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."

Wednesday, August 20, 2014

It’s Really Wonderful To See The Quality Gobbledegook NEHTA Comes Up With!

Spotted this a few days ago.
Here is the full page:

Our Work

eHealth Reference Platform

The eHealth Reference Platform is a clinically validated technical simulator for eHealth, with technical services and sample code supporting demonstration, training and development testing.
There are no articles in this category. If subcategories display on this page, they may contain articles.
 Link is here:
This is really one of the funniest pages I have seen in a good while and just typifies the old and failed NEHTA mindset. User understanding, not technology, is what is needed to e-Health to ever work.
There is a prize available for the first person to explain just how you clinically validate a technical e-Health simulator.
It is this sort of focus and direction of effort by NEHTA that confirms NEHTA has its priorities all wrong.
Just why exactly does a content-less page like this exist?
The sooner they are ‘dissolved’  and transferred to a more useful clinically and consumer orientated entity the better as far as I am concerned.
David.

Tuesday, August 19, 2014

Just Why Would It Be That A Study Funded By The Public To Assess The PCEHR Be Kept Secret By NEHTA?

This appeared late last week.

GPs slam PCEHR in secret report

14th Aug 2014
THE personally controlled e-health record is running chiefly on “goodwill”, and time-poor GPs say they have little reason to embrace it in its current form, according to a confidential report of the National E-Health Transition Authority (NEHTA) obtained by MO.
The report, dated 5 June, is a clinical impact assessment of the integration of e-health into primary care. It was prepared for a NEHTA program established to address major functionality and usability issues in the PCEHR.
Fifty-seven general practices responded to an expression of interest to take part, but 10 did not respond to emails or phone calls, six withdrew interest and four were ineligible because they weren’t using the PCEHR.
NEHTA ultimately received 35 completed questionnaires and selected 14 practices for face-to-face interviews.
Respondents said the time outlay was “onerous”; patients who had records did not know what they had signed up for; and that practices had to wear the cost of extensive troubleshooting, spending time “explaining and re-explaining their issue to multiple tiers of support personnel”.
The report also said the Practice Incentive Program eHealth Incentive did not incentivise practices to actually use the system, and that the “business case for PCEHR does not fit into the workflow of general practice”.
The report reinforces criticism that NEHTA’s focus has been on the technology rather than education and adoption.
Although the study set out to determine the proportion of primary care organisations likely to be affected by usability issues, it could not do this because “the sample is biased towards e-health experience and thus not representative of general practice in Australia”, the report conceded.
Lots more individual comments reported here:
What can I say other than what we know the NEHTA and DoH have delivered a dud and should be fundamentally re-considered in the light of a properly updated and agreed National E-Health Strategy.
Just consulting on the PCEHR in the absence of a deeper review is a farce.
Just release the report, fix leadership and governance of e-Health, confirm a proper national strategy and then decide what to do. Please not the cart before the horse!
David.

Monday, August 18, 2014

Weekly Australian Health IT Links – 18th August, 2014.

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

General Comment

Quite an interesting week with all sorts of amusement on the consultation regarding the PCEHR and the HIC Conference revealing that morale in the e-Health sector is less than ideal with the credibility of the those who are leading the e-Health Program failing to generate much in the way of confidence in their leadership. Will be interesting to see how things play out.
Enjoy the articles.
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Implementation of Australia's PCEHR system reviewed

By Michael Morris (view CV) and Phil O'Sullivan
At the end of 2013, the Federal Minister for Health announced a panel review into Australia’s Personally Controlled Electronic Health Record (PCEHR) system to consider implementation and uptake issues. The subsequent report, made public in May 2014, puts forward 38 recommendations to address the issues identified, which includes the recommendation that the PCEHR system should be transitioned to an opt-out model.
An edited version of this article first appeared in eHealth Law & Policy Journal for the July 2014 edition.
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PCEHR survey a banana skin for govt

12 August, 2014 Ruby Prosser Scully
The Federal Department of Health has been savaged for "appallingly bad practice" after running an online survey on the PCEHR that asked people to name their favourite fruit.
Alongside questions on "opt-out models" and PCEHR patient privacy was the question, "Which do you like best?", to which respondents could choose from "option apple", "option banana" or "option cherry".
Apparently the question was a default setting on the SurveyMonkey online system that bureaucrats used to run the questionnaire.
The banana question was later changed to: "What clinical measurements need to be included in a shared health record?"
The bugs have now been fixed.
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GPs slam PCEHR in secret report

14th Aug 2014
THE personally controlled e-health record is running chiefly on “goodwill”, and time-poor GPs say they have little reason to embrace it in its current form, according to a confidential report of the National E-Health Transition Authority (NEHTA) obtained by MO.
The report, dated 5 June, is a clinical impact assessment of the integration of e-health into primary care. It was prepared for a NEHTA program established to address major functionality and usability issues in the PCEHR.
Fifty-seven general practices responded to an expression of interest to take part, but 10 did not respond to emails or phone calls, six withdrew interest and four were ineligible because they weren’t using the PCEHR.
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Big Data: Exciting – until it’s not big data

| Aug 13, 2014 12:00PM | EMAIL | PRINT
Big data is everywhere at the moment, with many believing it is the next big leap in medicine.  So great is the interest in this area that Health Affairs journal recently dedicated an issue to the progress, possibilities and challenges of using big data in health. Big data obtained from thousands of electronic records combined with predictive analytics is thought to have huge potential not only in identifying patients at risk but in areas such as research and fraud detection.
In America, many companies are jumping in to see where big data can take them in health care.  Not surprising given that, according McKinsey , making sense of big data in health could save in excess of $300 billion a year in the United States.
In an article in the MIT Technology Review “Can technology fix medicine?”  a number of potential uses for big data currently being explored are discussed including understanding drug compliance, receiving alerts for potential adverse drug interactions and determining genetic predisposition.
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Analytics, Jamie Oliver and the quantified self

According to Dr Pradeep Philip, Secretary of the Victorian Department of Health, we’re on the cusp of seeing a radical reconceptualisation of the health system. This is coming through the rise of consumer sovereignty – the desire of consumers to have a voice in the services and products that they are accessing, as well as the rise of big data.
“Consumers want to be part of a health system where results are co-produced,” argues Dr Philip. “It’s a simple argument. Across the economy we are seeing a reconceptualization of consumer sovereignty, and now that is occurring in healthcare.”
Speaking exclusively with eHealthspace.org following his presentation at the HIC Conference, held in Melbourne earlier this week, Dr Philip said the best way to understand this reconceptualization is through the way that patients are communicating with each other - and with their clinicians.
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Our Work

eHealth Reference Platform

The eHealth Reference Platform is a clinically validated technical simulator for eHealth, with technical services and sample code supporting demonstration, training and development testing.
There are no articles in this category. If subcategories display on this page, they may contain articles.
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Question: sending PDFs via HL7 v2

Posted on August 11, 2014 by Grahame Grieve
This question is a follow up to one asked on Stack Overflow
Question:
On stack overflow you asked me to look at MDM message type. My question is that I know some systems can’t handle MDM message types so if this is the case how could sending of a url for a pdf be handle in that case?
What is the best way(appropriate message/event type) to put a url for a pdf in an hl7 message(ie what are the message types and segment, etc.. that are appropriate)?
Also does the HL7 standard allow for the unsolicited pushing of pdf messages whether it be a url to a message or an actual pdf document encoded in hl7? For example if an ADT message came in and was successfully loaded into my system and I wanted to create an hl7 message to send out with the link or embeded pdf that i created. What hl7 message would i use to send?
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ONC Hearing on the JASON Report – openEHR perspective

Recently I was asked to provide testimony to the ONC hearings on the JASON report, from an openEHR point of view. I did so on 31 July 2014. The JASON report is entitled “A Robust Health Data Infrastructure”. It surveys the problems of health data interoperability, and proposes the adoption of a unifying ‘software architecture’ as the solution. It also seems to imply a federated health record database. It’s primary assumption appears to be that APIs are the key element of the solution, and that their standardisation will fix the problem.
I made some comments on the report, as well as to specific ONC questions. These are attached below, and is summarised as follows:
  • the problem needs further articulation before a wide-ranging ‘solution’ can be defined.
  • the nature of the problem (as known by many of us working for many years on it) is such that a ‘software architecture’ can only be a small part of any overall approach, and that the solution concept needs to be reframed as an open platform definition.
  • most of the semantics that needs to be standardised are outside software and APIs, and found in artefacts like terminology, DCMs/archetypes, guidelines and ontologies.
  • defining APIs without detailed content and workflow definitions won’t solve the problem.
  • a content-based querying methodology needs to be part of any solution.
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Tech giants gambling on health technology

Date August 9, 2014

Mark White

When pharmacist Thuan Vuu plays basketball, he laces his feet into a pair of Nike Hyperdunk+ shoes fitted with a sensor that sends data to his iPhone. He can see how far he’s run and how high he’s jumped, and by setting himself goals – he aims for at least two kilometres per game – he can not only play to win, but also have a benchmark for a successful workout.
The trim and cheerful 29-year-old from Fairfield, Sydney, also has a Fitbit activity tracker, which measures steps taken, calories burnt and movement during sleep. His phone’s SleepBot app records sleeping activity, a Wahoo cadence meter reports how hard he pedals his pushie, and an Adidas miCoach chest strap and foot pod log his heart rate, step pace and G forces while training.
He logs his spending on YouNeedABudget.com and has bought the Meitrack device for his car to track his driving habits. He weighs himself on Aria Wi-Fi smart scales – and lost six kilograms by noting and varying his diet – and is thinking of buying the Cue at-home lab kit, which tests for five factors including vitamin D levels.
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Wearable device for seniors keeps tabs on their health

Date August 15, 2014 - 11:56AM
Most fitness trackers monitor the habits of relatively self-aware, healthy individuals — those looking to lose weight or hit a steps goal each day — but a new device intended for seniors keeps tabs on how they're doing and alerts caregivers when something might be wrong.
Tempo, by CarePredict, is a wristband tracker that doubles as a watch and logs the daily activities of its users. The product is currently looking for backers on crowdsourcing website Fundable, where it's listed for $US169.
Tempo looks to identify early warning signs of health issues that usually begin as changes in normal behavior patterns and even factors in activities like cooking, tooth brushing and eating to paint a better picture of the wearer's mental health.
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Robots pave way for a better way to see life

John Ross

BLIND people could soon swap canes for a handheld gadget which emerged from research to help robots navigate.
American psychologists have found that the device, which looks like a TV remote control, works as well as canes in helping blindfolded novices get around.
They say it could help relieve the “emotional stigma” that ­afflicts visually impaired people, particularly children, by removing the need to carry a white stick.
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Doctors fear turning off a patient's pacemaker risks murder charge

Date August 17, 2014 - 12:15AM

Julia Medew

Health Editor

Doctors are calling for Australians with pacemakers to write clear instructions about the circumstances in which they would like them switched off in case they want doctors to help them die at some point in the future.
While doctors have long been making decisions to withdraw ''life support'' measures for people in circumstances where the care is futile or the patient does not want to live with extreme disability, they say increasing requests for people's pacemakers to be turned off raise difficult ethical questions and may even expose them to criminal charges of murder, manslaughter or assisted suicide.
A leading intensive care specialist from Newcastle, Peter Saul, said one technician at his hospital refused to turn off a dying woman's pacemaker at her daughter's request because he feared being accused of killing the woman in potentially unethical or illegal circumstances.
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Medicare and PBS remuneration to be outsourced

11 August, 2014 Christie Moffat
The Australian Government is calling for Expressions of Interest from the private sector to take on claims and payment services for Medicare and the PBS.
A Department of Health advertisement appeared in The Australian Financial Review last Friday, calling for “dynamic and innovative commercial solutions” to improve the current collection and payment system.
Currently, the Department of Health contracts the Department of Human Services to deliver the system, which remunerates doctors and other health professionals.
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RBA may lose health payments to private sector

Joanna Heath

Key points

  • The RBA’s transactional banking division looks after Medicare and PBS contracts for the government.
  • Bupa, Medibank and Australia Post among those potentially interested in taking over payments.
The Reserve Bank of Australia could lose one of its historic functions under a plan to outsource government health payments to the private sector.
The central bank’s transactional banking division, which processes ­payments and transfers on behalf of some government departments and deposits money into personal bank accounts, handled $455 billion for the government in 2012-13.
One segment of its responsibilities is processing Medicare and pharmaceutical benefit payments for the ­Department of Human Services, a ­function that would be outsourced under a plan to make government more efficient.
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The next big thing in apps: Tech and the health revolution

Wednesday, 13 August 2014 15:20
Dennis Benjamin
Remember the popularity of video shops? I missed investing in them when they were hot. Suntan clinics? Was never interested in those as an investment, and they’re decidedly not hot now. Pizza chains, any of them – damn, another hot investment sector got away!
Want to know the next hot thing? It’s health. Not surprising really. Our average age is increasing, according to the US CDC (Centers for Disease Control and Prevention on Trends in Aging), the Australian Bureau of Statistics and my good old doctor, Dr Goldberg.
We're getting older and taller but heavier. Put simply, health is on our minds a lot more. It’s not surprising therefore that health will play a larger part in communications and, more particularly, mobiles and apps.
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GPs' test result systems confusing patients

13 August, 2014 Michael Woodhead 4 comments
Faced with increasing numbers and complexity of tests, general practices may need to upgrade their systems for communicating results to patients, researchers say.
Many practices are still relying on informal and ad hoc protocols to communicate test results to patients, and run the risk of catastrophic consequences from mistakes, according to a survey carried out by primary care researchers at the University of Birmingham, UK.
Their review found that while informal systems often worked well, they sometimes left doctors, practice staff and patients unsure as to who was responsible for communicating results.
Practice staff also faced an increasing workload in communicating ‘normal’ results to patients, while there was a lack of a fail-safe system for abnormal results, the review in Family Practice found.
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Sick asylum seekers treated via video conferencing

Date August 11, 2014 - 12:15AM

Sarah Whyte

Immigration correspondent

Sick asylum seekers on Christmas Island are being offered videoconference appointments with specialists on the Australian mainland after damning evidence showed the deplorable state of medical services in immigration detention.
Fairfax Media understands at least one young woman on Christmas Island, who has been complaining of stomach aches for four months, was told this week that she would be seeing a specialist via videolink and the appointment would happen immediately. 
The woman says she was told by nurses that if she did not accept the video link then ‘‘there mustn’t be anything wrong with her’’, but that medical professionals at both ends would discuss her medical history. 
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GP video consults in aged care on trial

A pilot program to test the viability of introducing Medicare-funded GP video consultations with aged care residents is currently underway in nine regions across the country.
The four-year trial funded by the Department of Social Services involves eight Medicare locals and aged care provider Feros Care.
The pilot will evaluate the possible inclusion of new telehealth items on the MBS as well assess the clinical appropriateness and impact of videoconferencing to deliver GP services in aged care.
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Australian hospital accidentally declares 200 patients dead

SYDNEY Thu Aug 14, 2014 2:25am EDT
Aug 14 (Reuters) - An Australian hospital apologised on Thursday after mistakenly sending out death notices for 200 of its - very much alive - patients.
Austin Hospital, in Australia's second most populous city of Melbourne, erroneously killed off the patients when it faxed death notices to their family doctors.
The notices were the result of an inadvertent change to the templates the hospital sends to doctors once a patient has been discharged, operator Austin Health said in a statement.
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Bianca Phillips: Telemedicine risks

Bianca Phillips
Monday, 11 August, 2014
PATIENTS in Australia can now access online medical prescription services — both overseas and Australian based — without the need to actually see a doctor.
Some services allow patients to select their own medications from a list and nominate their dosage requirements. The patient simply completes a questionnaire to assess their suitability for the medication and is asked to attest that they have read a medicine information sheet. Payment is made online with the option of having the drug or the prescription posted to the patient.
The prescription is written by a doctor who reviews the completed questionnaire but there is no face-to-face consultation.
It is questionable whether these online services can provide a holistic assessment of patient wellbeing, and sufficient counselling about medication risks and correct dosage requirements. On one website information sheets contain a significant amount of medical jargon, while another site requires the patient to navigate through several webpages to access the information.
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Telstra - up, up and away

It’s happy days at Telstra. All the numbers are up, with a hefty dividend increase, Australia’s biggest telco has announced its financial results for 2013-14. To nobody’s surprise, they are extremely healthy.
CEO David Thodey, five years in the helm, has presided over a vast improvement in Telstra’s fortunes. All key indicators are way up, and there are no dark clouds on its horizon. Those who invested in the three share floats and stayed with the company during the dark days of the unlamented Sol Trujillo have been handsomely rewarded.
…..
He said investing in new businesses and growing in new geographic markets was essential for Telstra’s growth ambitions, and good progress had been made through investments in the areas of eHealth, Global Enterprise and Services (GES) and Global Applications and Platforms (GAP).
“We continued to grow our capabilities in eHealth, acquiring DCA eHealth Solutions and 50% of Fred IT,” said Thodey in his statement announcing the results. “We also signed licensing agreements with Dr Foster, iScheduler and InstantPHR, building on our objective to deliver eHealth solutions via connectivity of health services, electronic health records and electronic prescriptions.
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Seven ways DARPA is trying to kill the password

From analyzing the way you walk to your heartbeat, these futuristic authentication systems could be here soon
A seemingly constant stream of data breaches and this week's news that Russian hackers have amassed a database of 1.2 billion Internet credentials has many people asking: Isn't it time we dumped the user name and password?
A lot of the best technology of today exploits biometric factors such as retina patterns, fingerprints and voice analysis, but beyond that a number of researchers are looking to tap into the way we think, walk and breathe to differentiate between us and an intruder.
Helping to lead the research is DARPA, the U.S. military's Defense Advanced Research Projects Agency. Its active authentication project is funding research at a number of institutions working on desktop and mobile technologies that work not just for the initial login but continuously while the user is accessing a device. The array of sensors already found in mobile phones makes some of the ideas particularly interesting.
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New NBN Co report blames company board for delayed rollout

Date August 13, 2014 - 6:02PM

Matthew Knott

The early rollout of the National Broadband Network was stymied by a board which lacked the necessary skills and experience to deliver the nation’s biggest infrastructure project, according to a damning review of NBN Co governance under the Rudd and Gillard governments.
The report, by advisory firm KordaMentha, also suggests the NBN Co board should have been more forthcoming to the government when it received independent advice raising concerns about the lack of directors with telecommunications and government enterprise experience.
The report, one of several commissioned by Communications Minister Malcolm Turnbull into the infrastructure project, was tabled in Parliament late on Wednesday. It follows the release of another review last week by former Telstra executive Bill Scales which found the Rudd government used a ''rushed, chaotic and inadequate'' public policy process to develop the NBN. 
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Government says 'no thanks' to NBN committee recommendations

Recommendation to revisit strategic review process rejected by Coalition
The federal government has issued a formal response (PDF) to the set of recommendations contained in in the interim report of the Senate Select Committee on the National Broadband Network.
The interim report was released in March. For the government to accept the recommendations of the Labor and Greens dominated committee would have represented an about-face by the Coalition, which since coming to power last year has moved to replace the Labor and Greens-backed fibre-to-the-premises NBN model with a 'multi-technology mix'.
The formal government response, signed by communications minister Malcolm Turnbull and finance minister Mathias Cormann, rejects three of the committee's recommendations — that NBN Co submit a revised strategic review; that the process of producing a "document with the deficiencies evident in the Strategic Review" be investigated, and that the "Senate amend the Committee's Terms of Reference to enable ongoing and robust Parliamentary oversight of the National Broadband Network".
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Over 1,800 exoplanets discovered and confirmed

As of August 11, 2014, the number of extrasolar planets (or exoplanets) that have been discovered and confirmed stands at 1,815. 
Exoplanets are defined as any planet that orbits a star outside of the Earth’s solar system. Therefore, an exoplanet may orbit, for instance, a star other than the Earth's Sun, a stellar remnant, or brown dwarf.
Two organizations (among others) are collecting data on exoplanets. One is The Extrasolar Planets Encyclopaedia at http://exoplanet.eu/. The Extrasolar Planets Encyclopaedia was developed and is maintained by the Exoplanet Team (http://exoplanet.eu/team/). 
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Enjoy!
David.

Sunday, August 17, 2014

Draft Submission To PCEHR Review Consultation - August 2014

Here is my draft submission. Comments are very welcome to improve it.
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PCEHR Review Consultation Submission - DG More - August 2014

Introduction

The following submission has been prepared to offer some commentary and input to the process now underway, being facilitated by Deloitte, to ascertain stakeholder views on the Personally Controlled Electronic Health Record System (PCEHR) and the recommendations  of the recently undertaken PCEHR Review which was commissioned by the Federal Health Minister in September 2013 and released publically in May 2014.

Author Of Document

This document is authored by Dr David G More MBBS BSc(Med) PhD FANZCA FCICM FACHI.
I have had over 20 years involvement, in one form or another, in the area of Health Information Technology (e-Health) and been a contributor to many projects in the area including the development of the 2008 National E-Health Strategy.
I am reasonably well known in Health IT circles as the author of a blog on Health IT (www.aushealthit.blogspot.com) which has now been in operation continuously since 2006 and I have been widely quoted in the professional clinical press, the national press and in reports published by the Parliamentary Library.
I have no financial interests in any entities involved in Australian Health IT and receive no payments from the work I undertake in the area.
Over the last 4-5 years I have made submissions in the Health IT domain when requests for such submissions have been made by Government and these are available on the DoH website (www.health.gov.au).

Purpose Of This Document

The purpose of this document is to make one simple point, namely, that to be consulting on the future of the PCEHR, in the absence of the context of the overall Australian Health IT environment, capabilities and requirements, and a current and agreed  National E-Health Strategy,  would seem to be very risky and dangerous and very unlikely to lead to success with the PCEHR Project.
There are a range of points that need to be made to support this view.
Firstly there is presently absolutely no evidence that in two years the PCEHR - which commenced operation in July 2012 - has made any difference to the quality or safety of patient care in Australia. Indeed there have been essentially zero efforts to assess the impact of the system despite reported investment of more than $1 Billion in the system over the last few years.
Secondly, for reasons best known to herself,  the former Federal Health Minister (Ms Nicola Roxon) (advised by NEHTA and DoHA) chose to proceed with an architecture and design for the PCEHR which had never been implemented elsewhere and which had simply no evidence base supporting what was designed and then implemented. Similarly there was no business case developed for what was planned.
Thirdly, as delivered the system has proven to be of little interest to both clinicians and consumers with most consumers being registered and then never accessing the system again. In essence the PCEHR is ‘neither fish nor fowl’ and fails to provide attractive usefulness and utility for any class of user.
Fourthly, there has not been any sufficiently deep process to place the PCEHR in the context of the overall national needs to Health IT and to allocate appropriate priorities for investment based on the available evidence of what works and what doesn’t. I defies logic that this consultation is being undertaken in the absence of publication of a full update of the National E-Health Strategy to inform discussion and assist in direction setting.
Fifthly, it is very unlikely, in my view, that anything other than a fundamental re-design of the National E-Health System is likely to succeed. This would seem to be likely to be very expensive and should only be undertaken in the context of widespread stakeholder agreement and enthusiasm for such a re-design.
Lastly, it makes just no sense to have a consultation process on the PCEHR being conducted and reported to the Department of Health who are the owners of and accountable for the PCEHR. Surely the new Governance Model or similar (as recommended in the PCEHR Review) should have been put in place first and  then driven the consultation process?  

Concluding Remarks

This submission makes one simple, and to me incontestable, point. To attempt to adjust, modify or fix the PCEHR in the absence of an updated and agreed National E-Health Strategy is pure folly and doomed to fail. It is true there can be many benefits for patient care, patient safety and health system efficiency with properly designed and implemented Health IT. What is presently happening will not have that happen I believe. Six week reviews and six week  consultation periods are not the way to achieve the optimal deployment and use of Health IT we all seek. Both DoH and NEHTA have proven themselves to have very considerable difficulties with the implementation aspects of Health IT and to not have a clear roadmap for the future just multiplies the already high risks of failure. It surely is critical the present senior management of Health IT need to go!
I am, of course, more than happy to discuss all the points made here in whatever level of depth might assist the consultation process.
David G More - August 18, 2014.
Post Script:
Among readers of my blog there appears to be a great deal of scepticism that the planned and current consultation is ‘fair dinkum’.
AusHealthIT Poll Number 231  – Results – 17th August, 2014.
Here are the results of the poll.

Do You Believe The Consultation Process Being Conducted By DoH On The PCEHR Is 'Fair Dinkum'?

Definitely 4% (2)
Probably 2% (1)
Neutral 2% (1)
Probably Not 13% (6)
Of Course Not 79% (37)
I Have No Idea 0% (0)
Total votes: 47
Very clear cut. 92% do not think the consultation process is ‘fair dinkum’.
Again, many  thanks to all those that voted!
David.

AusHealthIT Poll Number 231 – Results – 17th August, 2014.

Here are the results of the poll.

Do You Believe The Consultation Process Being Conducted By DoH On The PCEHR Is 'Fair Dinkum'?

Definitely 4% (2)

Probably 2% (1)

Neutral 2% (1)

Probably Not 13% (6)

Of Course Not 79% (37)

I Have No Idea 0% (0)

Total votes: 47

Very clear cut. 92% do not think the consultation process is ‘fair dinkum’.

Again, many thanks to all those that voted!

David.

Saturday, August 16, 2014

Weekly Overseas Health IT Links - 16th August, 2014.

Note: Each link is followed by a title and 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.
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IBM Unveils Chip Simulating Brain Functions

Tech Giant Claims Microchip Is a Sharp Break From Traditional Chip Design

By Don Clark
Aug. 7, 2014 2:00 p.m. ET
IBM has developed a microchip that simulates functions of neurons, synapses and other features of the brain to perform calculations.
SAN JOSE, Calif.— International Business Machines Corp. is claiming a major advance in emulating the brain in silicon.
The technology company has developed a microchip that simulates functions of neurons, synapses and other features of the brain to perform calculations. IBM says the chip, a sharp break from the fundamental design used in most computers, excels at chores like recognizing patterns and classifying objects while using much less electrical power than conventional hardware.
IBM's new chip is the latest in a series of efforts by the company and others to design brain-like chips as traditional chip manufacturing yields fewer breakthroughs. But its latest offering, described in a paper in the journal Science, has novel features that include its large size and the use of standard digital technology rather than esoteric materials or production processes.
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De-identification effective in maintaining patient privacy if done right

August 8, 2014 | By Katie Dvorak
As hospitals and healthcare organizations adopt new ways to store and share data, privacy and security of the information is a top priority--and with that comes de-identification of data.
When it comes to HIPAA, there are two standards that allow for the sharing of data while maintaining privacy protections, according to privacy attorney Scot Ganow and Khaled El Emam, senior scientist at the Children's Hospital of Eastern Ontario Research Institute, both of whom spoke with HealthcareInfoSecurity.com.
The first HIPAA method for de-identifying data, according to Ganow, of Faruki Ireland & Cox, is to strip out the data and identifiable elements, though, he added that doing so doesn't offer a lot of value. The second, he said, is to de-identify data through the expert determination standard, which allows researchers to "retain a lot of the value of the info ... [while] at the same time carrying a very low risk of re-identification."
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Data mining slashes Medicaid ER visits

Posted on Aug 08, 2014
By Erin McCann, Associate Editor
By mining state Medicaid data and utilizing a population health platform, the Wyoming Department of Health was able to slash its Medicaid-related emergency room visits by 20 percent in a one-year period.
The state, which has nearly 88,000 Medicaid enrollees, also saw small improvements in 30-day hospital readmission rates, as they declined in 2013, down to 6.89 percent, compared with 7.4 percent in 2012. 
Xerox, who serves as the Wyoming Department of Health's Medicaid quality care management vendor and is responsible for processing claims and billing data, announced the statistics this week. After analyzing the claims data, officials were able to identify top cost drivers in the Medicaid program, one of which was found to be emergency room services. 
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Why some docs will 'just say no' to MU

Posted on Aug 08, 2014
By Madelyn Kearns, Associate Editor, Medical Practice Insider
Thousands of eligible providers are working diligently toward EHR incentive payments, but some practices are choosing a different route: abandoning meaningful use altogether in favor of their own solutions, and finding ways to make up for the penalties they’ll incur down the road.
Some 6 percent of physicians, in fact, will be “abandoning meaningful use after meeting it in previous years,” according to the Medscape report on EHR use in 2014. In surveying nearly 20,000 doctors, Medscape found another 16 percent admitting that they would never be attesting to meaningful use in any capacity. 
And although those numbers may seem small now, chances are they won’t stay that way for long as MU requirements become progressively more stringent, said Art Gross, CEO of HIPAA Secure Now.
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ONC Task Force Seeks Answers to Interoperability Challenges

AUG 7, 2014 7:15am ET
A task force of the Office of the National Coordinator for HIT held a second listening session August 5 with stakeholders to get feedback on a report concluding the lack of interoperability among data resources for electronic health records is a major barrier to information exchange.
An independent group of scientists called JASON, convened by contractor MITRE Corp. to advise the government, published the report which was funded by the Agency for Healthcare Research and Quality. Authors recommend the government establish a “comprehensive, transparent and overarching software architecture” that would create an open, interoperable health data infrastructure. Karen DeSalvo, M.D., national coordinator for HIT, has encouraged stakeholders to take a look at the JASON report's recommendations and to provide their feedback.
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Poor ONC oversight left EHRs vulnerable to hackers

August 4, 2014 | By Marla Durben Hirsch
The Office of the National Coordinator for Health IT's lackluster monitoring of the Authorized Testing and Certified Bodies (ATCBs) under the temporary certification program did not fully ensure that test procedures and standards could secure and protect patient information in electronic health record, according to a new report by the U.S. Department of Health and Human Services' Office of Inspector General (OIG).
The report, released August 4, found that the ATCBs under the temporary certification program did not develop procedures to periodically evaluate whether certified EHRs continued to meet federal standards or develop training programs to ensure that staff were competent to test and certify EHRs and secure proprietary and sensitive electronic patient information. OIG pointed out that standards used met National Institute of Standards and Technology (NIST) requirements that ONC approved, but that they were not sufficient to ensure that EHRs were adequately secure. For instance, passwords were not sufficiently complex.
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Physicians question safety of medical auction site

August 6, 2014 | By Katie Dvorak
When prices for surgery and other medical procedures rise above what a patient can afford, they may find a cheaper deal online--but some physicians are critical of the practice.
One medical auction site is receiving some of that criticism. The site, now four years old, links patients with facilities and physicians that offer non-emergency care at lower costs, according to an article at Kaiser Health News. People can go on the website to post requests for surgery and receive bids from doctors around the country.
"Cheap sounds good, but in these auctions you're not getting any information: Was the guy at the bottom of his class in medical school?" Arthur L. Caplan, head of the division of bioethics at NYU Langone Medical Center in New York, tells Kaiser Health News.
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Guidebook offers action plan to address alarm fatigue

August 7, 2014 | By Susan D. Hall
The ECRI has issued a guidebook to help hospitals address what the institute has deemed a top health technology hazard, alarm fatigue.
"The Alarm Safety Handbook: Strategies, Tools, and Guidance"--available in print and in electronic formats--is designed to help hospitals identify ways to minimize alarm fatigue, develop an action plan and put that plan into practice.
"We hope hospitals look to this as a blueprint for building a sound alarm management safety process," James P. Keller Jr., ECRI vice president of health technology evaluation and safety, says in an announcement.
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As EHR adoption spikes, Meaningful Use Stage 2, HIE implementation lags

August 7, 2014 | By Katie Dvorak
Hospitals and healthcare systems made significant progress in adopting electronic health records in 2013, according to two studies published in the journal Health Affairs, but have a long road ahead of them to meet all the criteria for Meaningful Use (MU) Stage 2 and the implementation of health information exchanges (HIEs).
The authors of the studies and National Coordinator for Health Information Technology Karen DeSalvo spoke about the state of health IT at a briefing on the studies held today in Washington.
"We've made great investments and we need to build on them and weave together a fabric that serves everybody," DeSalvo said during her opening remarks.
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EHR Adoption Slow, Information Exchange Lagging

Cheryl Clark, for HealthLeaders Media , August 8, 2014

While many providers have the essential EHR components required to obtain federal financial incentives and avoid penalties, about 90% of hospitals still can't allow patients to view online, download, or transmit health information.

Thousands of hospitals and physicians in small office practices will be left out of meaningful use incentive payments, and may eventually be financially penalized, unless they speed up adoption of electronic health records systems to satisfy meaningful use 2 requirements, analysis indicates.
The findings of two papers published Thursday in Health Affairs arebased on survey data showing how many providers have the essential system components required to obtain financial incentives and avoid penalties under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
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Can Healthcare Execs Be Security Experts Too?

8/6/2014 09:06 AM
Mansur Hasib
Commentary
Trying to teach healthcare professionals security technologies is a risky idea. It's far easier to teach healthcare to security experts.
In the urgent scramble to hire cyber security executives, some organizations appear to favor time spent within a business vertical such as healthcare -- often against the advice of competent counsel. They bypass stronger cyber security professionals who would need to learn the new business environment in favor of candidates who understand the industry but need to learn cyber security. Essentially these organizations try to turn healthcare executives into cyber security executives, a very risky idea indeed.
It will take an organization about a year to figure out it hired the wrong person. During that time more damage and more atrophy will occur. Even a wizard cannot fix years of neglect quickly, so hiring the right person the first time matters greatly.
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Simple EHR Function May Trigger Audits, Hospitalist Cautions

Cheryl Clark, for HealthLeaders Media , August 7, 2014

Hospitals should adopt policies to encourage the appropriate use of the copy and paste function in electronic medical records systems because Recovery Audit Contractors who find similarities among patient records may use them as a basis to deny claims, says a physician.

Clinicians' use of the "copy and paste" function in electronic health record systems may soon be the subject of indiscriminate Recovery Audit Contractor reviews, a prominent hospitalist warns.
"We're worried that we're going to be audited based on good use of copy and paste, and that we're going to be prohibited from using copy and paste for the things that it really is good for," says Ann Sheehy, MD, a member of the Society for Hospital Medicine's Public Policy committee.
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Philips, Accenture Partner on Mind-Controlled Technology

AUG 6, 2014 7:26am ET
Royal Philips and Accenture have developed proof-of-concept software the companies say could ultimately give more independence to patients with amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases.
The application, connecting a wearable display to Emotiv Insight Brainware, demonstrates how existing technology could be used to transform the quality of life for ALS patients. When patients lose muscle control and eye tracking ability, they can still potentially operate the Philips suite of connected products, including a medical alert service, Philips SmartTV, and personal lighting, in their home environment through brain commands.
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ONC's interoperability vision draws concern from federal advisers

August 6, 2014 | By Dan Bowman
While an official with the Office of the National Coordinator for Health IT provided an overview of a forthcoming interoperability roadmap at a virtual meeting of the agency's health IT policy committee on Wednesday, committee members raised concerns that perhaps the aim of the agency's effort is too broad.
Erica Galvez, the interoperability and exchange portfolio manager at ONC, said a draft of the roadmap--which will be a companion document to the agency's vision paper published in June--is due to be published in October. A more robust version that includes feedback from ONC's health IT policy and standards committees would then be available for public comment by January.
Version 1.0 of the roadmap, which Galvez stressed would be a "living document," is anticipated to be ready by March 2015.
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SAMHSA Mulls Changes to Federal Substance Abuse Confidentiality Rules

by Helen R. Pfister, Susan R. Ingargiola and Marlee Ickowicz, Manatt Health Solutions Wednesday, August 6, 2014
The federal substance abuse confidentiality regulations (also known as the "Part 2 Regulations") have long provided important privacy protections for certain alcohol and drug abuse treatment information. However, in today's increasingly connected health care system, some health care providers perceive the Part 2 Regulations as a roadblock to coordination of a patient's alcohol or drug abuse treatment with other types of health care services. Accordingly, the Substance Abuse and Mental Health Services Administration, the federal agency that oversees the Part 2 Regulations, is considering several possible changes to the regulations to encourage more widespread sharing of alcohol and drug abuse treatment information.

Background on Part 2 Regulations

HIPAA is the legal foundation for health information privacy in the U.S. The HIPAA Privacy Rule restricts the use and disclosure of protected health information, or PHI, maintained by covered entities, which include health care providers, health plans and health care clearinghouses. HIPAA permits covered entities to use and disclose PHI for treatment, payment and health care operations without patient authorization. Alcohol and drug abuse treatment records covered under the Part 2 Regulations ("Part 2 Records"), on the other hand, are subject to more stringent protection. Unlike under HIPAA, a patient's authorization is generally required for release of these records, with few exceptions.
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On the intersection of artificial intelligence and bioinformatics

By Ron Vatalaro, Bisk Education/University Alliance
The field of health informatics has roots dating back to the 1960s when researchers realized how useful computer programs could be in storing and managing large amounts of data.
Today’s increasingly intelligent computer programs, meanwhile, have broadened the scope of study, fostering highly complex research while providing tools researchers can use to help them store, manipulate study and analyze data.
Let’s take a look at the current landscape, wherein AI and bioinformatics are moving closer to each other — just not without some challenges
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7 add-on apps to enrich your EHR

August 01, 2014 | Frank Irving - Editor
With more than four out of five doctors actively using EHR systems, we can confidently negate the notion that physicians resist new technology. Indeed, a growing number of applications and platforms target physician practices seeking enhanced usability or increased value from their EHR.
It's a matter of making good technology better.
Some sixty-three percent of 18,575 physicians surveyed by Medscape between April and June 2014, for instance, said their EHR improves clinical documentation. Still, there's room for improvement.
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OIG: Certified EHRs aren't so secure

Posted on Aug 05, 2014
By Erin McCann, Associate Editor
It turns out, ONC's electronic health record certification process has some serious shortcomings -- chief among them security practices that are wholly insufficient to adequately protect patient health information, according to a new report from the Office of Inspector General.
The report sheds light on the EHR certification procedure in its current form, which involves oversight from the Office of the National Coordinator for Health IT, and includes the National Institute of Standards and Technology, or NIST, the group responsible for developing these standards for testing and certification bodies to use.
When providers purchase certified EHRs (as of June more than 408,000 healthcare providers have received meaningful use incentive payments after purchasing a certified EHR, with CMS paying out a whopping $24.1 billion in incentives), they presumably expect these multi-million-dollar systems to meet federal security standards.
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Power to the people on testing times

Paul Hodgkin examines the mathematics of testing for disease, and concludes that professionals and patients are going to need some very clever apps to guide them through the results.
5 August 2014
So we can get our DNA tested with no questions asked. Boots will do it for you £129.
All sorts of tests are available at a price. If you want to know if your spouse, teenage son or direct reports are taking drugs, send off a hair sample and screen them to see what substances they’ve been consuming over the past 90 days.
Self-evidently the technology is running way ahead of the ethics here.   
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Telecare "not magic bullet" - WSD study

1 August 2014   Lyn Whitfield
Policy makers have been warned to avoid describing telecare as a “magic bullet” in the latest study to cast serious doubt on the cost effectiveness of remote monitoring and intervention.
The WSD projects in Newham, Kent and Cornwall were set up by the Department of Health in 2008, with the explicit aim of finding an evidence base for telehealth and telecare. 
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3 ways to avoid HIE missteps

August 5, 2014 | By Katie Dvorak
Organizations juggling having a fee-for-services business model while implementing value-based programs may face obstacles when it comes to interoperability and health information exchanges, Brian Ahier, director of standards and government affairs at Medicity, writes in a post for GovernmentHealthIT.
In order to enter that value-based care arena, the industry must avoid common missteps that may impede the sustainability of HIEs, Ahier says.
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Cerner to acquire Siemens' health IT division for $1.3 billion

August 5, 2014 | By Marla Durben Hirsch
Cerner Corporation and Siemens AG have announced that they have entered into a definitive agreement for Cerner to acquire Siemens' health IT business unit, Siemens Health Services, for $1.3 billion in cash.
The two companies will have a combined total of $4.5 billion annual revenue, $650 million in annual research and development investment, 20,000 associates in more than 30 countries and 18,000 client facilities worldwide.
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What Cerner Gets from Buying Siemens

AUG 5, 2014 6:20pm ET
Cerner Corp. is paying $1.3 billion in cash to acquire the hospital information systems business line of Siemens Healthcare. Large acquisitions usually don't succeed and time will tell on this one.
The acquisition, likely closing in early 2015, was expected as rumors have circulated in the industry for more than a week. The transaction does not include Siemens’ diagnostic imaging products and laboratory equipment lines, although Germany-based Siemens AG and Cerner have a new strategic alliance to combine Cerner’s I.T. products with Siemens’ imaging and medical device products.
Through the acquisition, Cerner gets the products and customers of another major U.S. health information technology vendor with a price tag closely matching annual revenue from the Malvern unit, says Steven Lazarus, president of Boundary Information Group, a Denver-based consultancy. “It’s that size issue, you’ve got that ongoing revenue stream,” he adds. Further, the cost of maintaining Siemens products and customers is much cheaper than the cost of getting new clients.
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Cerner Faces Challenges in Integrating Siemens

AUG 6, 2014 12:10pm ET
The pending $1.3 billion acquisition of the hospital information systems business line of Siemens Healthcare will enable Cerner Corp. to be a stronger competitor to Epic Systems Corp., while also being in line with Cerner CEO Neal Patterson’s vision of embracing change to make a difference. But danger looms.
That is the view of health information technology mergers and acquisitions consultant John Osberg, managing partner at Informed Partners LLC in Marietta, Ga. “But it will take a monumental effort to integrate Siemens, and some time,” he contends in comments to Health Data Management. “This deal was not for the amateurs. It is a lot more than a financial change of ownership.”
The industry is better served by having Siemens again under U.S. ownership, Osberg believes. German ownership was a barrier to growth and development of Siemens, as the company did not adapt to a rapidly changing healthcare industry.
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FDA proposal a huge boost to mHealth innovation

August 04, 2014Eric Wicklund - Editor, mHealthNews
In what's being hailed as a positive step for mHealth innovation, the U.S. Food and Drug Administration has freed dozens of mobile medical devices from the requirements of increased regulation.
The 12-page document issued on August 1 is part of the FDA's draft guidance for the regulation of mobile medical devices and apps. In this latest posting, the FDA has proposed that it will not require premarket submission requirements from certain Class I and II medical devices under the reserved criteria of section 501(I) of the Federal Food, Drug and Cosmetic Act of 2012.
The proposal is "a huge boost the to mHealth industry," said Bradley Merrill Thompson, an attorney for the Washington D.C. law firm of Epstein Becker Green and counsel for the mHealth Regulatory Coalition. 
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As Apple and Google Swarm Healthcare, StartUp Health Shares Lessons

Scott Mace, for HealthLeaders Media , August 5, 2014

By one measure, the amount of money invested in healthcare startups in the first half of 2014 exceeds the total amount invested in all of 2013. The co-founder of StartUp Health talks about where innovation is headed.

While the healthcare industry struggles to meet its mandates and stay in business, players outside the traditional industry have not been idle.
Google recently announced its Google X Baseline study to map the human body. In June, Apple launched its new Health app and HealthKit developer tool, to build an application platform for innovative mobile solutions. IBM promptly signed a deal with Apple to integrate its Watson analytics platform with Apple's technology. And Samsung announced it was investing $50 million to accelerate innovation in personal health.
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Where Health care is Going in the Cloud

AUG 1, 2014
As a model for enabling on-demand network access to a shared pool of configurable computing resources, the cloud seems to be everywhere these days, challenging traditional approaches to data center and enterprise application design and management.
However, cloud computing is not as ubiquitous in health care as it is in other industries. Out of eight sectors analyzed by technology vendor CDW, health care ranks seventh in terms of cloud adoption-just edging out state and local governments-according to a 2013 survey.
While health care might lag behind, it's still adopting at a pretty brisk clip: A June 2014 HIMSS Analytics survey found that 83 percent of surveyed medical practices, hospitals and health care systems are using cloud services, citing lower maintenance costs, speed of deployment and lack of internal staffing resources.
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FDA plan a 'huge' boost for mHealth

Posted on Aug 04, 2014
By Eric Wicklund, Editor, mHealthNews
In a move that's being lauded by mobile health innovators, the U.S. Food and Drug Administration has released dozens of mHealth medical devices from the requirements of added regulation.
The 12-page document issued Aug. 1 is part of the FDA's draft guidance for the regulation of mobile medical devices and apps. In this latest posting, the FDA has proposed that it will not require premarket submission requirements from certain Class I and II medical devices under the reserved criteria of section 501(I) of the Federal Food, Drug and Cosmetic Act of 2012.
The proposal is "a huge boost to the mHealth industry," said Bradley Merrill Thompson, an attorney for the Washington, D.C., law firm of Epstein Becker Green and counsel for the mHealth Regulatory Coalition. 
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Stage 2 MU: A bridge too far?

Posted on Aug 04, 2014
By Mike Miliard, Managing Editor
It turns out this stuff is really hard, after all.
About this time last year, we ran an article titled, "Stage 2 changes may be rude awakening." In it, one hospital IT honcho made the point that, with attestation for meaningful use still off in the distance, most providers were blissfully ignorant of just how difficult the process would be.
Too few people "really, truly grasp the magnitude of some of the changes," compared to Stage 1, he said.
Here we are, more than halfway through 2014, and the numbers are starting to roll in. They're anything but impressive.
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4 keys to successful HIT vendor-client relationships

August 4, 2014 | By Katie Dvorak
When it comes to relationships between health IT vendors and clients, there are many ways to ensure they are positive for both parties involved.
Whether the partnership is for implemenation of a core electronic health record, a specific system or an innovative program, vendor-client relationships all have common elements, Sue Schade, CIO at University of Michigan Hospitals and Health Centers, says in a healthsystemCIO.com post.
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The rise of nurses in health IT

August 4, 2014 | By Katie Dvorak
By Katie Dvorak
From chief nursing informatics officers to chief information officers, nurses increasingly are taking on new leadership roles in health IT and having a major impact on healthcare innovation and delivery.
For instance, nurse informatics are vital to information system development, implementation and optimization, according to the Healthcare Information and Management Systems Society's 2014 Nursing Informatics Workforce Survey, released in February. More than 70 percent of the survey's respondents hold a title that specifies informatics, and interest in additional training within the field is also shown to be on the rise.
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Electronic Reminders Can Help Patients Prevent Surgical Site Infections

August 1, 2014
A study reports on a simple digital messaging system that significantly increases patient compliance with a preadmission showering
The use of electronic reminders such as text messages, emails or voicemails is highly effective at getting surgical patients to adhere to a preadmission antiseptic showering regimen known to help reduce risk of surgical site infections (SSIs), according a study published in the August issue of the Journal of the American College of Surgeons.
Each year approximately 400,000 SSIs occur and lead to a death rate approaching nearly 100,000 according to data sources cited by study authors. To help reduce the risk of these dangerous infections, clinicians recommend that surgical patients take antiseptic showers 24 to 48 hours before admission.
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Only about 0.1% of mHealth apps are FDA-approved

Written by Akanksha Jayanthi (Twitter | Google+)  | August 01, 2014
Of the nearly 100,000 mHealth apps available on the market, only 100 are approved by the U.S. Food and Drug Administration, according to a New England Journal of Medicine report.
The industry is debating the level of mHealth app regulation the FDA should exert. While one side sees FDA-approval as critical to maintaining clinical quality and patient safety standards, others see the regulatory process as a barrier to innovation.
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Enjoy!
David.