Roxon lost on e-health, opposition claims

By: Suzanne Tindal

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.
"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.
We've seen no evidence of an agenda which we can support as we go forward.
The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.
Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."
His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.
"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.
The lack of drive and vision has seen talent go overseas to where the fruits of its labour might be implemented, he said. "[There are] disillusioned Australians from the National E-health Transition Authority and from Queensland Health and from a lot of healthcare areas, working hard to make sure that Singaporeans get an electronic health record next year."
What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions.
In order to move from this point, Boehncke highlighted three areas he thought needed urgent attention, the first being a national e-health investment strategy which was "much more than a business case" since it defined what would be built, for whom and why. NEHTA currently has a business case for a national e-health strategy, which needs to go before the Council of Australian Governments before funding can be allocated to it.
The second was a national infrastructure and definitions around how data would be shared, where it would reside and who owned the data. Where the data resided would go into consultation after the business plan was approved, according to NEHTA CEO Peter Fleming, speaking at an IIR conference last week.
"At this stage the current thinking is that we will not have one central electronic health record that everyone's part of. The expectation is that there will be multiple electronic health records around the country and that those health records will be provided by various players. In some cases it may be health insurers, in some cases it may be Google or Microsoft, it may be professional bodies," he said.
"Where I think we will end up is that we will have a large indexing service not dissimilar to the type of web technologies we know today that knows where an individual's records are stored and can pull that data back as required. Given the current physical restraints, I think that index will also contain some summary data, things that might be required in an emergency.
The last issue Boehncke outlined was the national health identifier, which he spoke on in expanded fashion since it touched upon prior work of his with the past government's controversial Access Card. "[NEHTA is] developing a number for every Australian. But having a number isn't the same as developing an identifier," he said. Boehncke said it was necessary to have that number linked to the physical person, for example, by using a card, but when he asked people in Australia how they thought the person would be linked to their number, he received a lot of different answers.
This type of stuff really makes the things that were stored on the Access Card seem insignificant.
"I get high-ranking state health ministry officials that tell me people in Australia don't need to be identified securely because they trust their GP... The GP will identify the patient," he said. "Other people tell you oh no, no, no, there'll be a new Medicare card. It'll be a smart Medicare card."
Those people thought it would be easy to upgrade the Medicare card to take on new duties, but it wouldn't be, according to Boehncke.
"Let me tell you, from my Access Card experience I know that's not going to be easy because you're moving from a payment card to what becomes an identity card. And you'll have all these questions like we had with the Access Card. Like can you put a photo on it."
When someone asked if the government was dithering because it was frightened of opening up an Access Card type can of worms, Boehncke said that an e-health card would be much more frightening than the previous government's controversial card because of the type of data it would have stored on it.
"This type of stuff really makes the things that were stored on the Access Card seem insignificant because your health data holds a lot more information about you," he said. "To be afraid of an Australia Card when you are trying to identify people in the health setting might be natural when you look at the Australian history in a lot of these debates," he said.
Yet he believed people would voluntarily take up an e-health card because unlike the Australia Card of the Access Card, an e-health card has a true value proposition — the opportunity to save lives.

Medical histories on internet

By:Anna Caldwell and David Earley

AN alarming privacy breach by one of Queensland's biggest pathology labs has splashed patient medical histories over the internet.

The names, contact numbers and private details of at least 100 patients, and potentially hundreds more, were plastered on the website of Brisbane-based Sullivan Nicolaides.

The breach has cast serious doubt on the safety of electronic patient record systems, and angry patients were last night demanding answers.

The Courier-Mail yesterday viewed 102 patients' details before it alerted the lab to the security breach, which has been blamed on a processing error.

Kay Faulkner from Brisbane was devastated to hear the details of her recently deceased husband were so easily accessible.

"This is disgusting," she said.

"Dishonest people can easily misuse the details of someone who has died so for me this is a serious breach."

Rick and Cindy Gore from north Queensland said the security lapse was "completely unacceptable".

"We were never given a password or website to access so there is no reason for this information to be online - it is not like we could log on and check it ourselves."

The use of electronic records in medicine has jumped as software systems become more sophisticated. But the failure at Sullivan Nicolaides has shown the potential for online records to fall into the wrong hands.

All patients affected by the breach were referred to Sullivan Nicolaides by their GPs for the management of warfarin doses, a blood-thinning drug.

Most were from Queensland and northern NSW, with the files dating back to 2007 and 2006.

The records detail relevant medical history, current medications, as well as patient's next of kin.

Sullivan Nicolaides CEO Michael Harrison initially refused to reveal how many patients records were violated and accused The Courier-Mail of "acting like terrorists".

He later apologised and said 103 files were breached, although The Courier-Mail believes it could be many more.

Mr Harrison said the company had taken the security problem "very seriously", and within an hour of being alerted, the records were removed.

He said patients' details were only meant to have been accessed by authorised doctors and staff.

"Honestly, we are flummoxed (by the breach)," he said.

Despite the violation, Mr Harrison said e-health was the future of medicine. "I don't want this to be adverse publicity for e-heath because electronic health records are crucial to ensuring patients get the right care."

Chair of the Privacy and Security Forum and board director of the Health Informatics Society of Australia Peter Croll said that although private medical records should never be publicly available, there was nothing in the law requiring a breach to be reported.

"Obviously it's totally inappropriate," Mr Croll said.

IBA Health raising $124m to pare debt

HEALTH information technology firm IBA Health Group will seek to raise up to $124 million by issuing new shares to reduce debt.

IBA said yesterday it was offering two shares for every seven held by shareholders, at 55c per share -- a 29 per cent per cent discount to the closing price on Wednesday.

The institutional component of the offer, representing about $77 million, was committed.

IBA said its largest shareholder, AEP Financial Services Holdings, had committed to taking up its full entitlement, equivalent to about $32 million.

The balance of the institutional offer, about $45 million, is underwritten by ABN AMRO and UBS.

The retail offer, on the same terms as the institutional offer, is not underwritten.

IBA said it intended to use the proceeds of the offer to retire subordinated secured borrowings of $60 million from AEP, and other senior borrowings.

"The equity raising places IBA in a strong capital position to continue to benefit from investment in health IT by governments worldwide, and the computerisation of healthcare records," IBA chief executive Gary Cohen said.

"The outlook for the company is robust," he said.

IBA reconfirmed its 2009 full-year guidance for revenue of $540 million to $560 million and earnings before interest, tax, depreciation and amortisation of $120 million to $130 million.

"The company is well positioned to generate growth in the current economic downturn, with approximately 90 per cent of forecast revenues for full-year 2009 funded by governments either directly or indirectly," IBA said.

"Additionally, as at the end of January 2009, approximately 94 per cent of IBA's forecast full-year 2009 revenues were recurring, contracted and expected."

IBA shares, which were in a trading halt on Thursday, last traded at 77.5c.

BI key to e-health, says SWAHS staffer

By: Suzanne Tindal

Using integrated business intelligence software can help harness the benefits of introducing electronic health records, according to a senior IT staffer at Sydney West Area Health Service (SWAHS).
The forklift's running around there in a fairly empty warehouse.
SWAHS staffer Trevor McKinnon
"The biggest issue you have with the electronic health records is that nursing staff are providing the bulk of the entry," SWAHS business intelligence and web development director Trevor McKinnon said in a recent interview with ZDNet.com.au. The nurses felt that they were not getting any of the benefit and doing all the work, he said.
Indeed, most of the advantages of having electronic health records were seen downstream, he said, when, for example, doctors were able to see the information nurses had entered.
He hoped that in years to come, business intelligence could alter this perception by running text analytics on the data from the electronic records to make nurses' workload less and not more. Business intelligence would use text analytics to "get into what's written" and pre-write a report which the nurse simply had to review, instead of creating.
"Business Objects certainly has the potential to do that," he said, although he didn't believe it would happen until 2011. NSW Health has a whole-of-state contract with Business Objects and uses the company's Xcelsius platform. McKinnon is one of the leading drivers of its use, taking on not just business intelligence for SWAHS, but for other area health services within the state as well.
Just as business intelligence would help electronic health record acceptance, the progression of electronic health records would help business intelligence. Although the groundwork for electronic records in NSW had been done, McKinnon said, only the emergency departments and intensive care were recording patient information electronically. In other departments nurses were still writing reports by hand.
This limited the breadth of data which McKinnon had at his disposal to run statistics using the business intelligence, with only information such as admissions and outpatient services available for use. "The forklift's running around there in a fairly empty warehouse," McKinnon said, although he admitted that the information being gathered already was prolific enough to keep him very occupied.
This data is currently used to measure performance for the hospitals, and Sydney West Area Health Service uses dashboards built on the information to benchmark how staff are performing. It also is used on the patient side. If a "frequent flyer" patient comes into the emergency department, the business intelligence application can inform the employees which professional the patient saw previously — this often allows cases which don't need hospitalisation to be given other treatment and sent home, freeing up beds.
McKinnon looked forward to when most patient records were being entered electronically so that business intelligence could carry out functions such as finding keywords in records which could alert a doctor to the fact that a patient may need attention, increasing the level of care. "We can't wait," he said.

NSW a silent success in e-health

NSW is leading the country in e-health with both doctors and patients benefiting from new technology, but why wont Health Minister John Della Bosca tell us about it, writes Bryn Evans.

When will some really good health news get some coverage? While the media has recently been fixated by the world financial crisis, political backstabbing, or the misdeeds of the latest rogue doctor, real progress has occurred in NSW e-health that will bring far-reaching benefits to everyone in the state.

On 1 October last year, St George Hospital implemented an electronic medical record system (eMR) for some 2300 clinicians across its emergency department, all wards including pathology and radiology, nine operating theatres and more than 300 outpatients clinics, and allows electronic discharge forms to be sent to general practitioners. The project has been hugely successful, and is the start of a state-wide program by NSW Health to introduce the eMR to every hospital in the state.

The eMR system was first deployed at the St George Hospital in the South Eastern Sydney & Illawarra Area Health Service (SESIAHS), followed by Calvary and Sutherland hospitals, and will be rolled-out to each hospital in the Area Health Service for some 1.3 million people.

All hospitals in the Illawarra region will go live in the next two months, followed by the Northern Coast Area Health Service which is in the middle of its eMR roll out.

In time eMR will spread state-wide.

Some Area Health Services with earlier, less comprehensive eMRs, are planning upgrades.

So why does NSW Health Minister John Della Bosca not tell us about it?

The eMR rollouts mean that patients treated in SESIAHS will have their patient details, medical history, test results and treatment notes updated and instantly available to any clinician attending to them.

No more tedious and inefficient questions such as “Which hospital and doctor did you last see?”, “What did your last test results state?”, “What medication are you on?”, or “Do you have your ultrasound scan with you?” that drive every patient to distraction.

There will be an immense improvement to patient safety as the eMR becomes available everywhere in NSW.

Adoption of an eMR on this scale is the most ground breaking IT project undertaken in Australian healthcare, and NSW Health is leading the way. It is the first step in a journey to provide electronic information that better supports clinicians and brings improved care to patients. Work procedures and practices will be fundamentally transformed as knowledge is shared to provide better patient care.

The eMR finally brings the benefits of ubiquitous online access, akin to electronic banking, within the reach of clinicians and health consumers. It also provides the foundation of information for the personal electronic health record, which health consumers could access over the Internet within the foreseeable future.

But why cannot NSW Health tell the public about this success?

Maybe they are scared of success, and the resulting demands by the Garling Inquiry for more funds to speed up deployment.

For once NSW Health have some really good news. It is following best practice, and has got it right, so they should tell us about it!

Health ignored in stimulus package

By ignoring the health sector in today's stimulus package the Federal Government has missed the opportunity to support one of the most important areas of the Australian economy, according to the Australian Healthcare and Hospitals Association (AHHA). The AHHA is the peak national body representing public hospitals, area health services, community health centres and public aged care providers."Health and community services contribute to the overall strength of our economy in a number of ways and should have been a key focus of this stimulus package," said Ms Prue Power, Executive Director, AHHA. "Firstly, health is one of the biggest components of the services sector, the largest section of the Australian economy. Health care is a growth industry which has the potential to further expand with support from the Federal Government. "Secondly, the health sector is one of our nation's largest employers with over 10 per cent of workers being employed in the area of health and community services. With widespread workforce shortages, there is considerable scope to train and employ health care workers throughout the sector thus creating new jobs and meeting existing needs for health care. "Thirdly, the productivity of our workforce depends upon high quality and accessible health care services. When people lack adequate access to health care it can reduce their capacity to work, affecting both them and their families and compromising the overall efficiency of our economy. "There is clear evidence that our health system currently does not perform well in areas such as the diagnosis and management of chronic disease and the provision of preventive dental care. This leads to the development of more serious conditions which can prevent people from seeking or continuing in employment. "AHHA urges the Federal Government to expand the suite of initiatives contained in today's stimulus package to include an injection of funds into the health sector, in particular focussing on the critical areas of infrastructure and workforce. "This would enable health services to upgrade their infrastructure, train more health care workers and increase the provision of essential health care to the Australian population, providing flow-on benefits to the economy and resulting in a healthier and more productive workforce," Ms Power said.

HealthSmart gets new head

By: Suzanne Tindal

The Victorian Department of Human Services has appointed a new CIO of health services who will also lead up the state's HealthSmart electronic health initiative.
Dr Andrew Howard, not the same Andrew Howard who holds the CIO position for the whole department and had previously been acting National E-Health Transition Authority CEO, will start next week.
A spokesperson for the Department of Human Services was sure there would be ample confusion caused by the two like-named CIOs.
The incoming CIO's role will include taking responsibility of HealthSmart, filling the shoes of Fiona Wilson who left last September.
HealthSmart began as a four-year, $320 million project to update IT systems in hospitals and other medical facilities right across Victoria, but has encountered deadline and budget problems.
Howard has had a medical career within the Victorian public health system, the spokesperson said, but has also held positions in the private sector at corporations such as NEC.