Thursday, May 31, 2012

It Looks To Me That Clinician Support For The NEHRS Is Fast Ebbing Away. Government Really Isn’t Trying.

Last week saw a lot of reports regarding clinicians and their involvement in the NEHRS (PCEHR).
Importantly we had a formal release on the matter from the President of the College of GPs (RACGP).

The personally controlled electronic health record (PCEHR) – decision time approaching for general practitioners and practices

As general practitioners (GPs), every day we see patients falling through the cracks in our fragmented health system. As GPs working in primary care we understand better than any other healthcare sector that without improvements in e-health and medical information management systems we will continue to see our patients exposed to unnecessary risks, including adverse events and medication errors. That is why to date the College has been strongly supportive of the development of a shared electronic medical record.
A shared electronic medical record has the potential to improve our patients’ health outcomes and their experience of the healthcare system.
Savings to the health system will be achieved through a shared electronic medical record. These savings will be achieved from better medicines management and through reduced unnecessary duplication of tests and referrals. Our Health Minister has described it as, “a long-term return of $11 billion for a government investment which includes around $465 million over the last two years, and another $233 million in the next two”[1].
However, the international experience is clear that for general practice, the implementation is often costly and takes time, training and infrastructure investment. e-health is a long term strategy and must be funded to succeed.
We are now only a matter of weeks away from the roll out of the PCEHR across Australian general practices. From July anyone seeking healthcare, anywhere in Australia, can register for a PCEHR.
A national e-health record system requires a national approach to implementation. This is not just a technology project; it is a program to change professional behaviour, professional practice and processes. Whilst there has been significant investment in the 12 e-health pilot sites [2], this year’s Federal Budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally. ‘Go live’ is now very close and adequate support for implementation across the thousands of Australian practices, despite heavy lobbying, has not been forthcoming.
Members will be aware of the College’s strong and consistent support for innovation and use of technology in general practice. The College has been working on standards, guidelines and support for the important role of general practice in e-health over many years. General practice is central to quality care for patients and our role in this initiative is critical. However, our members are increasingly anxious about expectations and ‘unknowns’ in participating in this initiative.
Our College has worked tirelessly to explore every avenue to appropriately support general practice in this important national initiative. Since the release of the Budget, our CEO and I have met with relevant Ministerial Advisors and appropriate Deputy Secretaries at the Department of Health and Ageing, seeking answers and commitments to better support general practice.
Members and practices must make decisions soon and the information below, I believe, summarises what is and is not known regarding the PCEHR roll out, so that practices can make an informed choice regarding their participation. To assist practices in this decision, until 1 July, we will be providing members with weekly updates via Fridayfacts on the government’s implementation of the PCEHR.
Lots more is found here:
The release then goes on to identify five key area it is not happy with

1. Clinical support for the creation and maintenance of the PCEHR

2. e-health PIP

3. On the ground support

4. Data safety / governance

5. Draft Terms and Conditions for the operation of the PCEHR

The RACGP has received the second draft of the Terms and Conditions for the use of the PCEHR by providers. Further consultation will occur and the RACGP has been informed that a ministerial advisory committee will be formed. The draft Terms and Conditions do not currently have the support of the RACGP.
.....
Professor Claire Jackson
RACGP President
There is coverage of this release here:

RACGP wary of PCEHR roll out

22 May, 2012 Kate Cowling
Just weeks before the launch of the PCEHR, the RACGP has reaffirmed its support for a shared electronic medical record, but echoed the lingering concerns of some members.
In a memo to members, RACGP president Professor Claire Jackson says an online record would save the health system significantly, but only if a “national approach” is adopted and a few issues ironed out.
“This year’s federal budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally,” she says.
With GPs having to make important decisions ahead of the 1 July rollout, doctors have expressed concerns, she says, about the ‘unknowns’ of the record, like data security, technological support and Medicare rebate specifics.
More here:
And here:

Money woes cause GP PCEHR moans

General practitioners are increasingly worried about the looming July 1 deadline for the introduction of the personally controlled electronic healthcare record (PCEHR). Among the issues concerning them are data governance standards, along with remuneration issues associated with creating and maintaining a patient’s PCEHR.
“Members are worried about the extra workload,” Royal Australian College of General Practitioners president Professor Claire Jackson told eHealthspace.org in an interview.
“They are concerned about resourcing at a practice level, and the people power needed,” she said. “They need more than five weeks to prepare. GPs are the ones who are doing the heavy lifting in the ehealth system.”
Lots more here:
The AMA has also spoken recently of its concern - see here:
This position was made pretty clear again very recently here:

System not ready for e-Health, say GPs

29/05/2012
Emma Connors
Doctors have called on the government to delay the roll-out of electronic health records, warning the technology is not ready and the business case for GPs is non-existent.
“We share the vision but the process and the timing is terrible. If general practices and hospitals won’t be able to use it by July 1, why this headlong rush?” said Australian Medical Association president Steve Hambleton.
“If it needs some more stimulation to get it to critical mass, then let’s do that. Otherwise we will be relying solely on individuals who are motivated and prepared to pay – and that is not going to work,” he said.
Much more here:
What I find interesting is that a month or so out from launch of a half billion e-Health program that the Government does not have the ducks lined up and have the support of clinicians who are vital to make the whole thing work.
While I understand the profession would want to optimise what it gets from its role in the NEHRS it seems to me that the Government is just going out of its way to ensure the approach it is adopting is not supported and is pretty under resourced and half baked.
Take this release:

$50 million for Medicare Locals to help rollout eHealth records

18 May 2012
Health Minister Tanya Plibersek today announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Gillard Government’s new eHealth records system.
Ms Plibersek said the funding was part of a package to support doctors and other health professionals to help rollout the new system.
“Family doctors co-ordinate healthcare for most patients, so we know they have an important role to play in the eHealth records system,” Ms Plibersek said.
“eHealth records will ensure doctors can access a patient’s medical information in one convenient online location, reducing errors and making diagnosis and treatment quicker and easier.”
Full release here:
Guess what - there are just a few under 25,000 GPs in Australia who are active so this amounts to about  $1000 per GP per year even if every cent made it to the GPs. Hardly enough to do all the support, hand holding and support that is needed.
It also seems the consumers are less than totally keen:

50% won’t sign up for PCEHR

21 May, 2012 Michael Woodhead
Six weeks away from its launch, only one in ten people have heard of the PCEHR, and 50% of consumers say they won’t sign up for it, a survey has found.
In findings to be presented at the National Medicines Symposium this week, a survey of 203 consumers found that only 9% were aware of PCEHR.
And while almost 60% agreed with the implementation of the personally-controlled electronic health records system, only 50% said they would sign up to have a PCEHR themselves.
More here:
All in all the selling of all this - as well as the inadequacy of what is being offered - is really meaning a lot of money is being wasted in my view. They are not really serious or they would be doing a lot more.
David.

Wednesday, May 30, 2012

Random Notes On The Senate Estimates Hearing on E-Health - May 30 - 2012.

Notes typed on fly. Accuracy not guaranteed. Did my best. Corrections welcome!
Session ran from 7.20pm to 8.20pm. Key responders were Ms Jane Halton, Mr Peter Fleming and Ms R. Huxtable.
Notes taken as questions were responded to.

Senator Sinodinos

1. Legislation is still out there and not yet passed - timing not discussed - think some things can still happen without passage if it comes to that.
2. Mr Fleming is looking pretty nervous as of 7:30.
3. GP Software is being worked on but not ready, it might be a while yet before we see some progress on this.
4. Training for CPs and so on is not in any way ready for June 30. Coverage for training is only those caring for the about 1.6 million people at Wave Sites.
5. People will be only be able to register - but only that - essentially zero else as of July 1.(Ms Huxtable).
6. Provider registration is rather behind time - maybe September.
7. Senator Sinodinos seems to be pretty focussed and getting DoHA pinned down.
8. Engagement with GP seems to really be very vague. Not clear on how this is moving this forward.
9. Ms Halton admits the benefits will be pretty slow to come. Mainly from connecting various information sources.
10. $110 on the PCEHR for the 2 years has been spent - $218 on NEHTA Functions.
11. $75 million spent so far on Pilot sites - also building infrastructure, evaluation etc...lots of the rest.
12. Pilot sites costs taken on notice - DoHA can’t remember.
13. Cost Benefits. More information is on Commonwealth Health Web Site. Headlines are better shared care and handover improvements.
14. Legal Liability - can affect adoption rates. Guidelines do not exist as yet publicly. Terms and conditions of use are also not resolved.
15. PIP is trying to set expectations on GPs and rules and plans are still being negotiated.
16. Identifiers are still not being used by GP Software, Aged Care and Pharmacy in any large way and is hoped to happen at some point.
17. Long term funding and governance is not settled after the next 2 years.
18. Operating Costs are apparently not going to rise after the next 2 years. The variable cost of adding people is not known.
19. Difference between variable and establishment cost not defined.
20. Clinical Safety Document - is summary - and has been consulted carefully.
21. Ms Halton suggests this is a new way - fixing the systematising of safety.
22. Dr Mitchell - Clinical Safety is a journey. Transparent information to patients will help.
23. NEHTA takes the responsibility for record safety formally - but they hope patient ownership will help this issue.
24. All this will only work if there is a reasonable level adoption.

Senator Di-Natale

25. Answer to where to complain: Complaint handling process is very bureaucratic it seems.
26. Consent to System Evolution as System Changes: They don’t know how this will be handled. DoHA thinks it is legal.
27. Once signed up you are in until you want out is essentially the message from DoHA.
28 Day One - Focus is on Consumer Registration - On-Line Later - Consumer Portal will enable patient entered notes. Provider Uploads will be September or later. All the Medicare Data (Immunisations etc. also later.)
29. Data Upload will be a bit later - end of September or so.
More commentary after we have transcript.
David.

Senate Estimates E-Health Program Change.

The session is now from 7:15 to 8:15 pm

Enjoy.

David.

Tuesday, May 29, 2012

The Senate Estimates Hearing On E-Health Will Be Very Interesting Tomorrow.

I alerted readers here to the hearing.

http://aushealthit.blogspot.com.au/2012/05/senate-estimates-hearings-on-e-health.html

Late breaking news is that the questions for the Liberals will be put by experts including Senator Arthur Sinodinos.

Here is a link to his mini-site.

http://www.aph.gov.au/Senators_and_Members/Parliamentarian?MPID=bv7

He was John Howard's Chief of Staff for many years in the last few Howard Governments. He did the job for a decade (1996-2006) so he know where bodies are buried!

If any one knows how to actually get answers from the bureaucracy this is your man.

This might be a really fun watch - starting at 7:30pm 30/05/2012.

If I were Ms Jane Halton PSM (Sec DoHA) or Mr Fleming (CEO NEHTA) I would be doing some very careful preparation. I know, for sure, that the Opposition and the Greens are keen for some answers on a range of topics!

Use the link above to find out how to see the session - it is planned to last for 1 hour.

David.

NEHTA Are Up To Their Old Tricks Again - Releasing Controversial Reports on Fridays. Finally A Clinical Safety Document.

The following lurched into view on Friday.

Clinical Safety Case Report PCEHR Release 1A

Here is the direct link:
Here are the document details from the title page:

 Clinical Safety Case Report
Project Name: PCEHR Release 1A
Reference: NEHTA-CSMS-REP-PCEHR-005
Version 1.1
27/4/12
Status: Issued
The heading box of the Executive Summary is really amazing.
“NEHTA has made an assessment that there are no clinical hazards identified in relation to PCEHR Release 1a that are classified as a High Clinical Risk which leaves a Tolerable Residual Risk Classification as per Appendix C, Table 4.
NEHTA therefore considers that there are no Unacceptable Residual Risks present in PCEHR Release 1a (R1a).”
When you read something like this you instantly want to know what “Tolerable” means.
So reading on we find the following.
If a clinical risk is “Medium” it is said to be “Tolerable”
This is described as needing the action as  follows:
“Customer to be notified of the Clinical Hazard as soon as practicable and appropriate mitigating action agreed where possible. Where agreed mitigation leads to Changes in relation to additional functional or non-functional parts of the Customer’s Requirements. These will be identified in the Clinical Safety Case Report and evidence for their achievement provided.”
I read this to say the issues need to be fixed pronto.
There are 4 issues that fall into this category.
Page 29 (of 39) on provides the details:

8 Results of Clinical Safety Assessment

8.1 Medium Clinical Risks

The following generic clinical hazards that are deemed to have a Medium Residual Risk rating are described below, along with some examples of associated causes and controls. These generic clinical risks include:
8.1.1 Reference data is absent or incorrect or inconsistent between different clinical systems (H020)
8.1.2 Clinical information is presented inappropriately or in a manner that its context is misleading or cannot be ascertained (H110)
8.1.3 Patient identification data or contact information may be missing, incorrect, incomplete, out of date or corrupt (H020)
8.1.4 Misleading or absent information in a patient’s clinical record (H050)
Generic clinical risks that are rated Low and Very Low are documented in the Hazard Register and are not specifically discussed in the body of this report.
---- End Extract.
Each of these is then expanded on in some detail you can read in the pages following.
I would have to say all of these need to be fixed and really quickly. They are clearly clinically dangerous. They also don’t look all that easy to fix in the short term.
Here is, however, the most amazing comment (Page 32):

9.3 Management of Clinical Safety Issues

During the development of this Release Clinical Safety issues have been identified and managed to reduce Clinical Risk within the constraints as noted in section 6.3.
Clinical Safety issues were managed by the Clinical Safety Unit as follows:
·         Provided feedback on requirements, functional and technical design documents to PCEHR project teams.
·         Raised a number of prominent risks in separate workshops (hazard assessment workshops) with the PCEHR team, Clinical Leads and other appropriate staff.
The feedback to date on clinical safety recommendations has not described to what degree they have been accepted in the design and if they will be included in future specifications.
----- End Extract.
So this work is all essentially being treated as needing just an optional response.
A couple of things need to be recognised here.
First this report is on the planned test version (1A) rather than the production version (1B) but it would have been useful to have the production version assessment available well before July 1 when ‘go-live’ is planned.
Second as I read the four medium risks described it is not clear just how easily they might be addressed in a few weeks. Some of these look to need a lot of work to fix.
With the E-Health Session of Senate Estimates on Wednesday 30 May, 2012 at 7:30pm one wonders if this was just not released in a rush to show there was at least one ‘Clinical Safety’ document in existence. I wonder where all the documents describing the methodology and the risk register are hiding?
So much for NEHTA’s embedded Clinical Safety Culture!
David.

Monday, May 28, 2012

Weekly Australian Health IT Links – 28th May, 2012.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

We are rapidly heading to the time when the NEHRS (PCEHR) rubber actually hits the road. As the time approaches we are seeing more and more concerns in a range of areas from implementation support, value to practitioners, safety and functionality among other things.
It is my feeling that the launch will be utterly drowned out by the commencement of the Carbon Tax which I am sure will cause all sorts of noise and carrying on at a political level. We will need to wait a while to see what the real outcomes are and to see if the fear-mongering was justified or not.
Otherwise it seems to me with the comments on the PCEHR and Medicare Locals from the Opposition that we are rather entering some contested times for e-Health in general and that it is a pity we could not be undertaking sensible e-Health developments in a bipartisan fashion.
It might just be that the Government approach has been so flawed that this is simply not possible for the Opposition and I can certainly understand a position of that sort. Maybe if we had taken a more bipartisan approach years back we might have got a good deal further long before now?
To see how far all this has come un-stuck you only have to go and read the 19 page document on the PCEHR from the National Health and Hospital’s Reform Commission.
Go here to browse (if you missed yesterday's blog):
-----

The personally controlled electronic health record (PCEHR) – decision time approaching for general practitioners and practices

As general practitioners (GPs), every day we see patients falling through the cracks in our fragmented health system. As GPs working in primary care we understand better than any other healthcare sector that without improvements in e-health and medical information management systems we will continue to see our patients exposed to unnecessary risks, including adverse events and medication errors. That is why to date the College has been strongly supportive of the development of a shared electronic medical record.
A shared electronic medical record has the potential to improve our patients’ health outcomes and their experience of the healthcare system.
Savings to the health system will be achieved through a shared electronic medical record. These savings will be achieved from better medicines management and through reduced unnecessary duplication of tests and referrals. Our Health Minister has described it as, “a long-term return of $11 billion for a government investment which includes around $465 million over the last two years, and another $233 million in the next two”[1].
-----

RACGP wary of PCEHR roll out

22 May, 2012 Kate Cowling
Just weeks before the launch of the PCEHR, the RACGP has reaffirmed its support for a shared electronic medical record, but echoed the lingering concerns of some members.
In a memo to members, RACGP president Professor Claire Jackson says an online record would save the health system significantly, but only if a “national approach” is adopted and a few issues ironed out.
-----

50% won’t sign up for PCEHR

21 May, 2012 Michael Woodhead
Six weeks away from its launch, only one in ten people have heard of the PCEHR, and 50% of consumers say they won’t sign up for it, a survey has found.
In findings to be presented at the National Medicines Symposium this week, a survey of 203 consumers found that only 9% were aware of PCEHR.
And while almost 60% agreed with the implementation of the personally-controlled electronic health records system, only 50% said they would sign up to have a PCEHR themselves.
-----

Thousands sign up to 'wotif.com' for doctors

Rhianna King
May 24, 2012 - 8:49AM
A WA website which allows patients to view GP availability across the city and book appointments online has resulted in 3,000 booking in three months alone.
The Australian-first service is now being rolled out across the country after it proved a success with patients who weren't prepared to wait for an appointment.
Perth GP Marcus Tan, the medical director of the Healthengine.com.au site, said it acted like a "wotif.com for doctors".
-----

GPs to access patient’s prescription histories

22nd May 2012
BEGINNING in July, GPs around Australia will be able to access a patient’s entire prescription history during consultation, as part of a bid to curb doctor shopping and improve quality use of medicine.
Along with detailed information on doses and types of drugs a patient has been prescribed, they’ll receive alerts if there’s evidence of drug dependency, a conference has heard.
The real time reporting software, called DORA, is already being piloted successfully in Tasmania at five general practices, Dr Adrian Reynolds, clinical director of Tasmania’s Drug and Alcohol Services, told attendees at the Royal Australian and New Zealand College of Psychiatrists congress in Hobart yesterday.
-----

eHealth to save $11bn for budget

David Ramli
The federal government has claimed its troubled electronic health programs will save more than $11 billion over the next 15 years as it guns for a budget surplus.
Health Minister Tanya Plibersek made the comments during a speech to the Committee for Economic Development of Australia in Melbourne last week.
“The national eHealth records system will mean better, more efficient, more convenient healthcare,” she said. “We estimate eHealth will save the federal government around $11 billion over 15 years. However you look at it, that’s pretty good bang for your buck.”
-----

New rules for e-health PIP revealed

21 May, 2012 Sarah Colyer
New details have emerged showing what GPs must do to avoid losing e-health practice incentive payments worth up to $50,000.
Under changes to come into effect next February, practices seeking the incentive payments will be forced to sign up for the personally controlled electronic health record (PCEHR) system and meet several conditions.
These will include showing they have the capacity to upload event summaries and shared health summaries - which will include a list of patients' diagnoses, medications, adverse reactions and allergies, and are meant to be used by hospitals, after-hours services and other health professionals.
-----

Money woes cause GP PCEHR moans

General practitioners are increasingly worried about the looming July 1 deadline for the introduction of the personally controlled electronic healthcare record (PCEHR). Among the issues concerning them are data governance standards, along with remuneration issues associated with creating and maintaining a patient’s PCEHR.
“Members are worried about the extra workload,” Royal Australian College of General Practitioners president Professor Claire Jackson told eHealthspace.org in an interview.
“They are concerned about resourcing at a practice level, and the people power needed,” she said. “They need more than five weeks to prepare. GPs are the ones who are doing the heavy lifting in the ehealth system.”
-----

PCEHRs will be kept for 30 years after death

24 May, 2012 Paul Smith
Patient clinical information in e-health records will be held by federal bureaucrats for 30 years after the patient’s death — even if the patient has “deactivated” their records.
The government is expecting millions of patients to eventually sign up for personally controlled electronic health records (PCEHR) after the system is rolled out from July this year.
But it has emerged that even if the patient deactivates their records — which will include health summaries, diagnoses, treatments, event and discharge summaries — the e-health record and its contents will not be deleted from the system.
-----

GP security vital to e-health success: NEHTA

But security, funding concerns remain unanswered.

Former iSOFT Australia managing director Denis Tebbutt has urged general practitioners to better collaborate with the Government's lead e-health body to ensure success of the personally controlled electronic health record (PCEHR).
The $628.3 million initiative, scheduled to go live on July 1, allows Australians to opt into a shared electronic health record, providing information to authorised GPs and doctors on one's personal history and medication.
The records would be stored on a federated cloud of repositories operated nationally, in states and territories and at large hospitals.
-----

BUDGET Review 2012-13 Index

E Health
Dr Rhonda Jolly
In the 2010–11 Budget the Government committed funding in of $466.7 million over two years to establish key components of a person-controlled electronic health record system (PCEHR).[1] While there was some strident opposition to the idea of a PCEHR, based on concerns about issues such as the security and privacy of records in the system, most health stakeholders initially expressed cautious support for the idea of electronic health records. This was because it was generally agreed that these records could save lives and help limit escalating health expenditure.[2] From the beginning, however, many stakeholders doubted whether the amount of funding allocated by the Government would be sufficient to deliver promised outcomes.[3]
-----

Troubled HealthSMART System Finally Cancelled in Victoria Australia

POSTED BY: Robert N. Charette  /  Mon, May 21, 2012
 The Victorian state government finally decided last week to throw in the towel on the nearly decade-long implementation of its HealthSMART e-health record system project after recognizing that the "e" actually stood for an "extravagance" it could no longer afford.
In 2003, Australia’s Victorian government embarked on an ambitious modernization of the state’s health IT infrastructure. The idea was to combine its health-related financial systems with its patient record management systems through the creation of a comprehensive, Victoria-wide electronic health record (EHR) system. The original HealthSMART project budget was $A323 million and a completion date was set for June 2007. However, by the end of 2007, while some 57% of the money had been spent, only 24% of the project had been completed. Projected costs to complete had risen to $A427 million, and a roll out date was estimated to be sometime in late 2009. There was talk at the time of cancelling the project, but the government decided to keep the effort alive given what it believed to be its significant potential benefits.
-----

Fresh fears over e-health policing plan

23 May, 2012 Sarah Colyer
A redraft of a contract giving bureaucrats powers to enter GP practices and access records has failed to allay the concerns of doctors' groups.
The initial version of contract -- drawn up by the Federal Health Department as a requirement for any GP practice wanting to participate in the national electronic health record system -- was sent back to the drawing board last month after outcry from doctors.
At the time, the AMA, RACGP, medical indemnity groups and the nation's most senior clinical advisor on e-health, Dr Mukesh Haikerwal, all condemned the "search and seizure" powers in the contract, which had been leaked to the media.
But a new draft of the contract -- released to doctors' groups under strict gagging orders prohibiting them from talking about its contents -- has failed to settle the dispute.
-----

$50 million for Medicare Locals to help rollout eHealth records

18 May 2012
Health Minister Tanya Plibersek today announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Gillard Government’s new eHealth records system.
Ms Plibersek said the funding was part of a package to support doctors and other health professionals to help rollout the new system.
“Family doctors co-ordinate healthcare for most patients, so we know they have an important role to play in the eHealth records system,” Ms Plibersek said.
-----

Medicare Locals get $50m for e-health

By Josh Taylor, ZDNet.com.au on May 21st, 2012
The Federal Government will provide $50 million to Medicare Locals over the next two years, to support the adoption of e-health records from 1 July.
Minister for Health Tanya Plibersek announced the funding on Friday, stating that it will be provided in addition to the $233.7 million set aside in the 2012 Budget for the launch of the personally controlled e-health records (PCEHR). Medicare Locals are networks that help to support frontline health providers.
-----

Coalition pledge to abolish Medicare Locals

25 May, 2012 Michael Woodhead
Opposition health spokesman Peter Dutton says the coalition will abolish Medicare Locals as part of a drive to reverse Labor’s creation of “multiple health bureaucracies”.
Speaking at the AMA National Conference in Melbourne today, Mr Dutton said Labor had started with good intent in health but had failed to deliver, ignoring most of the health reforms recommended by its own advisory commission.
The only result was the creation of additional bureaucracies such as Medicare Locals, the Independent Hospital Pricing Authority and the Australian Commission on Safety and Quality on Health, he said.
-----

Web to aid health service delivery

THE internet could soon start to accelerate inter-governmental collaboration on delivery social and health services.
Victoria Health was in the early stages of talks with other states to syndicate content delivered from its highly successful online portal Better Health Channel.

Gerardine O’Sullivan head of BHC said it was recognised that the sites content was costly to reproduce and maintain, and that sharing it with other jurisdictions made sense.
-----

Health risks for kids online

HEALTH experts say doctors, parents and schools have a crucial role to play in minimising the negative effects of internet pornography on adolescents.
Their comments  follow the publication of an editorial in the MJA that draws on the latest evidence to show how an explosion in the use of sexually explicit online content by young people is affecting their health. (1)
The editorial authors — Dr Rebecca Guy and Professor John Kaldor, both from the Sexual Health Program at the University of NSW, and Professor George Patton, from the Centre for Adolescent Health at the University of Melbourne — said adolescents were now more easily able to engage with pornography than ever before, both by choice and inadvertently. They referred to a comprehensive Australian survey that showed that 28% of 9–16-year-olds had seen sexual material online.
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Queensland Health wins major IT excellence award

QUEENSLAND Health, which had been reeling from massive problems with its payroll system, has hit back by snaring a major industry-wide IT award presented last night at CeBIT.
The excellence in eGovernment awards in information technology were presented at a celebratory dinner last night at CeBIT, a major national information technology show this week at Sydney’s Darling Harbour.
Queensland Health won its eGovernment award for “The Viewer”, a project that has streamlined how clinicians access patient information about their patients.

SA Health's journey to e-health

By Michael Lee, ZDNet.com.au on May 23rd, 2012
Implementing e-health services for an entire state is a daunting task, but, as South Australian Health manager for e-health services, Bill Le Blanc, has revealed, even the preparation steps are complicated tasks.
Speaking at the e-health track of CeBIT's 2012 conference, Le Blanc outlined the process through which SA Health went to transform its state-wide IT systems.
SA Health was forced to reconsider its IT systems and reporting lines because of legislative changes put in place to prepare for e-health records. Reforming the health department was a legislative requirement, relegating return on investment and other commercial considerations to be of lesser importance, according to Le Blanc. He said that the department consequently had to jump into reform headfirst.
-----
http://www.newcastle.edu.au/news/2012/05/23/epidemic-reporters-needed-for-national-flu-tracking.html

Epidemic reporters needed for national flu tracking
Published: Wednesday, 23 May 2012
The world’s fastest growing online influenza surveillance program is seeking more participants to register their symptoms and help researchers better understand the potentially life-threatening disease.
Flutracking.net, an Australian initiative of researchers from the University of Newcastle and Hunter New England Health, is the second largest program of its kind in the world.
This flu season the program’s organisers are aiming to boost the total number of participants from approximately 12,000 to 15,000 to further increase the accuracy of the community influenza snapshot.

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Clinical Safety

The national eHealth system will improve clinical outcomes, and to do that it needs clinically safe and efficient foundations. That’s why the clinical safety and integrity of NEHTA’s products guides everything NEHTA does as an organisation.
There are three key clinical quality and safety processes in NEHTA, the Clinical Safety Unit; the Clinical Safety Working Group and the Clinical Governance Review Board, each ensuring safety.
.....
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NCTIS Newsletter

Welcome to Edition 4 of our NCTIS Newsletter of 2012. We have exciting news about recent and upcoming events as well as information about recent product releases to share with you.
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Privacy Act changes finally introduced to parliament

The government has introduced reforms to the Privacy Act, after releasing its initial response to the ALRC inquiry over two-and-a-half years ago
Reforms to the Privacy Act 1988 have finally been introduced to parliament, six years after the Australian Law Reform Commission (ALRC) began its inquiry.
The reforms are part of the government's first stage response to the ALRC inquiry, which began in 2006.
The changes introduced to parliament include: Increased regulation of personal information for marketing purposes; extending privacy protections to unsolicited information; restrictions on sending personal information to overseas companies; improved access for consumers to information held about them; and an increased protection of personal e-health information.
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Intel researching computers that mimic human brain

Tova Cohen
May 25, 2012
Intel is launching research in Israel into technology that mimics the human brain and develops devices that "learn" about their user.
"Machine learning is such a huge opportunity," Justin Rattner, Intel's chief technology officer, told reporters in Tel Aviv.
"Despite their name, smartphones are rather dumb devices. My smartphone doesn't know anything more about me than when I got it," he added.
"All of these devices will come to know us as individuals, will very much tailor themselves to us."
The research, to be carried out by the Intel Collaborative Research Institute for Computational Intelligence along with specialists from the Technion in Haifa and the Hebrew University in Jerusalem, is aimed at enabling new applications, such as small, wearable computers that can enhance daily life.
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NBN struggles to connect

John McDuling

KEY POINTS

  • NBN Co will deliver a revised business plan next week.
  • Chief executive Mike Quigley says the rollout allows for a change of policy after the next election.
NBN Co chief executive Mike Quigley will admit tonight the $36 billion national broadband network faces significant construction challenges as he prepares to lower official connection forecasts.
Mr Quigley is expected to tell MPs that the government business enterprise is struggling to cope with obligations to roll out fibre to greenfield developments in remote areas, during what could be an explosive Senate estimates hearing.
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The nasties of the net

Matthew JC Powell
May 20, 2012
The innocent choice to click could send your computer into a crash.
As users of technology, we're constantly bombarded with warnings about the malicious things malicious people try to do to our computers. The malicious software they use to do this has a name: malware.
Malware comes in many forms, with names meaning subtly different things. What they do, how they can affect you and how they can be avoided need not be complicated. Along with malware, there are different types of attacks for different gains.
On the theory that a little bit of knowledge can make a big difference, here's just a few of the more important terms to know.
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Chrome dethrones IE as king of browsers

Peter Pachal
May 22, 2012 - 8:50AM
Chrome has just edged out IE, according to the latest stats.
This post was originally published on Mashable.
Google's Chrome web browser just passed Microsoft's Internet Explorer to become the most-used browser in the world, says the latest data from a digital analytics service.
Although Chrome has edged out IE before for short periods, the last week marks the first time Chrome was the No. 1 browser for a sustained period of one week. Exactly 31.88 per cent of the world's web traffic was done on Chrome, according to StatCounter, while IE is a close second at 31.47 per cent.
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Enjoy!
David.

AusHealthIT Poll Number 123 – Results – 28th May, 2012.

The question was:
How Likely Do You Think It Is That The NEHRS (PCEHR) Will Suffer The Same Fate As HealthSMART And Ultimately (5 Years) Be Defunded / Cancelled?
No Way
-  4 (8%)
Unlikely
  11 (23%)
Neutral
-  0 (0%)
Likely
-  14 (29%)
Virtually Certain
-  18 (38%)
Votes 47
There is a pretty clear view here that we won’t have a NEHRS that is operational in five years from now. Two thirds of respondents see it as likely or more to be cancelled.
Again, many thanks to those that voted!
David.

Sunday, May 27, 2012

The Person-controlled Electronic Health Record. From Recommendation To Reality NOT!

I thought it would be useful to have a close look at where the NEHRS (PCEHR) sprang from and just how poor the thinking around its conception was. Here are the key message and the recommendations of an amazingly short 16 page document (removing the duplicated recommendations) that started all this:
The document is date 30 April 2009 and can be downloaded in full from here:
This document is a late addendum to the Interim Report of the National Health and Hospitals Commission and was released just before the final report in June 2009.

 Person-controlled Electronic Health Records

 Key messages

o   Health care is knowledge intensive. The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care.
o   Current health information systems are disjointed, which often results in health care professionals operating with incomplete or incorrect patient information. It is estimated that up to 18 per cent of medical errors are a result of inadequate availability of patient information.
o   As technology, work practices and medical knowledge continue to evolve in the coming years, the complexity of health care interactions will become greater, which means the need to document and readily access a patient’s health profile will become more critical.
o   A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.
o   Investment in health IT lags well behind that of other information-centric consumer industries such as the financial and telecommunication industries, which have invested heavily over the last 20-30 years to achieve global connectivity.
o   According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record (EHR).
o   The implementation and widespread use of information technology in the health sector (e-health) is one of the most important enablers of personal health management and quality health care.
o   The overall economic benefit from increased productivity and reduced adverse events that would be achieved with a national individual electronic health record in Australia has been estimated to be between $6.7 billion and $7.9 billion in 2008-09 dollars over 10 years.
o   The protection of privacy and confidentiality is a key factor in winning widespread community acceptance and uptake of electronic health records.
o   Health providers and the IT industry must work together to develop open, nationally-agreed standards for the secure electronic capture and storage of personal health information.
o   The essential role of governments in a new e-health environment is to protect the public’s interest through legislative reform and ensuring people retain control over who has access to their personal health information.
Here are the recommendations.

Recommendations

1. We propose that, by 2012:
  •  every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person;
  •  every Australian should be able to approve designated health care providers to have authorised access to their personal electronic health record; and
  •  every Australian should be able to choose where and how their personal electronic health record will be stored, backed-up, and retrieved.
2. We propose that the Commonwealth Government legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers.
3. We propose that the Commonwealth Government must introduce:
  •  unique personal identifiers for health care by 1 July 2010;
  • unique health professional identifiers (HPI-I), beginning with all nationally registered health professionals, by 1 July 2010;
  •  a system for verifying the authenticity of patients and professionals for this purpose - a national authentication service for health (NASH) - by 1 July 2010; and
  • unique health professional organisation (facility and health service) identifiers (HPI-O) by 1 July 2010.
4. We propose that Australian governments drive the national development of open technical standards for e-health, and that they secure national agreement to open technical standards for e-health by 2011-12. These standards should include key requirements such as interoperability, compliance and security. The standards should be developed with the participation and commitment of industry, health professionals, and consumers.
5. We propose that the Commonwealth Government develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach.
6. We propose that significant funding and resources be made available to extend e-health teaching, training, change management and support to health care practitioners. The commitment to, and adoption of, e-health solutions by health care providers is key to the success of a person-controlled electronic health record.
7. We propose that the Commonwealth Government mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record, such that:
  • hospitals must provide key data, such as referral and discharge information, by 1 July 2012;
  • pathology providers and diagnostic imaging providers must provide key data, such as reports of investigations and supplementary information, by 1 July 2012;
  • other health service providers - including general practitioners, medical and non-medical specialists, pharmacists and other health and aged care providers - must transmit key data, such as referral and discharge information, prescribed and dispensed medications and synopses of diagnosis and treatment, by 1 January 2013; and
  • all health care providers must be able to accept data from other health care providers by 2013.
---- End Extract.
With a month to go it is clear we are nowhere near what was envisaged a little over 3 years ago and funded to the extent of almost $1/2 billion 2 years ago.
As you read the document it seems clear to me there is confusion about just what is being recommended and what it will do.
As always the Key Messages includes problems with information access and flows causing problems but totally lacks any clarity on just how much of the problem will be fixed by what is being proposed.
It is always good to also know that 82% of the public support something that they have no clear idea as to exactly what it is - like an EHR and I won’t even comment on the benefits claimed as they were claimed in the absence of any understanding as to what the system might actually do.
As far as the recommendations and the time frames suggested they do seem just a little ambitious (verging on fantasy even). (According the .pdf the author of the document is Peter one Broadhead who is an executive in DoHA who was involved in the NHHRC process but is now not even apparently associated with e-Health (if Google is to be believed) - smart man is all I can say.)
I will note in passing NASH is still not there, identifiers are not used by the majority of patients or practitioners, hospital are not ready to transmit information to repositories and there is hardly any planned personal control of where an individual’s information is held. And just how does one ‘own’ a clinical record that is in the hands of the Government?
Essentially the PCEHR is a thought bubble that has drifted off the reservation and will never deliver what was intended then and even what was planned when funding was allocated. It really is a model bureaucratic implementation fiasco.
David.