the Coalition be able to form a minority government with the gang of five independents.

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http://www.theaustralian.com.au/australian-it/opinion/a-rolls-royce-nbn-is-simply-not-commercially-viable/story-e6frgb0o-1225909068539

A Rolls-Royce NBN is simply not commercially viable

THE national broadband network will be a revolutionary piece of infrastructure with enormous benefits.

It will deliver 1GB high-speed internet to 93 per cent of Australians.

But there would also be speed and safety benefits to giving every Australian a Rolls-Royce, and the government doesn't do that because it would be ridiculously expensive, with many rarely leaving the garage.

So too the NBN.

The price we've been quoted is $43 billion, but that's only for the initial build.

Factor in the year-on-year running costs and the NBN rests somewhere between a losing investment and a financial black hole, guaranteed never to break even, let alone to turn a profit.

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http://www.theaustralian.com.au/australian-it/nbn-important-to-regions-but-you-cant-eat-it/story-e6frgakx-1225909090898

NBN important to regions 'but you can't eat it'

  • Andrew Colley, Mitchell Bingemann
  • From: The Australian
  • August 24, 2010 12:00AM

LABOR may be quietly rejoicing that regional telecommunications is shaping as a key bargaining chip in the battle to form government.

The party is armed with its $43 billion National Broadband Network, but regional backing for it to form government is far from certain.

Signs for Labor were positive when all three independents, Rob Oakeshott, Tony Windsor and Bob Katter, whose support is shaping as necessary to forming government, indicated broadband would crown their list of demands to take to the major parties.

As it became clear on Saturday night the election would lead to a hung parliament, Mr Oakeshott told ABC TV: "You don't need to be an Einstein to work out that telecommunications is one of the issues we will be talking about."

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http://www.theaustralian.com.au/australian-it/government/nbn-under-scrutiny-by-country-mps-windsor-katter-and-oakeshott/story-fn4htb9o-1225909874574

NBN under scrutiny by country MPs

  • UPDATED: Fran Foo
  • From: Australian IT
  • August 26, 2010 10:52AM

INDEPENDENT MP Tony Windsor has questioned the $43 billion National Broadband Network price tag, describing it as a "fictitious number".

Mr Windsor is one of three country MPs at the centre of power-sharing negotiations, including Rob Oakeshott and Bob Katter, who want access to Treasury secretary Ken Henry and Finance department secretary David Tune as they prepare a "roadmap" before entering into talks with Julia Gillard and Tony Abbott.

They've issued a "call for information'' on seven key areas, including access to the costings on all election commitments. As a result Labor could finally be forced to reveal how the $43bn figure was derived.

Mr Windsor described the request as "a test to the parties in terms of their promises going into the election" and questioned the veracity of the NBN funds.

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http://www.theaustralian.com.au/national-affairs/dick-smith-questions-nbn-benefits/story-fn59niix-1225909103250

Dick Smith questions NBN benefits

ENTREPRENEUR Dick Smith has fired a salvo against Labor's National Broadband Network.

He said he was concerned about the lack of a cost-benefit study and questioned the benefits for the bush.

Mr Smith said he was against the $43 billion plan "because it's never been properly costed".

Labor's plan was released without such an analysis to measure the claimed benefits in areas like e-health.

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http://www.theaustralian.com.au/business/telstra-in-limbo-with-broadband-on-the-line/story-e6frg8zx-1225908600813

Telstra in limbo with broadband on the line

A SHIFTING customer landscape and poor financial results had prepared Telstra to adapt to the advent of the National Broadband Network.

However, the election outcome has left the telco in uncertain territory.

Before Saturday, Telstra chief executive David Thodey knew the election would shape the giant telco's future.

A Labor win would mean the $43 billion NBN would go ahead -- and Telstra would be guaranteed a major role -- at the cost of dismantling its vertically integrated business.

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http://www.theaustralian.com.au/national-affairs/regional-internet-service-to-fore/story-fn59niix-1225908603884

Regional internet service to fore

BROADBAND is shaping up to be the key bargaining chip in the battle to form government.

This is occurring as Labor and the Coalition try to woo a clutch of independents from electorates starved of adequate telecommunications services.

Three independents emerged from the weekend's unresolved election with the power to bring either Labor or the Coalition to power in a minority government.

The three members -- Bob Katter from Kennedy in north Queensland, Rob Oakeshott from Lyne on the NSW mid-north coast and Tony Windsor from neighbouring New England -- all hail from electorates where access to high-speed broadband is rare and service is patchy, and where mobile networks do not reach towns with fewer than 100 people.

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http://www.theaustralian.com.au/national-affairs/abbott-set-to-shift-policy-ground-in-negotiations-with-independents/story-fn59niix-1225908602365

Abbott set to shift policy ground in negotiations with independents

  • Patricia Karvelas, Political correspondent
  • From: The Australian
  • August 23, 2010 12:00AM

TONY Abbott has revealed he is prepared to alter his election promises -- including on his proposed broadband network.

His move is an attempt to win over the crucial independent MPs who are weighing up their support for him.

Mr Abbott said yesterday that within the "broad" policy parameters he established during the campaign, he had every intention of negotiating on the themes the independents would raise with him.

"Obviously, I accept that broadband is important because I put forward a very good broadband policy. I don't want to pre-empt the discussions that I expect will be had over the next few days, just to say that I intend to be very pragmatic, but within the broad policy parameters which we discussed during the election," Mr Abbott said.

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http://www.commsday.com/commsday/?p=1432

COMMENT: Does the NBN have a mandate?

Posted on August 22nd, 2010 | 155 post views

One of the interesting conclusions to draw from Saturday night’s Australian election—where neither side gained a majority of seats and both sides scored a statistical dead heat in terms of two-party preferred vote—is that there was no clear verdict from the Australian people as to whether the next government has a mandate to either continue with or cancel the proposed NBN.

Three weeks into the campaign, with Labor riding on an NBN high with the publication of its proposed fibre maps and the Coalition wilting in the assault of a hostile media on its apparent lack of broadband smarts, it would have been safe to say that a potential Coalition win would have been in spite of its broadband policy, not because of it. It would have been quite legitimate for NBN advocates to continue to argue their case for a change in Coalition broadband policy no matter the result.

But the last two weeks of the campaign and the election results themselves muddy the waters.

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http://www.theaustralian.com.au/australian-it/exec-tech/tv-cables-as-quick-as-nbn-national-broadband-network/story-e6frgazf-1225909053431

TV cables as quick as NBN

IF the national broadband network ever gets built, it promises network speeds of 100 megabits per second.

There will be more in the future as the technology gets upgraded.

But you can get close to NBN speeds, at least in terms of download capacity, right now due to upgrades on the hybrid fibre cable networks laid down by the telcos back in the 90s to carry pay TV.

These have long offered internet access as well as pay TV and the latest DOCSIS 3.0 upgrade to the Optus HFC network pushes download bandwidth from 20Mbps right up to 100Mbps.

Note: This really works. A small pity the upload rate is only about 2Mb/Sec.

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Enjoy!

David.

Sunday, August 29, 2010

There is a Small Window For Sanity in E-Health as We Get a New Government. Maybe We Can Exploit It?

With the not entirely unexpected outcome of the recent federal election providing us with a moment or two of reflection time, it seemed to me there was a window open to maybe define a way forward that would work for all sides of politics.

If I were one of these, now rather important independents or Greens, (as both can’t govern in their own right) what would I be looking for?

First I would want to obtain acceptance that a transition to an e-Health enabled and improved health system will be neither quick and easy nor will be cost or pain free.

The evidence that we can improve the quality, safety and efficiency of our health system as well as making it more sustainable, through a planned, pragmatic, coherent deployment of e-Heath is in I believe.

Second I believe that we cannot endlessly put off serious commitment to making this transition for the whole health system, rather than just for those parts of the system that are controlled by the State health systems.

This inevitably means we need to move to a more inclusive, pragmatic form of national e-Health governance and leadership of which NEHTA is only a part.

From the blogs referenced in this post:

http://aushealthit.blogspot.com/2010/08/two-very-interesting-posts-what-does-it.html

it seems that others are also picking up that ‘business as usual’ for NEHTA is probably not appropriate going forward and that the time has come for another directional ‘transition’.

Third we really need to have a plan of how we move forward, how leadership and governance is to be provided, how engagement is to be obtained and how funding is to be provided.

Fourth we need to not only recognise the complexity of achieving an e-Health transition but also be prepared to learn from many other countries and health systems who have managed to make considerable headway from which useful lessons can be understood and adapted. This can be made to work but requires both health sector, consultative, technical and management skills!

Fifth we need to recognise that there are public concerns about the security, safety and privacy of their health information and that these concerns need not only to be allayed but clearly addressed.

Sixth, the time for technicians and government bureaucrats dreaming up plans in secret and then just ‘dropping them’ on the sector and public must surely be over. (Mr Rudd must be keenly aware just how foolish that approach is by now!). We need a new paradigm to match the new political reality in which we find ourselves.

Second last we do need to recognise that there are some good things happening around the country- and nurture them - while stamping out the silliness and obsession on the part of some who simply fail to grasp the 80/20 rule and seek perfection rather than practical useful outcomes.

Last I don’t believe we need to wait the many years for the NBN to be up and running before moving on this issue. (I almost wrote ‘moving forward (big grin!)). We already have the infrastructure we need to get started while other things evolve!

Were I the independents I would be wanting a proper detailed briefing on Health Issues (including e-Health) from both sides as well as the more high profile financial briefings and the like before making what will be pretty serious decisions.

We can only hope!

David.

AusHealthIT Poll Number 33 – Results – 29 August, 2010.

The question was:

Is The Full Investment in the NBN of $43 Billion Critical for e-Health in Australia?

Absolutely - e-Health Needs it All

- 15 (42%)

Possibly - But It is a Lot of Money

- 6 (17%)

I Think e-Health Can Work for A Good Deal Less

- 8 (22%)

About 1/2 the Funds is Enough for E-Health

- 0 (0%)

The $6B from The Opposition Would Do

- 6 (17%)

Votes: 35

This is a interesting outcome. I would have anticipated a little more scepticism about the need to spend $43B on NBN – based on the impact it might have both on e-Health and its other benefits.

There is definitely some uncertainty about the scale of the spend on Broadband needed to enable e-Health.

Again, many thanks to all those who voted!

David.

Saturday, August 28, 2010

Friday, August 27, 2010

Weekly Overseas Health IT Links - 27 August, 2010.

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. Note also that full access to some links may require site registration or subscription payment.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=23404

Beyond Alerts: Linking CDS to Evidence-Based Medicine

Alliance of Chicago’s dashboards can track performance at a glance, including Type II Diabetes quality measures. Screenshot courtesy of Chicago Alliance of Community Health Centers

Connecting clinical decision support (CDS) to evidence-based medicine can mean assembling or linking to knowledge bases, having reliable access to the latest research and practice-based evidence, and figuring out who pays and how. And those decision support systems better be workflow-sensitive. But organizations that take the CDS-evidence-based medicine plunge have a lot to gain, as do their patients.

In a recent review of 70 controlled trials, researchers from Duke University Medical Center and Old Dominion University’s College of Health Sciences found that CDS systems significantly improved clinical practice in more than two-thirds of trials. The research identified four CDS features that are predictors of improved clinical practice:

  • Automatic provision of decision support as part of clinician workflow
  • Provision of recommendations, rather than assessments only
  • Provision of decision support at the time location of decision making
  • Computer-based decision support

Of 32 systems possessing all four features, 30 (94 percent) significantly improved clinical practice, according to the researchers.

In the scope of meaningful use, the Department of Health and Human Services (HHS) defines CDS systems or tools as those that provide practitioners with “general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.”

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http://www.healthleadersmedia.com/print/LED-254873/Top-10-Most-Costly-Frequent-Medical-Errors

Top 10 Most Costly, Frequent Medical Errors

Cheryl Clark, for HealthLeaders Media, August 11, 2010

Avoidable medical errors added $19.5 billion to the nation's healthcare bill in 2008, according to a claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries (SOA). The report lists the 10 most expensive errors in healthcare settings.

Most of that amount, $17 billion, was the cost of providing inpatient, outpatient and prescription drug services to individuals affected by medical errors, says Jim Toole, chairman of SOA. "While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Pressure ulcers—the most frequent type of expensive error—were most often preventable, the authors wrote.

The other nine errors include postoperative infections and problems related to devices and prosthetics, among other complications.

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http://www.ehiprimarycare.com/comment_and_analysis/617/my_verdict_on_emis_web

My verdict on EMIS Web

10 Aug 2010

I went to the EMIS Web event at the Reebok stadium last week and was impressed. EMIS Web is the company’s ‘next generation’ system and it looks ready.

Some may say ‘about time’, but apparently EMIS is going through accreditation. EMIS Web is already running it in four practices, with the hope of 100 more this year and a couple of thousand next year.

Demand may be huge, though, and this will need to be managed by EMIS and by primary care trusts (at least until they are abolished and replaced by commissioning consortia).

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http://www.ehealtheurope.net/comment_and_analysis/615/expert_view:_david_akka

Expert view: David Akka

04 Aug 2010

The European head of Magic Software surveys progress on HL7 – and the integration approaches that can be taken to using it.

On 28 August 2005, Hurricane Katrina hit the southern coast of the US with devastating effect. More than 1,800 people lost their lives, and the total destruction of homes and property was estimated to top out at more than $81 billion.

In the resulting cleanup operation, the Health Level 7 (HL7) capabilities of the Houston-Harris County Immunization Registry enabled a total of 38,360 vaccination records to be searched in rapid time. The net result was 13,377 matches that saved more than $1.5m in needless vaccinations.

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http://www.modernhealthcare.com/article/20100818/NEWS/100819918

Health IT testing procedures issued

By Joseph Conn / HITS staff writer

Posted: August 18, 2010 - 12:15 pm ET

The federally supported National Institute of Standards and Technology has published a set of procedures for testing health information technology as part of a certification program that will determine healthcare providers' eligibility for government subsidies for the purchase of electronic health-record systems.

The NIST procedures are to be used by testing and certification organizations recognized by the Office of the National Coordinator for Health Information Technology. Providers must use a certified EHR in a "meaningful manner" to qualify for federal IT incentive payments provided under the Medicare and Medicaid programs and authorized by the American Recovery and Reinvestment Act of 2009.

The 45 test procedures "evaluate components of electronic health records such as their encryption, how they plot and display growth charts, and how they control access so that only authorized users can access their information," according to a statement from the NIST.

Read more.

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http://www.azcentral.com/arizonarepublic/business/articles/2010/08/20/20100820digital-hospital-records-more-efficient.html

Digital hospital records tied to higher efficiency

Patients treated at hospital emergency rooms that use all-digital-records systems are more likely to have shorter stays than at hospitals with paper or basic digital-records systems, according to a study by an Arizona State University professor.

The findings come at a time when several Arizona hospital systems and physicians seek to bolster their use of electronic health records while the federal government prepares to provide up to $27 billion to compel hospitals and doctors to adopt digital-records systems.

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http://www.fierceemr.com/story/report-epic-likely-get-massive-contract-replace-dods-ahlta-ehr/2010-08-19

Report: Epic likely to get massive contract to replace DoD's AHLTA EHR

August 19, 2010 — 9:44am ET | By Neil Versel

A week ago, FierceEMR reported that the man who would be top doc at the Pentagon--Dr. Jonathan Woodson, President Obama's nominee for assistant secretary of defense for health affairs--wants the development of an advanced EHR to be among his top priorities, should he be confirmed for the job. As it turns out, some of the gears already are turning.

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http://www.modernhealthcare.com/article/20100819/NEWS/100819896

CHIME publishes EHR guide for CIOs

By Andis Robeznieks / HITS staff writer

Posted: August 19, 2010 - 12:45 pm ET

The College of Healthcare Information Management Executives has just published The CIO's Guide to Implementing EHRs in the HITECH Era, an 80-page booklet aimed at assisting chief information officers and other IT executives in electronic health-record implementation and meeting the meaningful-use requirements to qualify for federal health IT subsidies provided for under the American Recovery and Reinvestment Act of 2009.

CHIME, an Ann Arbor, Mich.-based organization with some 1,400 members, noted that its latest guide evolved out of a similar publication, the Health Care Leader Action Guide on Implementation of Electronic Health Records (PDF), that it released this past July with the American Hospital Association.

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http://www.nytimes.com/2010/08/16/technology/16drill.html?_r=2&ref=health

Less Web Access Among Chronically Ill

By TEDDY WAYNE

Although the number of “cyberchondriacs” — people who research health information online — is at an all-time high, those who are afflicted with chronic conditions are less likely to have Internet access, according to data from Pew.

A Harris poll also found that, while Internet access has remained stable in the last five years, the percentage of frequent health information searchers leaped in the past year. The mean number of monthly searches for health information is 6.0, with 17 percent looking 10 or more times in the last month.

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http://healthcareitnews.com/news/patients-concern-about-access-medical-records-paramount-says-survey

Patients' concern about access to medical records is paramount, says survey

August 17, 2010 | Molly Merrill, Associate Editor

SAN FRANCISCO – Patients worry about not being able to access their paper medical records when they need them the most, placing that above concerns about whether their records contain inaccuracies or are stolen, according to a new survey.

The survey, which polled 500 female adults and 500 male adults on their paper medical records, was conducted by GfK Roper for Practice Fusion, a San Francisco-based EHR company.

According to the survey, inability to access medical records remained consistent as the top concern (26.7 percent) across all patient income levels, genders and regions.

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http://fcw.com/articles/2010/08/13/hhs-new-strategic-plan-emphasizes-health-it.aspx

HHS' new strategic plan emphasizes health IT

Draft plan sets goals for 2010 to 2015

The Health and Human Services Department is emphasizing adoption of health information technology and the fostering of innovation among its objectives for its new Draft Strategic Plan for Fiscal Years 2010-2015.

The strategy outlines three major goals: transforming the health care system, advancing knowledge and improving health. Within each goal, there are several objectives and specific projects.

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http://govhealthit.com/newsitem.aspx?nid=74469

Tiger team clarifies consent rules for HIEs

By Mary Mosquera

Tuesday, August 17, 2010

The federal privacy and security tiger team said health information exchanges cannot share sensitive patient information beyond a simple point-to-point exchange without first obtaining a patient’s consent.

The panel, which advises the Health Policy Committee, clarified the matter at an Aug. 16 meeting of the team. Its previous guidance was unclear about the privacy obligations of health information exchange organizations, according to panel members.

More specific language was required because some health information exchanges (HIEs) provide both multipoint exchange services among a provider community but also handle direct point-to-point exchange services.

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http://www.modernhealthcare.com/article/20100820/NEWS/100819894

Panel suggests some patient consent is needed

By Joseph Conn / HITS staff writer

Posted: August 20, 2010 - 12:00 pm ET

The federally chartered Health IT Policy Committee accepted a number of recommendations from its various work groups Thursday, including its Privacy & Security Tiger Team, but from the latter, acceptance came not without some controversy.

The tiger team presented its final list of proposed policy guidelines approved by the group last week. The group's recommendations targeted the exchanges of health information needed for providers to meet the meaningful-use requirements of the electronic health-record system subsidy program provided for under the American Recovery and Reinvestment Act of 2009.

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http://www.modernhealthcare.com/article/20100818/NEWS/100819920

Schwarzenegger: Telehealth the 'future of medicine'

By Joseph Conn / HITS staff writer

Posted: August 18, 2010 - 11:45 am ET

Gov. Arnold Schwarzenegger officially launched the California Telehealth Network on Tuesday at the UC Davis Cancer Center in Sacramento.

In a news briefing, Schwarzenegger lumped the telecommunications network's development in with construction of bridges, highways and other concrete-and-steel projects included in his administration's $60 billion infrastructure development program, but he also pointed to the special role information technology plays in saving lives and improving public health.

"Here, we're talking about the digital highway, broadband, that is also part of the infrastructure," Schwarzenegger told briefing attendees, including U.S. Chief Technology Officer Aneesh Chopra and state and local health IT officials. "A lot of people are not aware of that, but there are a thousand people a year dying in California of just someone misreading a prescription or not having the total medical records and so on, so this is inexcusable." With the launch of the California Telehealth Network, he said, "We are changing that, and reducing errors, and saving money at the same time."

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http://www.fiercehealthcare.com/story/california-debuts-telehealth-network-will-link-850-facilities-2012/2010-08-19

California debuts telehealth network that will link 850 facilities by 2012

August 19, 2010 — 1:04pm ET | By Sandra Yin

Telehealth, which can shrink the distance between patients and specialists and cut costs while improving patient outcomes, got a big boost when California Gov. Arnold Schwarzenegger launched what will become the largest telehealth system in the country Tuesday, the Los Angeles Times reports.

The California Telehealth Network is a peer-to-peer network that allows providers to share X-rays and other diagnostic test results instantaneously, and view treatments and procedures from remote emergency rooms or surgical centers in real time, according to InformationWeek. The network consists of a broadband stream that will be dedicated to healthcare information only and kept separate from the mainstream information highway, the Times reports.

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EHRs Can't Measure Stage 1 Meaningful Use

Two-thirds of the quality reporting requirements aren't captured in current hospital electronic health record systems, finds CSC study.

By Nicole Lewis, InformationWeek

Aug. 16, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226700296

As hospitals gear up to meet Stage 1 of the meaningful use requirements under the federal government's electronic health record (EHR) incentives program, a new report concludes that EHRs will only be able to provide about a third of the data requirements for Stage 1 quality measures outlined in the final rule.

Not only is time working against putting in place the necessary technology to meet the requirements for computerized physician order entry (CPOE), problem list, and so forth, but the quality reporting requirement adds to the duties. In short, hospitals, doctors, and other clinicians have their work cut out for them.

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http://www.ehiprimarycare.com/news/6162/docobo_offers_oz_client_management

Docobo offers Oz client management

16 Aug 2010

UK telehealth firm Docobo Ltd has announced an exclusive deal to distribute ComCare, an Australian community care client management system.

The ComCare product has been developed, and is widely used by, Silver Chain - a Western Australia-based, not for profit, charity that provides district nursing and care services to 40,000 clients annually.

ComCare is a client management application designed for community and residential health care organisations.

The system covers both staff and patient management system, and is designed to run on mobile devices, enabling case co-ordination and the support and management of community based staff.

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http://www.ehiprimarycare.com/news/6158/cochrane_backs_remote_monitoring

Cochrane backs remote monitoring

13 Aug 2010

Remote monitoring of patients with heart failure can reduce deaths and hospital admissions, according to a research review.

A Cochrane Database Systematic Review found those patients whose condition was being monitored remotely were 34% less likely to die than those without access to technology.

Among people taking part in a programme to remotely monitor heart failure, there were 102 deaths per 1,000 patients compared with 154 deaths per 1,000 patients who did not receive remote monitoring.

The review, which looked at 245 studies covering 9,500 patients with chronic failure and 2,710 undergoing monitoring, found a difference between remote monitoring involving digital or wireless transmission of data to a clinician and telephone support in which patients reported their own data over the telephone.

The report found that deaths were lower among patients offered telephone support, although the difference was less marked.

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http://www.ehiprimarycare.com/news/6161/microsoft_healthvault_

Microsoft HealthVault "stands ready”

13 Aug 2010

Microsoft’s international business development lead has told E-Health Insider that the company “stands ready” to work with the government on personal health records.

Should the coalition want to move forward with plans to introduce PHRs, Microsoft says it would hope to support them with its HealthVault platform.

EHI TV asked whether Microsoft is disappointed by the lack of action by the coalition government in developing PHRs, as suggested in last year’s Independent Review of NHS IT commissioned by the Conservatives.

In response, Mark Johnston said: “We stand ready to help support the ambition of the leaders in the government as well as the NHS.

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http://www.ihealthbeat.org/features/2010/storeandforward-telemedicine-eyed-for-mental-health-care.aspx

Tuesday, August 17, 2010

Store-and-Forward Telemedicine Eyed for Mental Health Care

by Kate Ackerman, iHealthBeat Senior Editor

As of September 2008, 77 million residents lived in the country's 3,059 mental health professional shortage areas, or HPSAs, according to the Kaiser Family Foundation. The foundation reported that it would take an additional 5,145 mental health care providers to meet a population to practitioner ratio of 10,000 to 1.

Telemedicine often is cited as a potential solution to the country's mental health provider shortage. However, synchronous telemedicine -- which involves live, two-way interactive video -- presents its own scheduling and technological challenges.

Peter Yellowlees -- professor of psychiatry and director of the health informatics graduate program at University of California-Davis -- noted that a large barrier to live telemedicine consultations is the difficulty of coordinating "five or six people to meet together at one time in two locations."

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http://govhealthit.com/newsitem.aspx?nid=74432

ONC sets up NHIN ‘governance’ workgroup

By Mary Mosquera

Friday, August 13, 2010

The Office of the National Coordinator (ONC) has created a new workgroup to make recommendations on establishing a set of high-level rules-of-the-road for organizations participating in the nationwide health information network (NHIN).

With creation of the “governance” panel, ONC wants to host discussions from the health IT community on what to include in a formal rulemaking on the issue planned for early next year.

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http://www.healthdatamanagement.com/news/health-care-technology-news-open-source-interoperability-40853-1.html

Emdeon Tests Open Source Clinical App

HDM Breaking News, August 13, 2010

Electronic data interchange vendor Emdeon Inc. is testing open source software to facilitate the exchange of clinical data.

The Nashville, Tenn.-based company is piloting the hData application developed by The MITRE Corp., McLean, Va. Emdeon sells revenue cycle management software and operates the nation's largest claims clearinghouse. It also electronically transmits lab orders/results and electronic prescriptions via its EDI network.

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http://www.ama-assn.org/amednews/2010/08/16/bica0816.htm

EMR purchase poses dilemma for doctors near retirement

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted Aug. 16, 2010.

Investing in an electronic medical records system was not something many physicians late in their careers were probably thinking about a few years ago. But the introduction of incentive pay for adopting an EMR -- and the penalties for not adopting -- have older physicians wondering if such an investment is worthwhile.

Starting in 2011, physicians will have the opportunity to earn up to $44,000 over five years in Medicare incentives, or $64,000 in Medicaid incentives, for "meaningful use" of an EMR as defined by the federal government. But if a physician plans to stay in practice more than five years and does not adopt an EMR, he or she can expect Medicare reimbursement to start declining in 2015, leading to a 5% total cut by 2019.

Todd Sherman, lead partner of the Sherman Sobin Group, a Mount Laurel, N.J.-based financial consulting group that specializes in physician retirement planning, said meaningful use is a hot topic for those deciding whether to invest in technology this late in a career.

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http://healthcareitnews.com/news/orlando-health-rolls-out-decision-support-tool-2000-docs

Orlando Health rolls out decision support tool for 2,000 docs

August 13, 2010 | Bernie Monegain, Editor

ORLANDO, FL – Orlando Health will implement a Web-based decision support checklist tool to assist physicians with diagnosis decisions.

The $1.7 billion not-for-profit healthcare organization with a community-based network of hospitals, tapped Isabel Healthcare for an automated system that it will make available to more than 2,000 physicians.

Orlando Health executives say the initiative is part of Orlando's commitment to quality and patient safety.

While most diagnoses are reached through the experience and knowledge of the physician, in 10 to 15 percent of cases they are more difficult to determine, according to industry reports. Isabel assists by accelerating the process for determining the diagnosis of a patient in those situations where there is some question.

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http://www.healthdatamanagement.com/news/health-care-technology-news-medications-medical-home-guidance-40857-1.html

Guide Covers Medications, Medical Home

HDM Breaking News, August 16, 2010

The Patient-Centered Primary Care Collaborative has released a guide describing the features and benefits of comprehensive medication management under the medical home model of care.

The Washington-based collaborative represents 600 employer, insurer, provider and consumer member organizations promoting the medical home model. The guide outlines the rationale for comprehensive medication management and the necessary steps to promote best practices and improve quality.

.....

The medication guide is available at pcpcc.net/files/medmanagement.pdf.

--Joseph Goedert

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http://www.modernhealthcare.com/article/20100816/NEWS/100819954

Reporter's notebook: Tracking at a crossroads

By Shawn Rhea / HITS staff writer

Posted: August 16, 2010 - 11:45 am ET

For the third year running, the supply-chain standards organization GS1 Healthcare US held a small roundtable discussion dinner for media, healthcare supply-chain professionals and suppliers during the annual Association for Healthcare Resource & Materials Management conference. This year's event occurred on the second evening of AHRMM's four-day conference, held this month in Denver.

The discussion had me thinking about the ongoing effort to implement a universal tracking system. GS1 has been politicking for several years to become top dog in the medical-products tracking standards arena, but healthcare reform has created a new sense of urgency to close the deal among proponents of the standards. Additionally, more than a few of the proponents are concerned that federal regulators aren't moving fast enough to develop rules and guidance that will ensure that standards for tracking the use of medical devices and products are appropriately linked to electronic health-record systems and useful to healthcare providers and patients.

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http://www.modernhealthcare.com/article/20100817/NEWS/100819934

Ingenix: A stimulated appetite for acquisitions

By Vince Galloro / HITS staff writer

Posted: August 17, 2010 - 11:00 am ET

Ingenix's voracious appetite for acquisitions is fueled in part by federal subsidies for electronic health-record systems under the American Recovery and Reinvestment Act of 2009.

In two of its three deals announced in the last month, Ingenix, an Eden Prairie, Minn.-based division of insurer UnitedHealth Group, has pointed to the stimulus law as a driving factor.

Ingenix's most recent deal is a definitive agreement to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen. The stimulus act provides $783 million in near-term direct funding for the implementation of statewide and regional health information exchanges, in addition to the $36.5 billion it provides in incentives for hospitals and physicians to make meaningful use of EHRs, Ingenix noted in its news release announcing the deal.

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http://www.modernhealthcare.com/article/20100816/NEWS/308169970

Ingenix to acquire Axolotl Corp.

By Vince Galloro / HITS staff writer

Posted: August 16, 2010 - 4:30 pm ET

Ingenix, Eden Prairie, Minn., said it has a definitive agreement in place to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen

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http://www.fiercehealthit.com/story/get-prescription-online-without-ever-seeing-doc/2010-08-16

Get a prescription online without ever seeing a doc

August 16, 2010 — 1:24pm ET | By Neil Versel

Editor’s Corner

A recent article in Forbes reports how patients in Britain are able to go to least a dozen websites for online consultations with doctors they've never met and have physicians prescribe medications. The sites are completely legal and regulated by an agency called the Care Quality Commission.

"The British websites are definitely an exception, but they are the start of a trend we will soon see everywhere," Norwegian telemedicine expert Dr. Steinar Pedersen told the business magazine. Pedersen was unable to name any other countries that allow physicians to prescribe medication remotely for patients they've never seen in person.

In countries including Canada, Denmark, Norway, Germany, and France, doctors are only allowed to treat patients online if they have previously seen them in person," Forbes reports. "In the United States, several companies offer online medicine," the article says, "but patients must typically speak to a doctor on the telephone or set up a videoconference for a live, face-to-face chat."

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http://www.govhealthit.com/newsitem.aspx?nid=74427

VA, DOD agree on single lifetime personal identifier

By Mary Mosquera

Wednesday, August 11, 2010

The Veterans Affairs and the Defense departments have agreed on a single common personal identifier, one of the keys to its efforts to build an electronic record that can be follow military service members throughout their lifetimes.

The agreement is a significant step toward making the complex Virtual Lifetime Electronic Record (VLER) project a reality because it will identify a service member whether they are seeking healthcare services or payment benefits and on active duty or retired, according to a senior VA official.

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Enjoy!

David.