Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, December 05, 2010

The Reason The Government is Being So Secretive About the PCEHR is That They Fear It Might be a Very Bad Idea As Presently Envisaged!

I have had the weekend to think about what went on last week and I have to say the more I think about what I saw, what I have been told, what others have written and what Government seems to be saying the more worried I am.

Let’s just walk through what we know. As of the time of the Conference earlier this week the Personally Controlled Electronic Health Record had transmogrified into the following.

1. An empty very basic static information style Summary Clinical Record which is linked to an individual persons IHI.

2. An access portal that allows a person who has opted to have a such a record available for their use to populate, or have someone else populate this basic record for access anywhere in the country - so by definition a national system - if not physically one data base a collection of keyed databases.

3. An indexing service which will go around ‘Google bot like’ and find clinical documents which have an IHI attached and keep track of there they may be found.

4. Some form of presentation service to assemble both the basic summary and other records as they are on-line (results, discharge summaries etc.) into something the person and whoever the person authorises can have a browse of.

This seems to me what is being called the PCEHR System

The following provides a little more detail and raises a key issue

Private sector key to e-health rollout, says Roxon

  • Karen Dearne
  • From: Australian IT
  • December 01, 2010 8:36AM

THE National E-Health Transition Authority will be contracted to deliver the $467 million patient e-health record system with private sector help, Health Minister Nicola Roxon has confirmed.

"We will be asking NEHTA to ensure the national infrastructure is delivered to a high quality standard and in a timely manner and to set the standards for how the system will work," she told the E-Health Conference in Melbourne yesterday.

…..

With the Gillard government holding the purse strings, the federal Health department will have ultimate oversight of the project, and including consultations aimed at striking the right balance between security and access to people's private health information.

"I can confirm the government is not going to build a massive data repository," Ms Roxon said. "We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks.

"Our system is about linkages of data – much of which exists already in various forms in general practices, at the pharmacy, at a hospital, with the maternal health nurse."

…..

"NEHTA will have a managing agent role, with responsibility for operational contract management, as well as development of the PCEHR core standards, national infrastructure and information architectures, and high-level business requirements and design," Ms Halton said.

"The contractors will be known as our national partners in the PCEHR program, as they will be critical in delivering it."

NEHTA will be looking for four delivery partners: A national infrastructure solutions partner (to provide the detailed design, build and integration); a change and adoption partner (to develop a strategy to encourage uptake); a benefits realisation partner (to develop and manage an assessment and evaluation framework), and an external delivery assurance adviser (ongoing oversight of the project).

Ms Halton said it was expected primary healthcare systems would be among the first ready to provide information to the PCEHR infrastructure.

More here:

http://www.theaustralian.com.au/australian-it/government/private-sector-key-to-e-health-rollout-says-roxon/story-fn4htb9o-1225963698809

So there will be a central slab of infrastructure and some services around it contracted and the huge question left hanging is ‘what next’? This is hardly a build it and they will come situation!

What also is needed are among things:

1. Provider agreement to provide their records to be indexed and retrieved - having obtained individual patient consent for this.

2. Interfacing and Information Standardisation of the contents of the provider records - as well as quality control.

3. Appropriate security and privacy controls that ensure any concerns about individual pieces of information being protected are address - citizens tend to want to know where their information is going and why.

4. Modification and updating of all potential feeder systems to conform to appropriate information, privacy, security and integrity controls.

5. A thorough regimen of piloting and testing on a pretty large scale.

6. Some fairly complex legislation to manage professional liability, system governance and so on

One thing that is certain is that, given the contracts for the partners are unlikely to be agreed by March 2011 that the possibility of having much more than a mock up to enrol in as a citizen looks pretty remote.

Additionally on this blog Professor Enrico Coiera has pointed out very recently just how potentially fraught the shared centralised record is. To summarise his view it is as simple as:

“I think I have distilled my point down to 'the SCR is unnecessary' - it is an additional component in a system that works just fine without it. In a distributed system we can have all the information moving, and if you need a summary, you create that in the presentation layer, dynamically. You don't hard wire it into the architecture like some massive goto statement with no scalability or flexibility.”

Given all the issues a static shared record raises I cannot but agree!

This report from the UK just confirms the that the idea of uploaded shared records is pretty problematic and may be just plain dangerous!.

One in ten electronic medical records contain errors: doctors

One in ten medical records on a new electronic database contain errors which could put patients at risk, doctors have warned.

Rebecca Smith 8:15AM BST 17 Jul 2010

Doctors in Birmingham have found that 10 per cent of the records that have been uploaded so far contained out-of-date information including errors on current medication patients are taking or drugs they are allergic to.

These mistakes could put patients at risk if doctors relied on the information in an emergency and administered a drug they were allergic to or gave them a medicine which interacts with one they are already taking.

The system must be halted as it is not safe, doctors said.

So far around two million electronic patient records have been uploaded to the central database and if the error rate was the same nationwide, which doctors say is not unreasonable to presume, then around 200,000 people could be at risk from inaccurate information stored about them.

GP leaders in Birmingham told Pulse magazine that the organisation running the system, Connecting for Health, knows about the error rate and has not taken action.

Dr Robert Morley, executive secretary of Birmingham Local Medical Committee, which represents local doctors, told Pulse: "The fact that in Birmingham 80,000 patients have had their records uploaded, the majority without their consent, and one in ten have been put at risk from inaccurate data, shows we believe that the uploading of the Summary Care Record has to be stopped immediately because they are not safe."

The Summary Care Record has proved controversial after it was highlighted that many people who were sent information saying their records were about to be uploaded had not recalled receiving the letter meaning they had not given proper consent.

More here:

http://www.telegraph.co.uk/health/healthnews/7895094/One-in-ten-electronic-medical-records-contain-errors-doctors.html

Already, now the AMA has figured out what NEHTA / DoHA are up to there is some push back!

http://www.theaustralian.com.au/national-affairs/ama-attacks-e-health-record-plan/story-fn59niix-1225963522922

AMA attacks e-health record plan

THE Gillard government's $466 million e-health record "won't work" , the Australian Medical Association says.

The AMA says it could be dangerous if patients were able to hide information about abortions or their use of anti-depressants.

AMA vice-president Steve Hambleton told an e-health conference doctors would not trust the new record if it did not contain all relevant patient information, and there was a risk of serious medical mishaps if information was kept secret.

And he says only doctors should alter information in the e-health record, which will be offered to patients from July 1, 2012.

"It should only be able to be changed by doctors who understand the implication of what is recorded, and this can certainly be done in consultation with the patient," he said.

The AMA's concerns fly in the face of Health Minister Nicola Roxon's promise that the e-health record would be personally controlled by patients.

Ms Roxon told the same e-health conference in Melbourne: "We understand that privacy is a key concern, and we are designing this project to take heed of privacy from the ground up.

"This will be a truly personally controlled record. That's why we're establishing new consent settings for sensitive information and auditing that doesn't currently exist for any of our records."

Dr Hambleton said if a patient wanted to hide the fact they were using anti-depressants, they might suffer serious adverse reactions if another medication was prescribed. A woman who tried to hide the fact that she had an abortion might leave midwives and obstetricians unaware she was at greater risk of cervical incompetence if she later became pregnant, he told The Australian.

More here:

http://www.theaustralian.com.au/national-affairs/ama-attacks-e-health-record-plan/story-fn59niix-1225963522922

A second report is here

http://www.smh.com.au/national/doctors-resist-plan-to-give-patients-control-of-records-20101130-18fe1.html

Doctors resist plan to give patients control of records

Mark Metherell HEALTH CORRESPONDENT

December 1, 2010

PATIENT control over what goes into their electronic medical records faces resistance from medical leaders, who are calling for a delay to the potentially hazardous patient control feature.

Steve Hambleton, the vice-president of the Australian Medical Association, yesterday said that patient control of records should be held off until the electronic records transfer system was bedded down and won the confidence of doctors and patients. The right of patients to hide elements of their records from some health professionals who do not need to access the information has been hailed by the government as a central element of the e-health plan, due to start in July 2012.

But Dr Hambleton said that patients wanting to hide their treatment for depression, for example, raised the possibility of a dangerous medication interaction if the patient was later prescribed painkillers by a doctor unaware of an earlier anti-depressant prescription. Such information needed to be available to all doctors. ''It should only be able to be changed by doctors who understand the implication of what is recorded - and this can certainly be done in consultation with the patient.''

More here:

http://www.smh.com.au/national/doctors-resist-plan-to-give-patients-control-of-records-20101130-18fe1.html

It looks very much like those who started a decade ago on this are having trouble. What chance do you give Ms Roxon all in a rush?

Roxon must act on e-health by end of year

  • Karen Dearne
  • From: Australian IT
  • December 03, 2010 6:22PM

HEALTH Minister Nicola Roxon must make key decisions on e-health management by the end of the year, including any future governance role for the National E-Health Transition Authority.

Health Department briefings for the incoming Gillard government published today show Ms Roxon must provide direction on the “options for the long-term governance of e-health, including the personally controlled e-health record system (PCEHR) and the role of NEHTA” within three to four months of the election.

The heavily censored documents were released today, in response to “multiple requests for access” under freedom of information laws.

NEHTA is presently funded until June 2012 and has received more than $366 million in funding from the Australian Health Ministers’ Conference (AHMC) and the Council of Australian Government since 2005.

Ms Roxon’s $467 million PCEHR system has commenced under interim governance arrangements, which require the establishment of a Commonwealth steering committee and federal health department advisory group.

The briefing says the 2010-11 budget allocation was intended to cover the first two years of a four-year work schedule, based on an agreed business case for a national e-health records system.

However, the funding does not cover the costs of integrating private and public healthcare systems with the PCEHR, nor financial incentives for participation.

“The national record system will build on existing capability and investments of governments and the private sector, and leave in place existing health information systems,” it says.

“Healthcare organisations and providers will continue to store detailed medical records and clinical information.

“Over time, states and private providers will integrate with the PCEHR when ready, adding to the benefits for patients and medical professionals.”

No details of plans for long-term governance for e-health records or NEHTA’s future are given, as one-page summaries were only provided for matters requiring action within the first two months of office.

More here:

http://www.theaustralian.com.au/australian-it/government/roxon-must-act-on-e-health-by-end-of-year/story-fn4htb9o-1225965343295

These three paragraphs are the key:

“The briefing says the 2010-11 budget allocation was intended to cover the first two years of a four-year work schedule, based on an agreed business case for a national e-health records system.

However, the funding does not cover the costs of integrating private and public healthcare systems with the PCEHR, nor financial incentives for participation.

“The national record system will build on existing capability and investments of governments and the private sector, and leave in place existing health information systems,” it says.”

Getting back to me overall theme I think it is pretty clear we have a largely unfunded project, which is architecturally questionable being rushed through by some bureaucrats who really don’t get what they have bitten off. And we haven’t even started to consider the issues around what would make the PCEHR sufficiently attractive for users to opt in to. I have yet to hear anything on this other than we will have a communications program - doh!

While I would really love to see success I believe the stars are aligned for an expensive and highly damaging failure.

Everyone needs to step back, we need to harness the enthusiasm developed this week and start planning for what will be a 4-5 year journey that may succeed if not driven by silly political fiat and ignorance. To come back to the title of the blog - they won’t tell because they don’t know and are afraid of ministerial fury. Rightly so in my view - many heads will roll when it is realised what a mess this is turning into!

There is no doubt in my view the light at the end of this tunnel is that of a huge oncoming train!

David.

AusHealthIT Poll Number 47 – Results – 05 December, 2010.

The question was:

Are DoHA and NEHTA Leading E-Health In Australia in the Right Direction?

They Have it Nailed

- 4 (8%)

Doing Pretty Well

- 6 (12%)

Need to Steer A Lot Better

- 9 (18%)

They Are Lost in the Forest

- 30 (61%)

Votes : 49

I think it is fair to say those who read here are of the view that based on what we have been told we are not actually paddling in the right direction!

Again, many thanks to those that voted!

David.

Saturday, December 04, 2010

Here is A Blog You Must Read! Eric Browne Nails It Wonderfully!

Eric has nailed it and I plan to develop these themes, and more, next week.

Anatomy of a PCEHR system

2010-December-03 | 16:10 By: eric Filed in: pcehr | policy and politics

Well, two themes dominated the two day e-health summit in Melbourne this week:-

  1. Infectious enthusiasm
  2. vagueness of the PCEHR

These two themes actually run hand in glove. Both the vagueness of the PCEHR model and the rampant optimism are in large part due to ignorance. There was an endless supply of fresh consumer, bureaucrat and clinician faces, unjaundiced from the attempts to progress e-health both here and overseas over the past 10 or more years. The summit compere, Peter Couchman must have used the words “exciting”, “impressive” and their ilk dozens of times when singing the praises of presenters and presentations. But amongst the delegates, there was also a silent minority of the skeptical knowledgable and experienced.

It is interesting to ponder how much of the vagueness and the enthusiasm was deliberately manufactured for the event and how much was real. If more sits in the latter camp, then things are worse than even I imagined. But there was plenty of the former, due in large part to Mukesh Haikerwal’s formidable skill at harnessing clinician support and painting a picture of the long term benefits from the deployment and adoption of e-health, rather than focussing on the difficulties (impossibility?) of implementing a national PCEHR system of any value by July 2012.

One got the feeling that Mukesh doesn’t much care if the July 2012 goal is not met; that the work will not go to waste, and that it is all about making progress towards the noble vision of a better e-health-enabled world that promises so much. In some respects, I agree with him. I certainly think that the process needs believers and pushers of his standing in order to gain significant amounts of investment. In some respects, it is like the stance of Senator Conroy and the National Broadband Network. Never mind the cost, just look in awe at the benefits!

There is a heap more that is just even better here:

http://blog.healthbase.info/?p=192

We should all be concerned just how poorly Eric sees this. I have to say I think he has also missed some other issues I will explore next week!

Read and realise you are being badly suckered by a rubbish Department of Health. They are utterly clueless. Eric gets it. They don’t!

The "Raving Sycophant" is still saying how wonderful all this is if you bother to look - but why bother?

David.

Weekly Overseas Health IT Links - 03 December, 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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Health Execs Laud EHRs For Boosting Care

Government Accountability Office report finds that e-health records support disease management by improving data sharing and communication.

By Nicole Lewis, InformationWeek

Nov. 23, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228300451

Integrated healthcare delivery organizations say electronic health records (EHRs) support their patient care strategies by increasing the availability of individual patient and patient population data and by improving communication among providers.

These findings are from a U.S. Government Accountability Office (GAO) report, Health Care Delivery: Features of Integrated Systems Support Patient Care Strategies and Access to Care, but Systems Face Challenges.

The GAO examined 15 private and public integrated delivery systems (IDSs) that are clinically aligned across primary, specialty, and acute care. These healthcare organizations vary in their degree of integration, specific organizational features, and payer mix (such as the extent to which they serve Medicare and Medicaid beneficiaries and the uninsured).

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http://www.healthdatamanagement.com/news/ncvhs-hhs-recommendations-sensitive-data-security-privacy-41395-1.html

NCVHS Advises on Sensitive Data

HDM Breaking News, November 23, 2010

An advisory body to the Department of Health and Human Services has made a series of recommendations on restricting the sharing of sensitive information in electronic health records.

In a report to HHS, the National Committee on Vital and Health Statistics offers initial definitions of categories of sensitive information. These include genetic, mental health, substance abuse, and sexuality or reproductive health information, as well as treatments paid for out-of-pocket and the rights of adolescent minors under some state laws to segregate certain information.

…..

Text of the 14-page letter, "Recommendations Regarding Sensitive Health Information," is available at ncvhs.hhs.gov.

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http://www.prlog.org/11096188-infocom-says-health-in-europe-already-multi-billion-market.html

InfoCom says e-health in Europe already a multi-billion market

E-health to grow significantly in the coming years — Available e-health solutions are tele-monitoring or services for disabled people — Mobile network operators offer most of available services.

PRLog (Press Release)Nov 24, 2010 – Stuttgart, Germany — According to a recent research carried out by InfoCom, in Western Europe, although the number of offers addressing different needs is growing steadily, most of available e-health solutions are services for tele-monitoring — for instance remotely monitoring vital signs of patients — or, alternatively, services addressing disabled people. Already a multi-billion market, e-health is expected to grow significantly in the coming years.

E-health in general consists of various telecommunication and IT solutions for the healthcare sector connecting medical informatics, health services and the delivery of information through the Internet and other related technologies. Most of e-health solutions are services supporting physicians and hospital staff, analysis services via mobile phones, emergency and locating services, healthcare hotlines and information services, multimedia solutions, offers for disabled people, reminder services and tele-monitoring.

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http://www.computerworld.com/s/article/352641/Healthcare_IT_No_Quick_Cure

Healthcare IT isn't living up to the hype

Computerization is slowly improving the healthcare system, but it's a long way from living up to expectations.

Mary K. Pratt

November 22, 2010 (Computerworld)

It's been 19 years since the prestigious Institute of Medicine urged greater adoption of computer systems in healthcare, and more than six years since then-President George W. Bush declared, "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care."

So, how are we doing so far?

There are positive signs at places like Methodist Dallas Medical Center, which has a nearly foolproof way to make sure the right drug gets to the right patient in the right dose at the right time: It uses bar-code technology to clear all medications through a computerized program.

Pamela McNutt, CIO at Dallas-based Methodist Health System, says the technology means the hospital can avoid drug errors, which are responsible for an estimated 100,000 deaths nationwide each year.

That success encouraged McNutt to push forward with other IT initiatives. "The reason we continue getting everything into an electronic format is so we can analyze our data, look at what's going on for efficiency reasons and monitor quality as it's happening," she says. "And the only way you can do that is through the use of structured data."

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http://www.modernhealthcare.com/article/20101124/NEWS/311249997/

Parties mull options after Rx privacy law struck

By Joseph Conn

Posted: November 24, 2010 - 9:00 am ET

In a split decision, a federal appeals court in New York has overturned a Vermont law seeking to restrict the use of prescription drug data in the marketing of pharmaceuticals to physicians.

The ruling by a majority of the three-judge panel in the 2nd U.S. Circuit Court of Appeals came in favor of the appellants—IMS Health; Verispan; Source Healthcare Analytics, a subsidiary of Wolters Kluwer Health; and the Pharmaceutical Research and Manufacturers of America—and found that the 2007 Vermont law constituted "an impermissible restriction of commercial speech."

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http://www.ama-assn.org/amednews/2010/11/22/prsa1122.htm

PROFESSION

Reaching the remote: Telemedicine gains ground

Services that provide specialists to patients in underserved areas are likely to expand as demands on the health care system increase.

By Carolyne Krupa, amednews staff. Posted Nov. 22, 2010.

Every Wednesday afternoon, Thomas Magnuson, MD, goes to a designated room at the University of Nebraska Medical Center to meet with patients in nursing homes around the state via an interactive video screen.

Many of his patients have Alzheimer's disease or other forms of dementia. Using teleconferencing technology, he is able to see and talk with patients, nursing home staff and family members.

The technology allows him to treat people who are hundreds of miles away and don't have easy access to a specialist. Through telemedicine, it's as though they are in his office.

"I live in a state that has not a lot of people, but a lot of area," said Dr. Magnuson, a psychiatrist specializing in geriatrics and an assistant professor at the medical center. "We have a lot of isolated places. We just had a big patient population out there that wasn't being seen."

Nationwide, telemedicine increasingly is being used to bridge gaps in access to care in rural and other medically underserved communities that have a hard time recruiting physicians. The technology provides primary care physicians and patients a vital link to specialists at large urban medical centers.

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http://www.futuregov.asia/articles/2010/nov/25/hk-targets-private-doctors-e-health-uptake/

Private doctors key to e-health uptake in Hong Kong

To realise its vision for a complete, territory-wide electronic patient records repository within five years, the Hong Kong Hospital Authority needs buy-in from the 70 per cent of private doctors who are yet to embrace ePR.

All patient records should be available electronically to every doctor in Hong Kong through a dedicated e-health portal within three years, and to all patients by 2015, noted Dr C. P. Wong, Co-Chairman, Clinical Informatics Programme Steering Committee, Hong Kong Hospital Authority.

But although 100 per cent of doctors in the territory’s 44 public hospitals are using the ePR system, only 30 per cent of Hong Kong’s 4000 private doctors are doing so too, he pointed out.

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http://www.detnews.com/article/20101123/BIZ/11230369/1001

Last Updated: November 23. 2010 1:00AM

Smartphone apps point toward closest ER

Melissa Burden / The Detroit News

A growing number of hospitals are looking to lend patients a helping hand — by smartphone — when health emergencies arise.

Henry Ford Health System and the Detroit Medical Center have introduced free smartphone applications to help guide patients to the nearest emergency room or urgent care.

Several Metro Detroit hospitals have mobile apps in the works, part of a nationwide trend among hospitals and insurance companies.

Health systems are tapping the growing popularity of apps not only to better serve patients, but also doctors and emergency workers. One local hospital is developing an app that will inform ambulance crews if an emergency room is closed.

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http://govhealthit.com/newsitem.aspx?nid=75165

Connect software gateway loses top two managers

By Mary Mosquera
Friday, November 19, 2010

The top two managers of the Connect exchange gateway are leaving the pioneering federal health information exchange (HIE) program as it sets new directions to advance the adoption of health information exchange for meaningful use.

Dave Riley, an independent consultant who is the Connect program’s lead technical manager, and Vanessa Manchester, an independent consultant who is Connect’s program manager, will be leaving by the beginning of December, according to a federal agency advisor. Both have helped shepherd the Connect exchange development community since 2007.

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http://www.healthdatamanagement.com/blogs/sabharwal_health_benefit_exchanges_health_reform-41370-1.html

Where To Focus: Health Exchanges Or The Individual Market?

Rajiv Sabharwal
Health Data Management Blogs, November 19, 2010

Isn’t that the million-dollar question? Not a single day goes by that I don’t hear or read opinions about the strategies to implement state-based health benefit exchanges, various architectures that will be required and, for that matter, the probability that HBEs will come into existence at all. And don’t get me started on the volumes of patients expected to use HBEs. I’ve heard numbers ranging from 20 million to 150 million by 2016, and all those widely disparate estimates were supported by sound research and logic.

These are early days for health care reform in general and HBEs in particular. A lot of very good ideas are floating around, some of which will succeed and some that will fall by the wayside. There’s too much political uncertainty even for truly great ideas to have a 100 percent probability of success. So what is an organization to do? Can a commercial plan start strategizing their business around state-driven exchanges? Can a vendor start planning for a common platform that could be used by most, if not all, states to deliver the exchange services? Can a small employer expect to ally with similar-sized employers to enhance its leverage with large plans?

In my book, the answer is “not at this time” to all those questions. With so much uncertainty and so many variables to factor in, the smallest mistake could lead to disastrous consequences. But does that mean one should risk being left behind if everything that is being touted (errr, planned) comes to fruition? My response is “definitely not.”

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http://www.modernhealthcare.com/article/20101122/NEWS/311229977

VA bares all

By Joseph Conn

Posted: November 22, 2010 - 11:15 am ET

The Veterans Affairs Department launched a program of clinical performance transparency, exposing its own internal clinical quality dashboard to public view.

The public exposure of the two Web-based dashboards, the Linking Knowledge & Systems, or LinKS, which has been in internal use at the VA for about two years, and the recently developed Aspire system, are part of a pledge made by VA Secretary Eric Shinseki when he took office in 2009 to make the VA “as transparent as possible,” said Robert Petzel, the VA's undersecretary for health.

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http://www.healthleadersmedia.com/content/LED-259279/ACO-Management-Depends-on-IT

ACO Management Depends on IT

Tom Enders, Jordan Battani and Walt Zywiak, for HealthLeaders Media , November 19, 2010

There will be wide variability in the types of accountable care organizations that are established in the near future. Some will be tightly organized around existing integrated delivery networks. Others will be based on independent physician associations without an integrated hospital. Still, others will be formed as a collaborative multi-stakeholder initiative, perhaps building from a sustainable health information exchange. There will be distinct payer relationships.

Some ACOs will be Medicare-specific, others focused on Medicaid managed care and others multi-payer. As the health benefit exchanges become established there will be an additional stimulus to the development of ACOs—some with integrated insurance functions, others operating in partnership with managed care plans.

No matter what the particular ACO form, six key success factors will be critical for successfully delivering on the potential of accountable care. As the ACO becomes more mature, the breadth of information technology necessary also will increase so as to provide the connectivity and the decision support needed to manage the continuum of care.

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http://www.cbc.ca/health/story/2010/11/22/electronic-health-records-telus.html

Consumer e-health portal rolls out

Last Updated: Monday, November 22, 2010 | 8:06 PM ET

CBC News

Canadians will be able to create, store and manage their health information on a new, secure portal for consumers, a technology company says.

Telus health space will provide patients and their families with access to their health information in an encrypted online environment, the company and a Toronto hospital said Monday.

The idea is to use Telus health space and its e-health record system, called My Chart, to securely move health information from home, the clinic, hospital or elsewhere to the consumer's fingertips.

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IT Speeds Bone Marrow Transplants To Save Lives

Business process management and analytics tools are expected to double number of transplants and halve wait time.

By Marianne Kolbasuk McGee, InformationWeek

Nov. 18, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=228300100

When people talk about health IT, it’s often in the context of how technology can improve patient care by preventing mistakes -- like alerting a doctor to a patient’s allergies or a drug interaction before a prescription gets ordered. But a project that’s underway by the National Marrow Donor Program reminds us that IT can do more than stop medical blunders. It can also facilitate life-saving cures.

The NMDP, which operates the national “Be The Match Registry,” organizes about 5,000 U.S. transplants a year, matching donors with patients who need transplants of bone marrow or umbilical cord blood to treat leukemia, genetic disorders and other life-threatening diseases.

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http://fcw.com/articles/2010/11/17/va-performance-report-veterans.aspx

VA reports on social media, software development

Updates presented on major areas

The Veterans Affairs Department has released its Fiscal 2010 Performance and Accountability Report that outlines progress on programs that include social media outreach, modernizing digital medical records and adopting an agile development model for new software.

The document was published on the VA’s website Nov. 15. It includes management objectives, performance goals and benchmarks and financial statement sections as well as background information on the department.

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http://www.modernhealthcare.com/article/20101122/NEWS/311229979/

Don't go further than HIPAA: FAH exec

By Joseph Conn

Posted: November 22, 2010 - 11:30 am ET

There was pushback on privacy and patient consent at Friday's Health IT Policy Committee meeting—specifically on the work still under way by the committee's privacy and security work group, or tiger team.

"The federation has concerns with some of the discussions that are taking place in the tiger team that may be outside of the scope of HIPAA," Samantha Burch, director healthcare policy and research for the Federation of American Hospitals, said during the public-comment portion of the meeting.

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http://www.modernhealthcare.com/blogs/it-everything/20101123/311239999

Is HIPAA enough?

The federally chartered Health IT Policy Committee met Friday, and a recording of the entire meeting is posted on HHS' website, so even if you missed the meeting, just click and you'll have it.

Samantha Burch, director of healthcare policy and research at the Federation of American Hospitals, spoke during the public comment period at the tail end of the meeting about the work of the committee's privacy and security tiger team. The tiger team is hustling to get its recommendations to the full Health IT Policy Committee, which is to advise the Office of the National Coordinator for Health Information Technology.

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http://healthsystemcio.com/2010/11/19/policy-committee-balks-at-nhin-proposal/

Policy Committee Balks at NHIN Proposal

Posted by Anthony Guerra on November 19th, 2010

Proposal Sent Back for Further Review

Despite eagerness to have formal recommendations in place, the full HIT Policy Committee this week balked at a proposal for the National Health Information Network’s governance structure and instead asked workgroup chair John Lumpkin, M.D, to flesh out some thorny details before it could formally vote on the issue.

Those thorny details revolved around a portion of the program which called for the creation of a non-government organization (NGO) that would disseminate best practices and resolve problems faster than a formal government body could.

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http://www.fiercehealthit.com/story/online-physician-diagnoses-come-under-scrutiny/2010-11-22

Online physician diagnoses come under scrutiny

November 22, 2010 — 11:38am ET | By Neil Versel

MDLiveCare, RingADoc and other companies that offer diagnostic and treatment services online or over the phone are drawing scrutiny from state regulators about the definition of a doctor/patient relationship, USA Today reports. Critics of such services wonder if conducting medical assessments of patients seen by webcam--or not at all--might miss signs of more serious conditions than the patient claims to have. The newspaper says a Colorado physician prescribed an antidepressant to a 19-year-old California student through an online pharmacy.

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http://www.fiercehealthit.com/story/canadian-hospital-tests-flash-based-web-pacs-viewer/2010-11-22

Canadian hospital tests Flash-based web PACS viewer

November 22, 2010 — 12:26pm ET | By Neil Versel

The cost of viewing PACS images is about to come down--way down.

Canadian software firm Client Outlook is testing its eUnity Flash-based viewing program at Sunnybrook Health Sciences Centre in Toronto, allowing clinicians to view diagnostic images in a web browser anywhere inside or outside the hospital rather than forcing them to go to a $20,000 PACS workstation.

"Not only is it something we don't have to install software [for] anywhere, but it's delivering those high-resolution images at an almost real-time speed--and that's not an easy thing, technically, to do," Sunnybrook PACS Administrator Andrew Volkening told the Canadian Press, reports Canadian Healthcare Technology.

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http://www.fiercehealthit.com/story/ahrq-survey-practices-continue-struggle-hie/2010-11-22

AHRQ survey: Practices continue to struggle with HIE

November 22, 2010 — 2:29pm ET | By Neil Versel

If the early results of an Agency for Healthcare Research and Quality survey are a reliable indicator, physician practices are continuing to struggle with health information exchange.

In the just-released preliminary results of the 2010 AHRQ Medical Office Survey on Patient Safety Culture, practices reported problems with the accuracy, completeness or timeliness of patient data at least half the times they've exchanged electronically with other healthcare entities in the past year. Specifically, the 470 medical offices surveyed said they had HIE problems 55 percent of the time with outside laboratories or imaging centers, 50 percent of the time in transactions with other medical offices, 52 percent of the time with pharmacies and in 58 percent of exchanges with hospitals, CMIO reports.

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http://www.ihealthbeat.org/perspectives/2010/meaningful-use-now-more-difficult-five-ways-to-stay-on-track.aspx

Monday, November 22, 2010

'Meaningful Use' Now More Difficult: Five Ways To Stay on Track

by Protima Advani

CMS and the Office of the National Coordinator of Health IT recently provided a critical clarification on "meaningful use" for hospitals and eligible professionals (EPs) that will make demonstrating the criteria more difficult. Their guidance states that hospitals and EPs must implement all the meaningful use functionalities of the certified electronic health record. While hospitals and EPs are afforded flexibility in determining which of the five out of 10 menu set requirements they will report on for the purposes of demonstrating meaningful use, they are not afforded this same flexibility as it relates to implementation of the certified EHR.

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http://www.ft.com/cms/s/2/6e10b422-f58d-11df-99d6-00144feab49a,dwp_uuid=9a36c1aa-3016-11da-ba9f-00000e2511c8.html

Microsoft drops US HealthVault profit plans

By Andrew Jack in London

Published: November 21 2010 16:57 | Last updated: November 21 2010 16:57

Microsoft has abandoned efforts to make profits in the US out of its “HealthVault” cloud computing system designed to store personal medical data, because of the complexity of the country’s health system.

Peter Neupert, corporate vice-president for health, told the Financial Times the benefits to Microsoft in the US of HealthVault was simply to “increase the brand relationship” by raising its image with customers as “important, critical and trusted”.

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Enjoy!

David.

Friday, December 03, 2010

A Very Useful Review of the Current State of Play in US EHRs.

The following appeared a week or two ago.

When and how to deploy e-health records tech

By Lucas Mearian, Computerworld
November 23, 2010 12:52 PM ET

Over the next two years, 58% of small physician practices plan to roll out electronic health records. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs.

To date, however, less than 20% of hospitals and 25% of physician practices have deployed EHR systems, and most of them would not meet the federal government's criteria for "meaningful use" of those systems, according to Karen Bell, chairwoman of the Certification Commission for Health Information Technology (CCHIT), nonprofit organization whose mission is to accelerate the adoption of healthcare IT systems.

Perhaps the biggest obstacles for physicians and hospitals are the magnitude of many healthcare IT projects and the need to meet those "meaningful use" requirements from the Office of the National Coordinator for Health Information Technology (ONC), which is part of the U.S. Department of Health and Human Services. To help providers overcome those obstacles, public and private financing is available for EHR rollouts. Moreover, there are cost-effective ways of deploying the technology, and it may not even be necessary to rebuild an existing IT infrastructure to accommodate an EHR system. One option is to share the data center of another local healthcare facility that has a large IT support staff.

Over the next two years, 58% of small physician practices plan to roll out electronic health records. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs.

To date, however, less than 20% of hospitals and 25% of physician practices have deployed EHR systems, and most of them would not meet the federal government's criteria for "meaningful use" of those systems, according to Karen Bell, chairwoman of the Certification Commission for Health Information Technology (CCHIT), nonprofit organization whose mission is to accelerate the adoption of healthcare IT systems.

Perhaps the biggest obstacles for physicians and hospitals are the magnitude of many healthcare IT projects and the need to meet those "meaningful use" requirements from the Office of the National Coordinator for Health Information Technology (ONC), which is part of the U.S. Department of Health and Human Services. To help providers overcome those obstacles, public and private financing is available for EHR rollouts. Moreover, there are cost-effective ways of deploying the technology, and it may not even be necessary to rebuild an existing IT infrastructure to accommodate an EHR system. One option is to share the data center of another local healthcare facility that has a large IT support staff.

Nonetheless, even with financing and alternative deployment strategies at their disposal, hospitals and other providers that haven't started using EHR technology might want to wait.

"I know there are incentives out there... but the $44,000 or $65,000 you can get comes over a five-year period," Bell said. "If you haven't gone through the readiness process, gotten your staff ready and gotten everyone on board with what this will entail and put a project plan in place, then you'd probably do better to wait -- maybe even until 2013, when a whole new set of criteria comes out."

By waiting, clinics or physician practices would not only be able to meet more of the criteria for meaningful use of EHR systems, but they would also be able to deploy systems that meet their own criteria for patient care and administrative automation.

The ONC uses the CCHIT to test and certify EHRs. To date, the CCHIT has certified 66 EHR products, many of which have varying levels of sophistication.

The CCHIT also has the authority to certify homegrown EHRs. If a hospital builds out its own infrastructure and pieces the software modules together, the organization can remotely access servers and work with administrators to offer a certification specifically for that system, Bell said.

There's no question that EHR technology can benefit both healthcare providers and patients, experts agree. EHRs allow physicians to share test results, radiological images and other clinical information in near real time with patients and other physicians. They can also reduce administrative tasks associated with paper-based systems, and they will eventually help ensure that caregivers adhere to so-called evidence-based medicine, or the use of best practices for treatment.

At the same time, physicians who employ EHR systems will be able to more easily use wireless devices, such as tablet PCs and smartphones, at the bedside and from remote locations.

The most basic in-house EHR systems cost about $250,000, but depending on the size of the organization and the capabilities of the technology, the price tag can quickly grow into the millions for larger hospitals, according to Judy Hanover, an analyst at research firm IDC's Health Insights unit.

Under the American Reinvestment and Recovery Act (ARRA) of 2009, physicians who implement EHR systems and demonstrate that they are engaged in meaningful use of such systems can receive reimbursements of up to $44,000 under Medicare and up to $65,000 under Medicaid.

Physicians and hospitals that don't roll out EHR technology or don't prove that they are making meaningful use of it by 2015 face penalties in the form of reduced Medicare reimbursements.

There are three stages of meaningful use, as defined by federal officials. Doctors and hospitals now implementing EHRs do so under Stage 1 guidelines released this past summer. Stage 2 and Stage 3 guidelines are set to take effect in 2013 and 2015, respectively, with the final rules coming out about a year before they go into effect.

The criteria for Stage 1 focus on improving the quality, safety, efficiency and coordination of care, and on reducing health disparities. They also call for adequate privacy and security protections for patient health information.

There are about 25 Stage 1 meaningful use objectives that must be met. Among other things, a computerized physician order entry (CPOE) system must be used for at least 80% of all physician orders and 10% of hospital orders, real-time electronic drug and allergy alerts must be enabled, and at least 75% of all prescriptions written by a clinician must be transmitted electronically to a pharmacy.

Pages more here:

http://www.networkworld.com/news/2010/112310-when-and-how-to-deploy.html

This is a really good summary of what the US is presently up to and is well worth a browse.

David.

Finally the Department of Health Releases a Description of the PCEHR. Does It Make Sense?

The 6 page document can be downloaded from here.

http://moreassoc.com.au/downloads/DoHA%20Fact%20Sheet%20No%201.pdf

The file is a .pdf and about 2.5 megs.

It seems to be the basic idea of all this is that their PCEHR will have a basic record for the absolute clinical basics and pull everything else in from current systems. It is very much like the US Health Information Exchange approach as best I can tell.

A grand vision that will take ages to implement! Note it will be easy to have people register to have something that won’t deliver for years into the future!

David.

Thursday, December 02, 2010

How Did We Go Getting Answers From the E-Health Summit? You Be The Judge.

A couple of weeks ago I published a blog asking the questions I had hoped the Summit might answer.

The full post is here:

http://aushealthit.blogspot.com/2010/11/few-answers-we-would-like-from-e-health.html

Here is what I wrote then (in italics) and how close I feel we got to clear answers in plan type

The key questions I want to see addressed are:

1. Just what exactly is meant by a Personally Controlled Electronic Health Record (PCEHR)?

I really did not get the feeling there was clarity among the speakers on this.

2. Exactly how is the PCEHR intended to operate?

We saw a five minute concept video.

There is a link to the video here:

http://www.thomson-webcast.net/au/dispatching/?event_id=e93ab89e7d50e535fd440f8850306913&portal_id=fa33b0f8ca2d2fedb15d66aaaede71f1&presentation_id=d3b54f477972365a695515a9c399b303

This is well worth a look as it is the most detailed information available so far on just what is presently envisaged. The presentation is about 1 minute in (and is also available from the 11 am Tuesday link found here:

http://www.ehealthconference.gov.au/agenda.asp

I have to say what is shown here on this link seems a bit more evolved but very similar to the DoHA effort.

http://www.axolotl.com/products/product-demos.html

3. What is the literature evidence that supports the adoption of this - rather than a more conventional - approach to the progressive implementation of e-Health?

None was offered that I saw.

4. Where has a PCEHR similar to the proposal been successfully implemented?

The concept of consumer control of an EHR which clinicians are to use is not really implemented anywhere I am aware of.

5. Where is the information to be held in the PCEHR to be sourced from and how will the quality of the information be assured? Will providers be paid for providing information?

The information is intended to be sourced from securely connected operational systems and the PCEHR will provide a presentation service and the security / authentication etc. Just why health professionals would provide information was not made clear.

6. What support is the Government planning for provider EHRs and Secure Clinical Messaging?

It was not clear if any further support - beyond standards setting and NEHTA’s assistance - was contemplated

7. What will be the medico-legal status of information held in PCEHRs and what will be the consequences if clinicians mistakenly act on erroneous information? Will they be indemnified?

This was not really addressed as far as I can tell.

8. What is the evidence base that supports the other Government e-Health proposals (teleconsultation and the like) as the optimal expenditure of the available funds?

It was not clear that this area has been addressed by DoHA.

9. How do the PCERH and the other proposals fit with the National E-Health Strategy which has been endorsed by Health Ministers and has yet to be implemented?

This is not at all clear and was not really explained in what I heard.

10. When are the issues of absent leadership and failing governance in the e-Health domain going to be addressed?

The Health Minister indicated that DoHA would be driving the PCEHR project. NEHTA is to be a delivery manager of private sector contracts in a range of areas to support the as yet fully defined initiative.

The separate e-Health managing entity suggested by the National E-Health Strategy and the AMA is yet to be agreed.

The full speech from the Health Minister is now available on the web and is worth a browse for the details (which sadly it does not seem to provide).

See here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr10-nr-nrsp30112010.htm?OpenDocument&yr=2010&mth=11

You can read Senator Conroy’s speech here:

http://www.minister.dbcde.gov.au/media/speeches/2010/013

There is some fun analysis of what he said here:

Conroy's NBN health hustle

Rob Burgess

Published 7:35 AM, 2 Dec 2010

Stephen Conroy is Australia's greatest hustler. And the NBN is a giant hustle that the newly dubbed 'Minister Assisting the Prime Minister on Digital Productivity' knows will utterly snooker the opposition at the next election.

Senator Conroy was out pulling his usual trick in Melbourne yesterday, singing the praises of the NBN at the 'e-health Conference 2010: Revolutionising Australia’s Health Care'.

The trick works like this – tell the punters about the amazing health services the NBN will make possible, but studiously avoid the two main criticisms levelled at the NBN by Shadow Communications Minister Malcolm Turnbull and his pool-room buddies:

1) Aren't these services mostly possible using existing technology?

2) Can't the market mostly provide the infrastructure to deliver these services?

Beyond the public eye, Conroy has good answers to both (and I will address them in a separate article), but his speech to the conference yesterday, as usual, did not include them.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Stephen-Conroy-NBN-broadband-internet-Turnbull-pd20101202-BQRRC?OpenDocument&src=sph

All in all as a commenter said on a recent blog this was really a conference that was organised for the ‘wrong’ audience.

What is contained in the discussion paper which is to be delivered early in the new year now becomes crucial to see if this is a real project or folly!

David.

Wednesday, December 01, 2010

Wrap Up of the E-Health Summit. Was it Worthwhile?

Well the e-Health Summit has just wrapped up. This morning we had two formal presentations and a demonstration of telehealth working quite reasonably despite the fact we have not actually built the NBN yet! (Not that the NBN - when it comes - won’t make a pretty big improvement).

First - Senator Conroy gave us an e-Health focussed discussion of how important the NBN is. No real news there except for a grant of some funds to trial telehealth.

Second Mr Shane Solomon, Head of Healthcare, KPMG Australia gave a really useful presentation on the near two decade journey the Hong Kong Health Authority has undertaken to a presently pretty impressive - but still evolving - e-Health system.

It was fun to hear Shane point out that much of the progress happened by fiat of the CEO of the Health Authority. He decides and the HK Health System does! Might not quite work here.

His examples of what you can do once you have EHR systems in place in terms of use of information to assist care delivery and care quality were just excellent.

The presentations and slides will be available, I am assured by DoHA, real soon now.

In the early afternoon there was a forward looking discussion with a group of experts that explored the blue sky that might be possible for 2025.

We are now seeing some press coverage of the proceedings.

Examples are here:

http://www.computerworld.com.au/article/369816/nbn_first_release_sites_trial_telehealth/?eid=-6787&uid=25465

NBN first release sites to trial telehealth

Federal Government provides $4 million in funding to NSW Health to trial high-speed health monitoring

Two of the first mainland release sites under the National Broadband Network (NBN) will receive telehealth monitoring units in coming months, as part of a $4 million trial conducted by NSW Health.

As part of the trial, telehealth monitoring units and videoconferencing systems will be installed in homes and primary healthcare clinics of veterans with chronic diseases and those aged over 65 in the sites of Armidale and Kiama Downs. Under the rollout of the NBN, each of the sites are expected to encompass up to 6000 premises connected to speeds of up to one gigabit per second (Gbps).

The federally funded project was announced by communications minister, Senator Stephen Conroy, this week at an e-health conference hosted by the Department of Health and Ageing and is expected to determine the benefits of greater bandwidth afforded by the NBN for telehealth and other e-health systems.

And here:

http://www.theaustralian.com.au/australian-it/government/private-sector-key-to-e-health-rollout-says-roxon/story-fn4htb9o-1225963698809

Private sector key to e-health rollout, says Roxon

  • Karen Dearne
  • From: Australian IT
  • December 01, 2010 8:36AM

THE National E-Health Transition Authority will be contracted to deliver the $467 million patient e-health record system with private sector help, Health Minister Nicola Roxon has confirmed.

"We will be asking NEHTA to ensure the national infrastructure is delivered to a high quality standard and in a timely manner and to set the standards for how the system will work," she told the E-Health Conference in Melbourne yesterday.

"But we want the best available expertise so there will be an open approach to the market for key elements of the program."

Ms Roxon said the government was not looking to run the whole system.

"Our job is to contract partners to build the infrastructure and the linkages, and to set the standards and regulations," she said.

"It will not be our job to deliver all of the technological advances – that’s what we’re looking for from the innovators in industry."

And here:

http://www.theaustralian.com.au/national-affairs/ama-attacks-e-health-record-plan/story-fn59niix-1225963522922

AMA attacks e-health record plan

THE Gillard government's $466 million e-health record "won't work" , the Australian Medical Association says.

The AMA says it could be dangerous if patients were able to hide information about abortions or their use of anti-depressants.

AMA vice-president Steve Hambleton told an e-health conference doctors would not trust the new record if it did not contain all relevant patient information, and there was a risk of serious medical mishaps if information was kept secret.

And he says only doctors should alter information in the e-health record, which will be offered to patients from July 1, 2012.

"It should only be able to be changed by doctors who understand the implication of what is recorded, and this can certainly be done in consultation with the patient," he said.

----- End Quotes.

Summary impressions.

1. We have been warned this is a long term - decade + - process - so funding that runs out in 18 months is not smart. The costs are also much larger than presently admitted and this was raised repeatedly on the second day.

2. I think all I have seen from the conference misunderstands the level of complexity and the barriers that will be faced. Attempting to have something working and useful in 19 months is fanciful in my view.

3. I think the program governance plans are inadequate as presently framed. It is hard to believe the community will be keen on the present ill-defined plans. The AMA is right to demand a single Government Entity to run all this - as recommended in the National E-Health Strategy.

4. I believe the Department developing a central infrastructure and expecting the rest of the Health Sector to just ‘hop on board’ and pay their own costs is nonsense.

5. Until more information on the plans from DoHA / NEHTA is properly formulated, documented and widely discussed and reviewed all the optimism expressed by attendees is pretty premature.

6. The PCEHR concept is very likely to be opposed by the AMA in the way it is presently being talked about and if that is the case it is a ‘dead duck’. Refinement to make the plan acceptable to most of the doctors is an urgent issue!

7. At the last panel discussion it was clear that the key barrier to success of the PCEHR will be utility to both clinicians and consumers. At present none of the plans have addressed these issues in any realistic or sensible way.

8. The Department chattering on about sustainability and how the private sector will need to contribute to make this work mis-understands just who is hoping to benefit and it is not the providers!

9. Amazingly the Deputy Secretary closed saying they were starting serious planning and consultation on the PCEHR next year. Runway is looking a bit short!

Sorry we have had a lot of noise but little light! I fear the PCEHR might just need a major rejig to be made even half of what is naively hoped for by its proponents.

David.