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, September 20, 2009

Useful and Interesting Health IT News from the Last Week – 20/09/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

The NHHRC final report: view from the hospital sector

Ian A Scott

eMJA - Rapid Online Publication - 14 September 2009

Abstract

  • The National Health and Hospitals Reform Commission (NHHRC) report attempts to deal in the short term with hospital access block by funding more beds in emergency departments, while, over the longer term, reforms aim to improve hospital efficiency, transfer care of patients to non-hospital settings, optimise use of outpatient clinics, fund hospital activities on the basis of efficient cost, and improve governance and accountability.

· The single most potentially effective recommendation is the considerable investment in and expansion of subacute and non-acute services, which will free up acute-care hospital beds for urgent cases. Population-based chronic disease management driven by Primary Health Care Organisations can also reduce future hospitalisations considerably.

· What the NHHRC could have dealt with more fully is the need to: (i) prioritise clinical interventions and the need for hospitalisation using evidence of cost-effectiveness obtained from clinical trials and longitudinal patient data; and (ii) move quickly towards funding of all health care by one level of government.

· Even the most effective reforms will not have a significant impact on future bed demand if professional and public expectations remain unsustainably high and do not acknowledge the need to change the role of hospitals within a reconfigured health care system.

More here:

http://www.mja.com.au/public/issues/191_08_191009/sco10877_fm.html

Interestingly we also find the following paragraph in the document.

“Making hospital care more safe and effective

The patient-held electronic health record proposed by the NHHRC will allow busy ED and clinic doctors to more quickly retrieve past history and investigation results and render care safer and more effective. The NHHRC report could have given more emphasis to computer-based clinical decision support systems, referral and triage algorithms, and interprovider information transfer and telecommunication systems designed to make hospital referrals more clinically appropriate and collaborative. Evaluating outcomes of hospital care at a national level using patient-level longitudinal data from various sources (hospital episode of care data, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, death registries, etc) linked by a unique identifier (Medicare number) is welcome, given the benefits of such data.”

My emphasis. Seems most commentators agree that personal health records are at best only a part of what is needed.

Second we have:

Is Brown Qld Health's white knight?

Suzanne Tindal, ZDNet.com.au
15 September 2009 09:12 AM

CIO profile Ray Brown stepped in two weeks ago as the latest chief information officer for Queensland Health, hoping to bring some stability to a division that has seen a number of faces move through the head technology spot in quick succession.

The health department's technology leadership game of musical chairs started in July last year when Paul Summergreene, who had moved over to health in the closing months of 2007 from his CIO position at the state's Department of Transport, left after less than a year in the chief information officer job.

His contract had been terminated, Queensland's Health informed the press at the time. There had been reports that his expenses were being examined, but the department wouldn't comment on the issue.

His position was filled briefly in an acting capacity by the clinically adept Dr Richard Ashby. Ashby had served in several hospitals in emergency medicine and medical administration roles. The Australian Medical Association was pleased of the appointment because of Ashby's clinical experience.

"We have seen millions of dollars in health IT funding wasted over the years in Queensland, so the appointment of a highly regarded senior hospital clinician who is acutely aware of exactly what is required to provide optimal patient outcomes is very welcome," it said at the time.

Yet Ashby didn't remain long, leaving in January to become the executive director and director of medical services at Princess Alexandra Hospital.

Queensland Health again had to fill the void with an interim appointment, reaching into the ranks of its information division. Brown had been acting as the executive director ICT service delivery since June 2008, before which he had been pursuing an IT career in the Queensland public service, holding senior roles in the Police, Corrective Services and the former Department of Families.

Queensland Health may have hit the jackpot this time. Brown hasn't followed the pattern of leaving after only a brief stint on the job. Instead, he was appointed formally to the chief information officer position last week.

And despite much attention being directed at the leadership turmoil, the CIO doesn't believe that it has damaged the long-term technology strategy of Queensland Health.

Since 2006, the IT gurus of Queensland Health have had a mission: to bring the state's hospitals into the modern world of state of the art clinical information systems. Summergreene's predecessor Sabrina Walsh had primed the way by obtaining funding of upwards of $650 million over four years for e-health initiatives.

Whichever leader was in the hot spot, the e-health holy grail was never out of sight, according to Brown. "The e-Health strategy has stood the test of time and remained sound. Each incumbent of the Queensland Health CIO role has built on the direction and progress of the e-Health Strategy without the need to re-visit significant elements of the strategy or the project artefacts delivered," he tells ZDNet.com.au in an interview last week.

When the CIO started in the role in the acting capacity, it had been his focus and it would continue to be so for the next few years, he says.

Around 20 per cent ($243 million) of the funding first made available in the 2007/2008 financial year had been spent, Brown says. The remaining 80 per cent would be spent by 2011/2012.

So far one of the standout successes has been getting an enterprise discharge summary system up and running, a national first, Brown says. The system sees hospital reports go out to GPs who can use them to service outpatients. Brown says, 55,000 summaries have already gone out from 56 hospitals, with June next year seeing 120 facilities being capable of issuing the summaries.

Much more here:

http://www.zdnet.com.au/insight/software/soa/Is-Brown-Qld-Health-s-white-knight-/0,139023769,339298502,00.htm?omnRef=1337

Given it is already in place this really supports the points I have been making about the over-egging of approaches to simple issues such as discharge summaries being taken by NEHTA. I am pretty sure what Qld Health has done does not implement the NEHTA approach to either content or messaging methodology. Once you have things actually going then you can incrementally improve.

Third we have:

Deal struck on access to patient records

17-Sep-2009

By Michael East

THE Federal Government has backed down on plans to allow Medicare bureaucrats to access patients’ medical records.

The Health Insurance Amendment (Compliance) Bill 2009 was introduced into Parliament today by the Federal Human Services Minister, Chris Bowen.

The Bill gives Medicare Australia the power to obtain documents from doctors to substantiate Medicare rebates, which includes handing over private and personal patient details if necessary as evidence for auditing of Medicare claims.

Under the earlier draft bill, administrative staff employed by Medicare would have been able to access medical records without the patient’s permission.

However, an 11th hour deal struck between the Federal Government and “key medical stakeholders” means that only “medical advisers” employed by Medicare can view the records.

More here (registration required):

http://www.australiandoctor.com.au/articles/93/0c064093.asp

This is very good – as it sees some sanity return to the management of investigations requiring patient record access.

Fourth we have:

e-Health: Patients Manage Chronic Diseases Better through Enabling Broadband in Australia

Date: 15 Sep 2009 - 23:10

Source: Government of Australia

The Minister for Broadband, Communications and Digital Economy, Senator Stephen Conroy, today launched a new e-health project improving chronic disease patient care.

"CDM-Net is a great example of the digital revolution taking place in healthcare as the Government establishes Australia's 21st century broadband foundation," Senator Conroy said.

"Patient care plans are an important part of chronic disease management and providing online and real-time collaboration means they are easier and more effective to use."

"These types of innovations have significant positive implications for the economics of healthcare and patient welfare."

The Minister launched CDM-Net today at Geelong Hospital. The project is a collaboration between Precedence Health Care and partners and received funding under the Government's Clever Networks program.

Trials of CDM-Net in the Barwon South-Western Region of Victoria and the Eastern Goldfields of Western Australia have shown significant improvements in care plan use and collaboration.

More here:

http://www.egovmonitor.com/node/28177

I wonder where one can read the evaluations of these trials? I have not seen much to date. Links welcome!

Fifth we have:

Technology closes in on hospital botches

DANIEL HURST

September 14, 2009 - 5:13AM

Queensland hospital managers will be forced to provide feedback to staff members about botched medical procedures when the health department's flawed computer reporting system is upgraded.

The improvements, scheduled to be rolled out by the end of the year, come after a review found health workers were struggling to log clinical incidents and near-misses in the state's hospitals.

Doctors and nurses using the web-based PRIME CI system cannot track the progress of their own reports and receive feedback, according to the Prince Charles Hospital's executive director of medical services, Stephen Ayre.

Dr Ayre, who investigated the handling of incident reports at Bundaberg Hospital in the lead up to the March state election, wrote the system flaws were partly responsible for the "poor feedback" provided to staff.

The review was sparked by allegations hospital management failed to properly deal with dozens of incident reports, including claims an elderly patient died while waiting for an emergency bed and a baby was thrown on the floor.

Full article here:

http://www.brisbanetimes.com.au/queensland/technology-closes-in-on-hospital-botches-20090913-fm60.html

Seems to me a working system to handle this area is vital for understanding emerging issues in safety and quality are critical. Should have been in place ages ago.

Sixth we have:

8153.0 - Internet Activity, Australia, Jun 2009

NOTES

INTRODUCTION

  • The Internet Activity Survey (IAS) collects details on aspects of internet access services provided by Internet Service Providers (ISPs) in Australia.
  • The scope for the June cycle of IAS has been expanded to contain results for all ISPs operating in Australia with more than 1,000 active subscribers at the end of the reporting period (i.e. as at 30 June 2009). Previously in the June cycle, data have only been collected from ISPs with 10,000 or more subscribers at the end of the reporting period.
  • This is an electronic release of Internet Activity, Australia. More detailed and historic information is available in the accompanying datacubes.
  • When comparing historical data care should be taken due to the change in scope to ISPs with more than 1,000 active subscribers.

HIGHLIGHTS

  • At the end of June 2009, there were 8.4 million active internet subscribers in Australia.
  • Digital subscriber line (DSL) continued to be the major technology for non dial-up connections, accounting for 57% (4.2 million) of these connections. However, this percentage share has decreased since December 2008 when DSL represented 63% of non dial-up access connections.
  • Mobile wireless subscribers had the next highest share, increasing significantly from 20% of all non dial-up connections (1.3 million) in December 2008 to 27% (2 million) in June 2009. This represents an increase of 51% over the six month period. (Note that mobile wireless subscriptions to the internet via a datacard or USB modem are included in the scope of this survey, but connections to the internet via mobile telephones are excluded).
  • Northern Territory subscriber numbers continued with an upward trend increasing by 20% since December 2008 to 83,000.
  • The general trend towards higher download speeds continued, with 57% of subscribers now using a download speed of 1.5Mbps or greater, compared with 51% in December 2008.

More details here:

http://www.abs.gov.au/ausstats/abs@.nsf/mf/8153.0?OpenDocument

Given the importance of broadband to e-Health it is useful to keep an eye on these figures. The rate of wireless uptake is pretty impressive as are the number of broadband connections overall.

Commentary is here:

Opposition: wireless scrambles NBN plan

DAN OAKES

September 15, 2009

THE explosion in the use of wireless broadband has undermined the rationale for the $43 billion national broadband network, according to the Federal Opposition.

The claim comes as Telstra waits to see what punishment the Government will inflict on it through legislation that BusinessDay believes will be introduced to Parliament today.

The legislation will outline the regulatory measures the Government will impose on Telstra to increase competition as the new network is built.

The prevailing opinion seems to be that the Government will enforce a functional separation of the telecommunications giant's wholesale and retail arms, but will not force it to sell its 50 per cent stake in Foxtel or the high-speed cable network it uses to deliver pay TV.

The Australian Competition and Consumer Commission is likely to be given greater powers to make binding pricing decisions.

More here:

http://www.smh.com.au/business/opposition-wireless-scrambles-nbn-plan-20090914-fnx2.html

Seventh we have:

Baby bonuses claimed for dead people

AAP

September 17, 2009 05:09pm

A MEDICARE worker has been sentenced to four years' jail for using dead people's identities to claim more than $300,000 in baby bonus payments and sending some of the money to relatives overseas.

Bernard Monyenye, 34, pleaded guilty to 24 counts of obtaining financial advantage by deception, attempting to obtain financial advantage by deception and sending proceeds of crime to accounts in Kenya, Uganda and the United Arab Emirates.

The Perth court heard Monyenye used Medicare records to claim baby bonus payments and the maternity immunisation allowance, totalling $318,286.70, between June and November last year.

District Court Judge Kevin Sleight described the act as a "grave breach of trust'' and sentenced him to a non-parole period of two and a half years.

More here:

http://www.news.com.au/story/0,27574,26086963-421,00.html

One wonders why it took so long for these breeches to be detected. Clearly the Department of Human Services and Medicare should be looking closely at this. That Medicare is to operate the IHI service is a worry if this can happen.

Lastly the slightly more technical article for the week:

5 open source project management apps to watch

Five tools to help CIOs and IT project managers keep their projects on-track and on-schedule -- without blowing the budget!

Rodney Gedda (CIO) 14 September, 2009 13:40

Managing projects is hard work at the best of times, but there are a number of free and open source (FOSS) applications available that can help CIOs and other managers streamline the administrative aspects of project management.

CIO found five tools to help CIOs and IT project managers keep their projects on-track and on-schedule -- without blowing the budget:

1. OpenProj

OpenProj is a cross-platform desktop project management application that paints itself as an alternative to Microsoft Project, including file compatibility. OpenProj features Gantt charts, network diagrams (PERT charts) and earned value costing. Parent company Serena Software also offers commercial project management solutions.

URL: http://openproj.org

Licence terms: CPAL

Read about the other 4 here:

http://www.computerworld.com.au/article/318425/5_open_source_project_management_apps_watch?eid=-219

A useful list to assist get those projects under control!

More next week.

David.

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