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Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Australian Health Information Technology Links

Dr David More

articles by this author...

From a Medical IT Perspective: I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology. There is no choice.. it has to be made to work! That is why I keep typing. Disclaimer - Please note all the commentary are personal views based on the best evidence available to me - If I have it wrong let me know!

Visit my blog http://aushealthit.blogspot.com/

This blog has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on how things are progressing in e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Thursday, December 01, 2011

Electronic Prescribing and Prescription Transmission Seems To Be Working In the US. A Bit Different Here I Suspect.

This interesting report appeared a little while ago.

eRx worthwhile, but still problematic for docs, pharmacies

November 22, 2011 | Mike Miliard, Managing Editor ROCKVILLE, MD – A new study by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality finds that physician practices and pharmacies are both keen on e-prescribing's ability to improve safety and save time – but that both groups face barriers to realizing its full benefit. The study, published online in the Journal of the American Medical Informatics Association, focuses on the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed. It finds that e-prescribing helps reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. But prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists – particularly drug name, dosage form, quantity, and patient instructions – continue to pose problems. "Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, MD. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients." Researchers at the Center for Studying Health System Change in Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies. Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than 25 percent of the community pharmacies reported they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently. Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription. ..... The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," is available at jamia.bmj.com. Lots more here: http://www.healthcareitnews.com/news/erx-worthwhile-still-problematic-docs-pharmacies Here is the abstract: J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000515

  • Research and applications

Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies

  1. Joy M Grossman,
  2. Dori A Cross,
  3. Ellyn R Boukus,
  4. Genna R Cohen
  • Received 29 July 2011
  • Accepted 15 October 2011
  • Published Online First 18 November 2011

Abstract

Objective A core feature of e-prescribing is the electronic exchange of prescription data between physician practices and pharmacies, which can potentially improve the efficiency of the prescribing process and reduce medication errors. Barriers to implementing this feature exist, but they are not well understood. This study's objectives were to explore recent physician practice and pharmacy experiences with electronic transmission of new prescriptions and renewals, and identify facilitators of and barriers to effective electronic transmission and pharmacy e-prescription processing. Design Qualitative analysis of 114 telephone interviews conducted with representatives from 97 organizations between February and September 2010, including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions via Surescripts. Results Practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions. Conclusions Electronic transmission of new prescriptions has matured. Changes in technical standards and system design and more targeted physician and pharmacy training may be needed to address barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions. The full paper is here (free). http://jamia.bmj.com/content/early/2011/11/17/amiajnl-2011-000515.full It is interesting to note that as of a few weeks ago over 50% of use physicians were using electronic prescribing and prescription transmission. See here: http://www.surescripts.com/news-and-events/press-releases/2011/november/0911_saferx.aspx It really seems the US has their act together in this area - while we still seem to be trying to sort out Standards and have a couple of presently non-interoperable prescription transmission providers. This is an area where the leadership from DoHA has been just woeful to say the least. This from DoHA in June 2008 says it all!

KPMG CONSULTANCY IN ELECTRONIC PRESCRIBING AND DISPENSING

JUNE 2008

DEPARTMENT OF HEALTH AND AGEING RESPONSE

The Department of Health and Ageing considers electronic prescribing (ePrescribing) to be an important element of the national eHealth strategy and one that has the support of a large range of stakeholders. The development of technical and business process standards for ePrescribing and dispensing of medications will serve as building blocks for broader opportunities arising from developments in medication management systems and individual electronic health records. A number of amendments to State and Federal legislation have already been enacted across jurisdictions to enable ePrescribing systems to be implemented. It is in this context that the Department of Health and Ageing in December 2007 contracted KPMG to undertake a research and consultation process to develop a national ePrescribing framework. The KPMG report titled “Consultancy in Electronic Prescribing and Dispensing of Medicines (ePrescribing)”, finalised in June 2008, identifies strategic, technical and operational perspectives for developing ePrescribing across the various prescribing settings, namely: general community, private and public hospitals and the aged care sector. The report provides an overview of the emerging issues in Australia, considers past experiences, international developments and broad stakeholder views in formulating a guide to the development of standards and guidelines for nationally consistent ePrescribing systems. The process undertaken by KPMG was robust and importantly included substantial stakeholder consultation and investigation of the key issues. The report identifies a number of implementation steps to support a nationally consistent ePrescribing systems environment. The four key recommendations made in the report (page 6) are accepted by the Department of Health and Ageing and will be progressed in conjunction with broader eHealth initiatives. A full copy of the KPMG report can be found at  www.health.gov.au ----- End Release Almost 3.5 years later just where are we? We have the Pharmacy Guild and Medisecure / RACGP competing for the market and the Commonwealth incentive funds. The Australian Standards are still in draft and contentious and progress is less than optimal! This really could have been done just so much better! David. Posted by Dr David More MB PhD FACHI at Thursday, December 01, 2011 0 comments

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Wednesday, November 30, 2011

This Incompetent Piecemeal Approach Really Annoys Me. Just Hopeless.

The following appeared a few days ago.

DHS seeks Web portal to combat chronic disease among indigenous Australians

The portal will build upon a pilot portal, built by HP on the Microsoft SharePoint platform

The Department of Human Services (DHS) is on the hunt for a provider to develop and host a Web portal with the aim of better managing and preventing chronic disease among indigenous Australians. The Indigenous Web Based Primary Health Care Resource (IWBPHCR) will be a Web portal which integrates with clinical systems and enables healthcare staff to access materials relating to the prevention and management of chronic illness among indigenous Australians. “The IWBPHCR collates and presents in a single resource existing tools, guides and other online information that promotes best practice in the prevention, identification and management of chronic disease in indigenous Australians,” the documents reads. “It covers the key chronic diseases contributing to the burden of disease including cardiovascular disease, diabetes mellitus type 2, chronic respiratory disease, chronic kidney disease and cancer.” Under the 24-month contract, the successful tenderer will develop a detailed project plan and conduct a clinical review of content to select, review and remove information, which will also include “intensive” development in the initial phase to expand content. It will also provide high availability IT hosting and software development to ensure the relevance of content and conduct ongoing marketing of the project to ensure uptake by healthcare professionals. Following this, the provider will monitor and evaluate the efficiency of the service and how well it benefits users. According to DHS documents, this request for tender (RFT) builds upon an initial RFT for a pilot Web portal in 2010, which HP won and built on the Microsoft SharePoint platform. The pilot Web portal was to enable easy access and identification of materials relevant to managing chronic disease among indigenous Australians. It was issued after the department pinpointed a need for healthcare professionals to access materials including patient education, management tools, guidelines and references to effectively manage chronic disease. Following this, it embarked on a review and consultation process with stakeholders which found extensive clinical resources were already available online. More here: http://www.computerworld.com.au/article/408192/dhs_seeks_web_portal_combat_chronic_disease_among_indigenous_australians/ It seems to me this is archetypical ‘reverse discrimination’. If there is a business case to create a provider portal for 2.2% of the population (the Indigenous Population according to Wikipedia) then the case for a National Portal for all professional healthcare providers must be utterly overwhelming. Pure and simple siloed and ignorant policy development and implementation in my view. The same sort of dreadful policy development quality that cuts the incentives for students to study science and maths in the Budget Update. Both are utterly appalling and prejudice our future. David. Posted by Dr David More MB PhD FACHI at Wednesday, November 30, 2011 3 comments

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Here Is A List DoHA and NEHTA Ought To Think Carefully About.

The following appeared overnight.

GAO's 9 common critical success factors of federal IT projects

November 22, 2011 | Tom Sullivan, Editor Knowing which tactics make for smooth, investment-worthy IT efforts can be as tricky as the projects themselves. Looking to shed some light on the matter, the Government Accountability Office (GAO) compiled a list of best practices based on interviews with CIOs and other acquisitions and procurement officials. Using as a basis seven government IT projects – one of those being the VA’s Occupation Health Record-keeping System – the GAO boiled that list down to the “common factors that were critical to the success of three or more of the seven investments.” Those are:

  1. Program officials were actively engaged with stakeholders
  2. Program staff had the necessary knowledge and skills
  3. Senior department and agency executives supported the programs
  4. End users and stakeholders were involved in the development of requirements
  5. End users participated in testing of system functionality prior to formal end user acceptance testing
  6. Government and contractor staff were stable and consistent
  7. Program staff prioritized requirements
  8. Program officials maintained regular communication with the prime contractor
  9. Programs received sufficient funding

In the report, titled "Critical Factors underlying successful major acquisitions," the GAO also listed its top seven projects – so judged because they “best achieved their respective cost, schedule, scope and performance goals.” More here: http://www.govhealthit.com/news/gaos-9-common-critical-success-factors-federal-it-projects With a ridiculous testing time table, low levels of stakeholder engagement, specifications dreamt up in a vacuum I leave it as to reader exercise to score NEHTA / DoHA out of 9! Won’t be high I suspect. David. Posted by Dr David More MB PhD FACHI at Wednesday, November 30, 2011 2 comments

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Tuesday, November 29, 2011

This May Be The One And Only Opportunity You Get To Save E-Health In Australia. Take It!

The following report appeared in the Australian today.

Performance of NEHTA to go under Senate spotlight

THE performance of the National E-Health Transition Authority will be scrutinised in a Senate inquiry into the Gillard government's e-health record legislation. The Community Affairs committee has been instructed to examine the design and capability of the $500 million personally controlled electronic health record system, including its expected functionality on the July 1 launch date next year. Health Minister Nicola Roxon tabled her PCEHR bill and companion regulations in the lower house last Wednesday. She needs to shepherd the legislation through parliament quickly to meet her political deadline. Victorian Liberal senator Mitch Fifield has immediately referred it for a broad-ranging public inquiry. Its scope includes "any other issues the committee considers appropriate". The committee will consider the security arrangements, risks to patient privacy, the likelihood of data breaches and the proposed penalties. It has also been instructed to examine NEHTA's use of consultants, contractors and the tendering process during the development of the PCEHR. In particular, it will look at the products that NEHTA has designed, made, tested and certified for use in the system. The Medical Software Industry Association has repeatedly warned that unresolved technical and clinical issues could put patients' safety at risk. It said the Healthcare Identifiers service -- designed by NEHTA with little industry input -- was flawed and could result in duplicate individual identifiers, while there was no means of correcting operator or system errors in users' downstream systems. Meanwhile, privacy and consumer advocates have complained about NEHTA's lack of consultation over key concerns. Lots more here: http://www.theaustralian.com.au/australian-it/performance-of-nehta-to-go-under-senate-spotlight/story-e6frgakx-1226208562245 You can read the terms of reference for the enquiry. http://www.aph.gov.au/senate/committee/selectionbills_ctte/reports/2011/rep1711.pdf The details are found in Appendix Six. While it is very good that the topics cited above are being reviewed my major concern relates to the need to have the appropriate leadership for the whole e-Health program and to have the sort of governance frameworks in place that will ensure there is a sensible balance of all stakeholder’s interests as we move forward. It goes without saying that for me this involves a fundamental review of the evidence for and business case supporting the PCEHR and a root and branch review and audit of just what NEHTA has been doing over the last 5+ years. I will be preparing a submission on my own account to try and push the Senate Committee to ask the really hard questions and to not be fobbed off as they can be in a short Senate Estimates hearing. These two paragraphs found later in the article make it utterly clear that big change is needed. “Mr Fleming said last month that he was "committed to resolving the matter to the satisfaction of both organisations". But in a second letter to Dr Clarke last week, he said NEHTA could not "accept a situation" where Dr Clarke continued to use "firm and direct communications" as he saw fit.” You can read the full letter here: http://www.privacy.org.au/Papers/NEHTA-Fleming-Reply-111123.pdf Mr Fleming, it seems, is not at all comfortable with a little assertiveness on the part of a pretty well respected privacy advocate (Chair of the Australian Privacy Foundation at present) whose job it is to be just that!  He apparently does not agree with the views expressed and he (or his staff) seem to be trying to suppress these views by denying attendance at forums. It is just this sort of issue that properly a designed governance framework and sensibly respectful leadership would swiftly address and save us all from a great deal of toing and froing. Indeed in the letter Mr Fleming makes it clear he needs and wants respectful communication and co-operation. This is clearly vital on both sides  - especially when matters are seriously contested in the public space. Again a proper governance framework can assist greatly in getting the right outcome. The bottom line to me is that both sides in a disagreement like this actually need to really listen to each other and understand what is being communicated in terms of concerns and issues. You can read all the correspondence here: http://privacy.org.au/Papers/NEHTA-Fleming-111111.pdf For this and a whole host of other reasons leadership and governance are top of my list for the enquiry. Bureaucrats need to remember they are ‘public servants’ and we are all the public! Another point I also intend to make is around the frequently stated fiction from DoHA and NEHTA that implementing the PCEHR is implementing the National E-Health Strategy of 2008. This is just plainly and simply NOT true! Lastly, on the governance issue, we have this claim from Minister Roxon on the legislation.

E-records legislation to be investigated

29th Nov 2011 Mark O’Brien THE Senate will investigate new legislation intended to create Australia’s personally controlled e-health record (PCEHR) system after the two relevant bills were referred to the Senate Standing Committees on Community Affairs last week. The legislation, which includes provision for the merging of MBS and PBS information for the first time, was tabled in the lower house by Health Minister Nicola Roxon last week before being referred to the committee in the Senate on Friday. ..... Ms Roxon told parliament on Wednesday the legislation was developed through two rounds of public consultation and a draft version of the bill. “The central theme of our system and this bill is that any Australian will be able to register for an e-health record, and they will be able to choose the settings for who can access their record and the extent of that access,” Ms Roxon said. ..... Full article here: http://www.medicalobserver.com.au/news/erecords-legislation-to-be-investigated With decent governance we would have a digest that shows how the Government responded to the submissions mentioned above and what changes were made. Of course we don’t have a clue and no one knows if their time was utterly wasted in responding! The details of how to make a submission to the Senate Enquiry are found in this post. http://www.aushealthit.blogspot.com/2011/11/senate-enquiry-into-pcehr-alert.html The closing date is January 12, 2012 - so get thinking and writing if we are to see some better e-Health in the years to come! Feel free to indicate in comments areas you think need to be addressed by the enquiry. David. Posted by Dr David More MB PhD FACHI at Tuesday, November 29, 2011 5 comments

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Monday, November 28, 2011

Weekly Australian Health IT Links – 28th November, 2011.

Here are a few I have come across this week. 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

It has really been a busy week. We have had PCEHR legislation introduced into Parliament - a day before it shuts down for the year - we have had a continuation of NEHTA into a rather murky future and we have had a whole set of untested specifications released by NEHTA to the Wave Sites for them to implement! My feeling is that we are now seeing a move towards some trinary outcome. Either it will all go swimmingly and the PCEHR will be a great success, or it will limp along slowly into some quiet oblivion a few expensive years down the track or the whole project will implode on itself. Which do you think is the most likely? ----- http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=779:msia-things-i-should-have-said&catid=16:oz-hit&Itemid=226

MSIA: Things I should have said...

Written by Dr Geoffrey Sayer | 21 November 2011 I wish I had kept a diary for the past two years during my time as the Medical Software Industry Association President (MSIA). The things I have seen, heard and read have generated all sorts of emotional responses: surprise; laughter; disappointment; frustration; sadness; anger; and humility. Health at the best of times is a hot topic. Throw an “e” at the start of Health and all sorts of “emotional” responses are brought forward. Throughout this roller-coaster ride of ups and downs, where often you only have a narrow window to get a point across, there are a number of things that, with the benefit of hindsight, I wish I had said. The current politicians’ need both better advisors and to make public servants actually responsible for their actions if they want to progress change. The political process is a short-term cycle and the objective seems to be simply to stay in power. We should accept this as a fact of how politics works. It is not as complicated as they would want us to believe. More time (and money it seems), is spent on spin doctoring rather than calling to account the people or organisations that money is provided to. ----- http://www.theaustralian.com.au/australian-it/government/e-health-authority-to-live-on/story-fn4htb9o-1226203136895

e-Health authority to live on

THE National e-Health Transition Authority will live on post-June 2012, with the federal and state governments agreeing to continue their joint funding arrangements for the time being. NeHTA’s immediate future was decided at a meeting of the Standing Council on Health in Brisbane this month, although there is no commitment to a long-term role for the organisation. No public announcement has been made and the level of funding is yet to be agreed. Federal Health Minister Nicola Roxon has been slow to commit to further funding for the e-health program beyond the launch of her personally controlled e-health record (PCEHR) system on July 1. Forward budget allocations for e-health programs drop from $433 million in the current financial year to $35m annually in each of the next three years. ----- http://www.computerworld.com.au/article/408192/dhs_seeks_web_portal_combat_chronic_disease_among_indigenous_australians/

DHS seeks Web portal to combat chronic disease among indigenous Australians

The portal will build upon a pilot portal, built by HP on the Microsoft SharePoint platform

The Department of Human Services (DHS) is on the hunt for a provider to develop and host a Web portal with the aim of better managing and preventing chronic disease among indigenous Australians. The Indigenous Web Based Primary Health Care Resource (IWBPHCR) will be a Web portal which integrates with clinical systems and enables healthcare staff to access materials relating to the prevention and management of chronic illness among indigenous Australians. “The IWBPHCR collates and presents in a single resource existing tools, guides and other online information that promotes best practice in the prevention, identification and management of chronic disease in indigenous Australians,” the documents reads. “It covers the key chronic diseases contributing to the burden of disease including cardiovascular disease, diabetes mellitus type 2, chronic respiratory disease, chronic kidney disease and cancer.” ----- http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=771:video-consulting-from-hospitals-to-the-home-and-everywhere-in-between&catid=16:australian-ehealth&Itemid=268

Video consulting telehealth – from hospitals to the home and everywhere in between

Written by Chris Ryan | 15 November 2011 Video consulting is a big subject, within a big subject (Telehealth), within a big subject (eHealth). Articulating what is involved can be like articulating the health system itself — not an easy task. This is because video consulting is just normal consulting with another travel option. The trouble is that most people’s horizons only extend to considering the ‘transport’ components (video conferencing), rather than all the end‑to‑end management and logistics that we take for granted under normal circumstances, and more besides. For people who want do more than just hold a Skype video conference twice a year, comprehending the opportunities and issues involved is like watching stars come out — you see the one or two that most closely relate to your perspective, then a few more, and then you realise the sky is full of them. ----- http://ehealthspace.org/news/health-informatics-ehealth-spotlight-sallyanne-wissmann

Health informatics in the ehealth spotlight: Sallyanne Wissmann

Posted Wed, 23/11/2011 - 11:14 by Josh Gliddon Massive growth in health information systems, coupled with the forthcoming personally controlled electronic healthcare record (PCEHR) has created significant opportunities for health information managers. But according to Sallyanne Wissmann, there are only two tertiary courses teaching health informatics, creating the possibility of skills shortages in the future. “The demand for people with these skills is growing by the day,” said Ms Wissmann, who is also director of health information services at Mater Health, in Brisbane. ----- http://www.theage.com.au/victoria/bungling-in-state-public-sector-blamed-for-it-blowouts-20111123-1nv3g.html

Bungling in state public sector blamed for IT blowouts

Reid Sexton

November 24, 2011 INCOMPETENCE and poor practices in the Victorian public sector have been partly blamed for huge cost blowouts in information technology projects that have left taxpayers hundreds of millions of dollars poorer. State Ombudsman George Brouwer, in a report tabled yesterday, has delivered a scathing assessment of 10 public sector information technology projects, including the notorious myki transport ticketing system and the Victoria Police database. The report found that the estimated cost of delivering the 10 projects that he examined was a combined $1.44 billion more than originally budgeted. ----- http://www.cio.com.au/article/408348/q_i-med_network_cio_bart_dekker/

Q&A: I-MED Network CIO, Bart Dekker

Dekker talks about service delivery improvements through automation and e-health projects

I-MED Network chief information officer, Bart Dekker. Bart Dekker has been chief information officer of Sydney-based private medical diagnostic imaging group, I-MED Network, for seven years. During that time he has been responsible for a number of e-health services including the creation of an x-ray application for the iPad which allows its doctors to view x-ray images and patient documents on their devices. What does an average work day involve for you at I-MED? I-MED has 200 diagnostic imaging clinics and is an organisation whose workflow is very dependent upon IT. Out of necessity and design, we also use IT to differentiate ourselves from our competition so a large part of my day is spent discussing how we can improve IT service delivery. ----- http://www.theaustralian.com.au/australian-it/government/pcehr-event-document-specs-released/story-fn4htb9o-1226205947810

PCEHR event document specs released

  • by: Karen Dearne
  • From: Australian IT
  • November 25, 2011 12:30PM

SPECIFICATIONS for a key part of the $500 million personally controlled e-health record have been released and a vendor portal launched to support software developers working on products for the system. Doctors and other medical professionals will create summaries of relevant health "events" and upload them to their patients' record in the PCEHR system, where the information will be accessible by other healthcare providers treating that patient. ----- http://www.theaustralian.com.au/australian-it/government/personally-controlled-electronic-health-record-system-coming/story-fn4htb9o-1226203867730

Personally controlled electronic health record system coming

  • by: Karen Dearne
  • From: Australian IT
  • November 23, 2011 4:28PM

HEALTH Minister Nicola Roxon has today introduced legislation for the $500 million personally controlled e-health record system into Parliament, and announced that the Information Commissioner will have a key regulatory role. "The legislation will strike the right balance between security and access," Ms Roxon said in a statement. "Two rounds of consultation were held on this legislation prior to its introduction." But the government is yet to respond to a large number of concerns raised by medical, consumer and privacy groups in submissions to the draft exposure bill, and it appears few changes have been made. ----- http://www.cio.com.au/article/408352/federal_govt_introduces_e-health_legislation_/

Federal Govt introduces e-health legislation

Minister Roxon introduced the Personally Controlled Electronic Health Records Bill 2011 into Parliament

The Federal Department of Health has introduced e-health legislation into Parliament pertaining to its $467 million Personally Controlled Electronic Health Record (PCEHR) project, scheduled for completion by 1 July 2012. The Personally Controlled Electronic Health Records Bill 2011 was introduced by the minister for health and ageing, Nicola Roxon, and includes requirements for privacy breaches, the ability for patients to nominate authorised individuals to have rights in regards to their e-health records and the establishment of an Independent Advisory Panel to advise on policy and operations. It also has provisions around audit logs for consumers, and stipulates the Australian Information Commissioner will become the system’s key regulator. ----- http://www.medicalobserver.com.au/news/ehealth-records-one-step-closer

E-health records one step closer

24th Nov 2011 Andrew Bracey and AAP THE federal government has taken another step towards setting up its patient-controlled electronic health records (PCEHRs) system, with Health Minister Nicola Roxon introducing the legislation to Parliament yesterday. Ms Roxon said the proposed national system – which has attracted criticism from doctors for the lack of remuneration offered to GPs who would be responsible for helping to set up and maintain the records – would drag the management of health records into the 21st century. She said individuals' health information was fragmented rather than attached to the patient, resulting in unnecessary retesting, delays and medical errors. ----- http://www.theaustralian.com.au/australian-it/pcehr-users-must-secure-data/story-e6frgakx-1226204250244

PCEHR users must secure data

  • by: Karen Dearne
  • From: Australian IT
  • November 24, 2011 6:11AM

FRAUDSTERS and snoops after personal medical information will target privately owned computer systems rather than attempting to crack government-controlled systems, a legal expert warns. Thomsons Lawyers special counsel Kathie Sadler says people using the government's personally controlled e-health record (PCEHR) system will have to address their own storage and security requirements to ensure ongoing protection of medical data. "Each of the doctors, hospitals, aged care facilities and allied health professionals legitimately accessing the PCEHR system will themselves be subject to privacy and confidentiality obligations to the patient," she said. ----- http://www.theaustralian.com.au/australian-it/microsoft-slams-local-data-centre-edict/story-e6frgakx-1226205393994

Microsoft slams local data centre edict

MICROSOFT Australia has come out swinging against the Gillard government's insistence on local data centres for the personally controlled e-health record system.  "Healthcare information stored in a PCEHR will not necessarily be better secured and protected simply by virtue of data being held within Australia's territorial boundaries, as compared to (offshore) storage repositories and portals operated under world's best practice security and privacy systems," it says in a just revealed submission on the draft bill. "By regulating the geography where the data is held rather than the level of security under which it is held implicitly establishes criteria for data protection that are not related to principles of technology security. ----- http://www.computerworld.com.au/article/408313/telstra_launches_bundled_telehealth_rural_regional_patients

Telstra launches bundled telehealth for rural and regional patients

Healthcare providers will be offered a $6000 rebate for investing in the device under a $620m Federal Government initiative

The new Telstra bundled telehealth platform Telstra has launched two new bundled telehealth offerings aimed at rural and regional healthcare providers under a $620 million Federal Government initiative. Under the initiative, ‘Connecting Health Service with the Future’, the government will provide up-front payments and rebates of about $6000 for doctors who deploy the standalone Telehealth Professional unit, a combination of hardware and software by Polycom. The Professional offering includes a Polycom HDX4000 desktop videoconferencing unit, broadband access with one megabit per second (Mbps) dedicated video access, installation and set-up of the device and the Telstra virtual meeting room service. ----- http://www.medicalobserver.com.au/news/next-top-model

Next top model

21st Nov 2011 Pamela Wilson A new modelling tool could help you identify and prevent adverse events in at-risk patients, writes Pamela Wilson. GPs generally wait for patients to realise they are sick and come knocking on the door.  But imagine if you knew when a patient was likely to experience an adverse event – even before they did – and you could contact them to discuss early or preventive treatment. This is not a futuristic plot from a sci-fi movie – it’s a scenario that is entirely possible through the use of Predictive Risk Modelling (PRM). -----http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=780:nehta-and-vendors-plan-for-wider-use-of-amt&catid=16:australian-ehealth&Itemid=268

NEHTA and vendors plan for wider use of AMT

Written by Bettina McMahon | 23 November 2011 The National E-Health Transition Authority (NEHTA) has released a plan to accelerate uptake of the Australian Medicines Terminology (AMT). Developed with the software industry, the plan helps vendors to make a decision about if and when they want to include AMT in their software. Ultimately, NEHTA’s long term goal is semantic interoperability. The plan works towards this goal while acknowledging the different approaches vendors can adopt, and being realistic about what steps vendors are willing to take at this stage in our progress. ----- http://www.nehta.gov.au/media-centre/nehta-news/937-specifications-plan-for-ehealth-software

Specifications plan for eHealth software

17 November 2011. The specifications and standards plan for software vendors working on the personally controlled electronic health records (eHealth records) system has been released. The plan, produced by the National E-Health Transition Authority (NEHTA), outlines the timeframes and process for the release of standards for the personally controlled eHealth records system, set to launch nationally on 1 July 2012. The plan is designed to provide software developers and implementers with an agreed set of logical and technical specifications to guide enhancement of their systems to connect to the eHealth records network. For a program of this scope to succeed, a suite of nationally defined specifications and standards is essential. ----- http://www.computerworld.com.au/article/408188/ios_developers_take_10k_prize_ios_vs_android_hacktahon_event

iOS developers take out $10k prize at iOS vs Android Hackathon event

Health based app provides medical advice, uses SAPI

  • Lisa Banks (Computerworld)
  • 22 November, 2011 11:10

A team of Australian iOS developers have won $10,000 for their health focused app ‘Medic’, which provides non-urgent medical advice to users not needing to call 000. Team Bonobo+1, made up of Michael Del Borrello, Nathan Hamey, Ben Hamey and Daryl Teo, were awarded the prize at Melbourne’s iOS vs Android Hackathon event on the weekend, with team member Ben Hamey saying he hopes the app will be released to the public shortly. “We think Medic is a genuinely useful app and we will be releasing it onto the app store after a bit more refinement,” Hamey said. ----- http://www.ferret.com.au/c/Bizcaps/Healthscope-fast-tracks-rebate-claims-thanks-to-Bizcaps-MCIS-software-n1827718

Healthscope fast tracks rebate claims thanks to Bizcaps MCIS software

by Bizcaps Pty Ltd An innovative software solution from leading Australian software developers Bizcaps Pty Ltd is helping a major private healthcare provider streamline their rebate claims processes with increased processing speed and fewer errors.   For private hospitals, rapid and accurate processing of health care rebates for costly items such as prosthetics can have a significant positive effect on cash-flow. However, extracting the correct rebate code for each surgical prosthetic can be a complex and time-consuming process.   One of the country’s major private health providers, Healthscope Limited has now been able to streamline some of the more complex areas of their rebate claims processes to speed up their rebate claims and reduce costly administrative errors.   Operating a network of 48 private hospitals across Australia, Healthscope in a recent quality audit of their prosthesis claim systems discovered that inconsistent practices and a lack of tools were hindering efficiency.   ----- http://www.techworld.com.au/article/407952/123456_worst_passwords_2011

123456: The worst passwords of 2011

If one of your passwords is "654321" or "superman" or "qazwsx" congratulations for having one of the least secure passwords of 2011.

  • Jared Newman (PC World (US online))
  • 19 November, 2011 07:24

Internet users never learn. No matter how many times we hear about obvious, hackable passwords, people keep using them. And the situation doesn't seem to be getting better. Below is a list of the 25 worst passwords of 2011, compiled by SplashData. The security software developer generated the list from millions of actual stolen passwords, posted online by hackers. Not surprisingly, the most common passwords are also the worst, including "password," "123456" and "qwerty." Even passwords that seem kind of unique, like "trustno1" and "shadow" are actually quite common. And why does "monkey" always show up on these lists? ----- http://www.computerworld.com.au/article/408012/nbn_knife_edge_optus/

NBN on a “knife edge”: Optus

Optus CEO, Paul O’Sullivan, says price and spending caps are needed for the National Broadband Network (NBN)

The National Broadband Network (NBN) is on a “knife edge” unless spending and pricing costs are regulated by the Australian Competition and Consumer Commission (ACCC), according to Optus chief executive officer, Paul O’Sullivan. Speaking at a Committee for Economic Development of Australia (CEDA) event in Sydney where the company also celebrated its 20th anniversary, O’Sullivan said the NBN could either be a major success or a huge failure. According to a report from UK-based consulting firm, SPC Network, commissioned by Optus, the NBN must have clear rules and regulations if it’s going to deliver quality services at the lowest cost. “Based on the report and our own analysis, we believe the ACCC has a crucial role to play in policing the NBN,” O’Sullivan said. “There are five issues that need looking at.” ----- http://www.theaustralian.com.au/australian-it/exec-tech/cloud-pushes-the-limits-for-home-user-storage-of-digital-data/story-e6frgazf-1226201801613

Cloud storage pushes the limits for home user storage of digital data

WHERE do we put our growing array of digital belongings? The good old PC hard drive is fast clogging up with all the digital stuff of modern life, such as the HD movies spooling off our smartphone cameras, music collections, family snaps and documents of all types. The PC hard drive as a storage medium is vulnerable to failure and online attack. There are plenty of choices for secure, long-term storage of important stuff. There's a bevy of gadgets purpose-built for secure storage and a bunch of storage services that sit in the cloud. ----- Enjoy! David. Posted by Dr David More MB PhD FACHI at Monday, November 28, 2011 3 comments

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Senate Enquiry Into The PCEHR - Alert - Responses Due 12 January 2012.

The following appeared a few hours ago.

Senate to probe Gillard government's e-health legislation

A Senate committee will examine enabling legislation for Health Minister Nicola Roxon's electronic patient record system. Source: HWT Image Library THE Gillard government’s $500 million personally controlled e-health record program will come under scrutiny at a Senate inquiry into the enabling legislation tabled in Parliament last week. The Selection of Bills Committee has referred the PCEHR bills for examination of issues related to the system’s design and capabilities, security and the potential for exposure of sensitive information. More here: http://www.theaustralian.com.au/australian-it/senate-to-probe-gillard-governments-e-health-legislation/story-e6frgakx-1226208011456 Here is the official  page:

Personally Controlled Electronic Health Records Bill 2011 and one related bill

For further information, contact: Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Australia Phone:  +61 2 6277 3515 Fax:        +61 2 6277 5829 Email:     community.affairs.sen@aph.gov.au http://www.aph.gov.au/senate/committee/clac_ctte/pers_cont_elect_health_rec_11/index.htm Responses are due by January 12 2012. Just the usual nonsense of asking for submissions on serious matters over the holiday period. Treat the public as idiots as usual it seems! David. Posted by Dr David More MB PhD FACHI at Monday, November 28, 2011 0 comments

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AusHealthIT Poll Number 98 – Results – 28th November, 2011.

The question was: Do You Believe NEHTA's 'Tiger Teams' are the Right Approach To Developing the Required PCEHR Standards? Yes -  6 (16%) Probably -  1 (2%) Probably Not -  7 (19%) No Way -  17 (47%) What is a Tiger Team? -  5 (13%) Votes : 36 It looks as though about 70% think the Tiger Team is not the way to go for the PCEHR Standards and almost 15% or readers are not paying attention! Again, many thanks to those that voted! David.
Posted by Dr David More MB PhD FACHI at Monday, November 28, 2011 0 comments

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Sunday, November 27, 2011

The Tiger Teams Are Off And Rolling. To Where Is Really Unclear!

On the 17th November, 2011 there was a daylong meeting of the Tiger Team which is working to specify what is to be the Consolidated View of the PCEHR. As it happens a kind soul has made available some of the documents that were used / came from this meeting. First to provide some context. It is intended that the PCEHR will be accessed via an Orion Systems Home Page for that particular patient. There will be a space for the usual controls and for a document list at the left of the screen - some patient ID across the top of the screen and the Consolidated View (CV), which will include access to the Shared Health Summary and then a range of Event Summaries (Discharge Summaries, Test Results etc) will be at the right. From this point on it would seem the design - which is due to be frozen come November, 30 - would still seem to be rather fluid with a large range of design decisions yet to actually be taken. The focus of the meeting was on presentation of the clinical information in the screen real estate available - there apparently being confidence the data issues around the contents of all the information were already resolved. Time will tell if this is true. You can get a flavour of one of the options being discussed from this screen shot.
 (Click image to enlage) 
Now this is all well and good if it was planned to develop and implement the PCEHR over a number of years - but really - in 8 months they are dreaming. To allow for a sensible period of testing this means the whole thing needs to be specified, developed and delivered in six or so months. Really? If there is one issue that really I struggle with in all this is why we are going for such apparent complexity so early. This is really going for nuclear fission when we are lucky to be only just moving into the steam age! As I have said more than once why not just have the most basic of Shared Health Records to start off with and then, once that works, slowly add. I note that this is the approach the UK NHS are adopting:

Working group to consider SCR add-ons

17 November 2011   Rebecca Todd A working group is being arranged to consider how additional information will be added to Summary Care Record via GP systems. A Department of Health SCR Programme Update for October says 73% of out-of-hours doctors using the records feel they have increased patient safety. But 74% also say that having additional information on the record would increase their ability to make informed decisions. The update, included in the minutes of a British Medical Association and Royal College of GPs joint IT sub-committee meeting , says a working group is being put together to consider how additional information could be added. “A working group is being arranged to consider and set a direction of travel for how additional information will be added and maintained via GP practice systems,” it says. “It is essential that this work has input from the professional bodies and patient groups and that a way forward is jointly agreed by all parties. An initial meeting is being scheduled for November 2011.” More here:
http://www.ehi.co.uk/news/primary-care/7320/working-group-to-consider-scr-add-ons Worse I really can’t fathom just how, as this record develops from a recently established record to the longitudinal life-long record just how material can be organised, searched and ordered in useful ways. 10 years of pathology results from a complex patients- some discrete and some in other formats - seem to me to be a real challenge to manage, sort and so on. Just how much of the record needs to be reviewed when a patient is first encountered is also an interesting question. I really think we need to walk before we run. There are already standards for a simple Continuity of Care record from the US and the Shared Care Record from the UK. Surely we could start here rather than taking this over-engineered and almost certainly doomed to fail approach. The number of open issues identified by the Tiger Team on the CV just two weeks before was due to be finalised makes that utterly clear. NEHTA and DoHA think again before it is too late. You might just be able to snatch victory from the jaws of defeat! David.

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