Now Here Is A Wonderfully Provocative Article On EHRs That Makes A Lot Of Sense To Me.

This appeared a little while ago.

Is the Electronic Health Record Defunct?

by Jerome Carter on April 28, 2014

When building software, requirements are everything. And although good requirements do not necessarily lead to good software, poor requirements never do.   So how does this apply to electronic health records?   Electronic health records are defined primarily as repositories or archives of patient data. However, in the era of meaningful use, patient-centered medical homes, and accountable care organizations, patient data repositories are not sufficient to meet the complex care support needs of clinical professionals.   The requirements that gave birth to modern EHR systems are for building electronic patient data stores, not complex clinical care support systems–we are using the wrong requirements.

Two years ago, as I was progressing in my exploration of workflow management, it became clear that current EHR system designs are data-centric and not care or process-centric. I bemoaned this fact in the post From Data to Data + Processes: A Different Way of Thinking about EHR Software Design.   Here is an excerpt.

Do perceptions of what constitutes an electronic health record affect software design?  Until recently, I hadn’t given much thought to this question.   However, as I have spent more time considering implementation issues and their relationship to software architecture and design, I have come to see this as an important, even fundamental, question.

The Computer-based Patient Record: An Essential Technology for Health Care, the landmark report published in 1991 (revised 1998) by the Institute of Medicine, offers this definition of the patient record:

A patient record is the repository of information about a single patient.  This information is generated by health care professionals as a direct result of interaction with the patient or with individuals who have personal knowledge of the patient (or with both).

Note specifically that the record is defined as a repository (i.e., a collection of data).   There is no mention of the medium of storage (paper or otherwise), only what is stored.   The definition of patient health record taken from the ASTM E1384-99 document, Standard Guide for Content and Structure of the Electronic Health Record, offers a similar view—affirming the patient record as a collection of data. Finally, let’s look at the definition of EHR as it appears in the 2009 ARRA bill that contains the HITECH Act:

ELECTRONIC HEALTH RECORD —The term ‘‘electronic health record’’ means an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff.  (123 STAT. 259)

Even here, 10 years later, the record/archive/repository idea persists.  Now, back to the issue at hand: How has the conceptualization of the electronic health record as primarily a collection of data affected the design of software systems that are intended to access, manage, and otherwise manipulate said data?

Repository-oriented thinking results in an emphasis on software system designs that primarily optimize data-centric functionality such as capture, validation, retrieval, and storage.

Conceptually, EHR systems are, first and foremost, patient data repositories.  Now, if one sets out to build a repository, in the best of all possible worlds that is exactly what will be built.   The question, of course, is whether repositories are the ideal systems to assist in complex patient care tasks.  Ask any clinical professional struggling with an EHR system this question and the answer will be a resounding  “No.”

Paper records are passive and do not participate in care processes.  Rather, they are accessed as needed for information and documentation purposes.   This is both a blessing (no troublesome alerts) and a curse (no helpful alerts).   Where did the idea arise that records should inject themselves into care processes?  The answer to this question is critical to designing the next generation of clinical care systems, because if paper records were never active clinical care participants, why should one assume their electronic cousins should be?

Efforts to improve EHR systems to support complex clinical care needs have not resulted in significantly better systems.  Instead, it has only led to systems with kludged-on and slapped-together features. Workflow engines, clinical decision support, interoperability, and user configurable interfaces – in fact, the very idea of usability—are features one expects in productivity software, not patient data repositories.    Look again at the definitions of the electronic health record that have been offered over the years. Care quality, clinician productivity, and patient safety are never mentioned as part of the core definition.  This is fitting because paper and electronic records were never intended to be anything other than what they are defined as being—data archives.  We have been working from a requirements mindset that is focused on producing records/archiving systems and not clinical care systems.

Look at the types of criticisms lodged at current EHR systems.

1. Poor usability
2. Hard-to-navigate interfaces
3. Difficult to learn
4. Not good at sharing information/ poor interoperability
5. Poor at population health management
6. Not ideal for sophisticated reporting
7. Difficult to implement
8. Implementation results in decreased productivity
9. Workarounds are common
10. Poor support for workflow/no user-configurable workflow
11. Decision support clunky

These complaints arise because EHR systems are being used as clinical care support systems, which means they should enhance the productivity of clinical professionals and support their information needs, not hinder them.

Why not take a new approach to clinical software systems?  Why not go back to the drawing board and this time say exactly what we want—systems that support the work of clinical professionals.  Software systems conceived primarily as clinical care support tools have design goals and requirements that differ significantly from systems conceived primarily as record systems, and they should be defined accordingly.

Lots more, and some recommendations on how to move forward are found here:

http://ehrscience.com/2014/04/28/is-the-electronic-health-record-defunct/

The last paragraph is just key and totally relevant it we are to really make a difference with e-Health going into the future.

Very important reading for all interested in the area.

David.

The Wisdom Of Providing Consumers Access To Test Results Needs Careful Consideration.

The drivers of the PCEHR Program are keen to have results included in the PCEHR. There have been some recent articles that bear on this issue.

First we have:

Study: Many patients don’t understand electronic lab results

Author Name Jennifer Bresnick   |   Date August 21, 2014   |  

More and more patients may be accessing their personal health information online through patient portals thanks to Stage 2 of meaningful use, but only slightly more than half of patients, on average, were able to decipher electronic lab test results on their own, says a study from the University of Michigan.  Patients who scored on the lower end of numerical and health literacy tests were twice as likely to express confusion when shown a hypothetical blood glucose test result, said study author Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health.

The researchers recruited more than 1800 adults to take an online test, and asked them to respond as if they had Type 2 diabetes.  The participants were also given quizzes to measure their mathematical literacy and familiarity with viewing health information.  When presented with a display that showed blood test results common to a diabetic patient, 77% of patients who scored highly on the literacy tests were also able to identify hemoglobin A1C levels that were out of range.  Just 38% of patients who scored on the lower end of the literacy tests could do the same, illustrating a significant difference in how patients are able to digest their own information.

“We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them,” Zikmund-Fisher said. “The problem is many people can’t imagine that giving someone an accurate number isn’t enough, even if it is in complex format.”

More here:

http://ehrintelligence.com/2014/08/21/study-many-patients-dont-understand-electronic-lab-results/

Then we have this:

Records access may reduce GP pressures

19 August 2014   Lyn Whitfield

Giving patients access to their GP records can reduce demand for traditional appointments and telephone calls to practices, a research study has suggested.

The government has set a target of giving all patients who want it access to their GP record – or the elements included in the Summary Care Record - by 2015.

But in a forward to the study by Caroline Fitton, published in the London Journal of Primary Care, Brian Fisher, a GP in Lewisham, says “many practitioners worry that their workload will increase as a result”.

He says GPs worry that patients “will not understand what they read”, leading to more demand for appointments.

Lots more here:

http://www.ehi.co.uk/news/primary-care/9591/records-access-may-reduce-gp-pressures

Also more generally this article raises some issues.

Sharing electronic records with patients gains traction, raises new concerns

August 19, 2014 | By Marla Durben Hirsch

More hospitals and physicians are choosing to provide their patients with access to their electronic records, but the practice is also raising new controversies, according to a recent article on National Public Radio.

In the article, Leana Wen, director of patient-centered care research in the department of emergency medicine at George Washington University, points out that sharing notes with patients has been a positive experience, enabling her to correct errors caught by patients' review of the records and providing information that helps her diagnose conditions more quickly. The access also increases trust.

She additionally reports that the OpenNotes program--which began as an experimental program among Boston-based Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center in Washington state several years ago--has been so successful that it has spread to other health systems. The U.S. Department of Veterans Affairs also shares the data from its EHR system with its patients.

BIDMC earlier this year expanded the OpenNotes program further by allowing patients to access their mental health notes.

However, the trend, which has been predicted to become the standard of care, is not without unintended consequences and new "side effects." For example, questions have emerged regarding how much of the mental health notes a patient should have access to and how to deal with patients who post their records on social media.

More here:

http://www.fierceemr.com/story/sharing-electronic-records-patients-gains-traction-raises-new-concerns/2014-08-19

The range and types of concerns and discussion of the data access issue shows to me there are many issues to be considered in patient access to information besides technical feasibility.

If ever there was an issue where there should be properly consulted with all stakeholders to ensure that all interests are properly catered for this is it. Roll on the new E-Health Governance Framework we have been promised in the PCEHR Review.

David.

Submission To The PCEHR Review - Sent By E-Mail Today.

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 a role in the development of the 2008 National E-Health Strategy and discussions on the 2014 Update.

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, updated, agreed, finalised and funded National E-Health Strategy,  would seem to be very risky and dangerous and very unlikely to lead to success with the PCEHR Project or any other significant e-Health initiative.

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, safety or efficiency of patient care in Australia (surely the objective of the Program). 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 the then 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 - as opposed to earlier concept designs.

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. It 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, an updated Strategy and demonstrable 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?  This all feels to be a very much ‘ cart before the horse’ approach.

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 achieve the desired outcome 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 strategic roadmap for the future just multiplies the already high risks of failure. It surely also the time for a refresh of the management of Australian Health IT.

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 26, 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 – 17^th 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.

Equally confidence in e-Health leadership does not seem high.

AusHealthIT Poll Number 232 – Results – 24th August, 2014.

Here are the results of the poll.

Do You Believe The Present Leadership Of NEHTA and DoHA E-Health Initiatives Will Be Able To Deliver A Successful PCEHR?

For Sure 15% (41)

Probably 4% (10)

Neutral 2% (4)

Probably Not 14% (36)

No Way 65% (172)

I Have No Idea 1% (2)

Total votes: 265

The poll speaks for itself.

David.

----- End Submission

David.

Weekly Australian Health IT Links – 25th 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 - even excluding the excitement of legal letters etc.

Good to see a review of what Telstra is up to as well as useful analysis of what we need from e-Health Standards.

The article on the use of evidence based guidelines is important. This is something e-Health applications should be integrating as fast as they can to assist in this domain.

The exploitation of the Heartbleed issue as regards health records is an important canary in the coalmine I suspect.

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http://www.businessspectator.com.au/article/2014/8/19/technology/just-what-doctor-ordered-telstra

Just what the doctor ordered for Telstra

• Harrison Polites
• August 19, 2014

Telstra’s glowing results may have stunned investors last week, but not enough to shrug off questions about the telco’s future avenues for growth.

Eyes are firmly fixed on Telstra’s burgeoning cash pool, its renewed appetite for niche technology acquisitions and its Asia-focused international division that posted a 63 per cent year-on-year increase in revenue last year.

But the focus on Telstra’s core competencies has seen many overlook an interesting little project that's been bubbling away on the side: its eHealth division.

The eHealth department hasn't been operating for long, but as last week's results showed, it earned a modest $40 million in its first year alone. That’s just pocket change for Telstra, which reported a grand total income of $26.3 billion in FY14, but it's a start nonetheless.

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http://wolandscat.net/health-informatics/desiderata-for-successful-e-health-standards/

Desiderata for successful e-health standards

Recent Changes

20/08/2014 – added stability, industry-acceptable licensing

19/08/2014 – initial writing

Introduction

This page discusses the question of evaluating e-health standards for longevity.

Over the last 20 years many attempts have been made to solve the wicked problem of health data interoperability, and more recently, ‘semantic’ versions of the same. The problem to be solved is essentially:

• semantic interoperability across and within enterprises,
• semantic interoperability between layers of functionality within a system,
• with an ultimate aim of being able to compute intelligently on the data

A much larger list of concrete needs can be constructed from this abstract description. Solving these challenges would result in great advances for:

• shared care, community care, since health records can be not just shared but treated as a single point of truth
• individualised, preventive medicine, since semantically computable EHR data are amenable to automated evaluation of clinical guidelines
• medical research, since data would be far more computable, and more data per patient could be aggregated from multiple sources
• public health, since aggregation of computable data of large numbers of patients will clearly enable epidemiological functions as well as routine health statistics
• cost determination, re-imbursement, fraud detection and better management of public and private payer funds.

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http://www.smh.com.au/it-pro/security-it/us-hospital-breach-biggest-yet-to-exploit-heartbleed-bug-20140821-106n1h.html

US hospital breach biggest yet to exploit Heartbleed bug

Date August 21, 2014

Hackers who stole the personal data of about 4.5 million patients of hospital group Community Health Systems broke into the company's computer system by exploiting the "Heartbleed" internet bug, making it the first known large-scale cyber attack using the flaw, according to a security expert.

The hackers, taking advantage of the pernicious vulnerability that surfaced in April, got into the system by using the Heartbleed bug in equipment made by Juniper Networks, David Kennedy, chief executive of TrustedSec, told Reuters on Wednesday.

Kennedy said that multiple sources familiar with the investigation into the attack had confirmed that Heartbleed had given the hackers access to the system.

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www.hcn.com.au

Help For Patients Booking Appointments Online

Next release to launch built-in online appointments

The Medical Director and PracSoft Summer update will bring a host of great features and benefits to Australian practices. Amongst the features is the announcement of an online appointment module integrated into PracSoft.

Not only does this feature allow practices the flexibility to offer their patients online appointments in a secure environment, it smoothly integrates directly into Pracsoft.

Link:

http://www.hcn.com.au/onlineappointments/

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http://www.sharecafe.com.au/roger_m.asp?a=AV&ai=31386

Making Sense Of ResMed's New Platform

BY BEN MACNEVIN - 22/08/2014

ResMed Inc (ASX: RMD) has launched its new flow generator platform, the AirSense 10, and first impressions are positive.

Informatics, or the collection of useful data, is the next step in the value chain for manufacturers of sleep apnoea devices. Funding by Government agencies and private insurers is becoming increasingly dependent upon patient compliance, so in order to remain competitive, the manufacturers must provide as much information as they can to suppliers and users.

The AirSense 10 platform is being marketed as an end-to-end solution, which will not only help suppliers effectively maintain their patient relationships, but also provide greater control for patients to manage their own therapy. For instance, the machine can diagnose mask failures and alert the user to order a new one.

ResMed is hoping that the platform will provide such a compelling package that it will be an easy decision for doctors to prescribe to patients. ResMed also considers that the “informatics” features of the AirSense 10 will prove more economical for suppliers than their lower-priced competitors.

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http://www.medicalobserver.com.au/news/subpoenas-threatening-patient-privacy

Subpoenas threatening patient privacy

21st Aug 2014

Flynn Murphy

DIRT-DIGGING subpoenas that force GPs to turn over patient records or potentially face jail are threatening the doctor-patient relationship and influencing the way that some GPs practice.

A study published in Australasian Psychiatry said lawyers are being granted unfettered access to psychiatric records, particularly to “dig up dirt” in family law and civil proceedings.

Study co-author Dr Yvonne Skarbek, a psychiatrist, said GPs faced the same threat. “We’ve seen the increased practice of ‘wide scope’ subpoenas, where each doctor’s record is subpoenaed with devastating consequences in terms of loss of trust.”

GP Dr Stan Doumani has practised in Weston, ACT, since 1978 and reckons he gets subpoenaed about once a month.

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http://www.itwire.com/government-tech-news/govenrment-tech-policy/65108-australian-it-managers-unaware-of-privacy-laws

Australian IT managers 'unaware of privacy laws'

• 18 August 2014
• By  Graeme Philipson

A new study shows that extent to which Australian IT decision makers have not acted on recent changes to Australian privacy laws.

Many organisations in Australia are uncertain of how they should be managing their data without risk, four months after the changes to the Australian Privacy Principles were introduced.

Despite claiming to be aware of the changes, over 70% of Australian IT decision makers seek third party guidance on management of their data. The findings are contained in a white paper commissioned by NTT Communications ICT Solutions (NTT ICT) and Hitachi Data Systems (HDS) and researched by IDC Australia.

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http://www.afr.com/p/business/companies/australian_start_up_takes_on_intel_2cf0RDGhWXiGVHq3z7T4WI

Australian start-up takes on Intel to care for Parkinson’s

PUBLISHED: August 22, 2014

Jessica Gardner

A Melbourne medical start-up that has developed a wearable device to care for sufferers of Parkinson’s disease says it is not scared of technology giant Intel moving into the burgeoning market.

Global Kinetics Corporation has already pierced annual sales of $1 million for its wristband device that monitors the tremors of Parkinson’s sufferers using similar technology that devices like Fitbits use to measure how well users are sleeping or how much exercise they are doing.

Managing director Andrew Maxwell said the company had approval to sell its device, the Parkinson’s KinetiGraph or PKG, in Australia and Europe and was expecting clearance from the US regulator soon.

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http://www.australiandoctor.com.au/news/latest-news/ignored-guidelines-costing-millions-nhmrc

Ignored guidelines costing millions: NHMRC

19 August, 2014 Michael Woodhead

Clinical guidelines often fail to make the grade and sit on shelves unread, a scathing report from the NHMRC suggests.

Australia has hundreds of clinical guidelines costing up to $1.6 million apiece to draw up, but many are not fit for purpose, according to a review from the body that sets the standards for guidelines.

In its 2014 Annual Report on Australian Clinical Practice Guidelines, the NHMRC found there were “ongoing serious and systemic problems in the way guidelines are funded and developed in Australia”.

Problems identified by the agency in more than 1000 sets of guidelines include failure to reveal funding sources and conflicts of interest, lack of information on the review processes, and the lack of plans to disseminate and implement the guidelines.

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http://www.smh.com.au/it-pro/government-it/death-certificate-delays-cause-angst-for-families-20140817-101tkv.html

Death certificate delays cause angst for families

Date August 18, 2014

Kim Arlington

There have been dealys in the issuing of death certificates. Photo: Peter Stoop

Grieving families have been unable to administer estates, sell property or pay for funerals after a system upgrade at the NSW Registry of Births Deaths and Marriages caused long delays in issuing death certificates.

Certificates are usually obtained in about two weeks. But since the registry’s new business operating system was launched on June 23, some people were told they could wait up to 10 weeks, preventing them from finalising the affairs of their late loved ones.

John Kaus, the executive secretary of the Funeral Directors’ Association of NSW, said the system had caused ‘‘massive delays’’ for families and funeral homes and an increasing number of errors on the documents. Without a death certificate many families could not be granted probate, access bank or utilities accounts or settle funeral expenses, he said.

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http://www.abc.net.au/news/2014-08-20/gx-diabetes-meeting/5682824

Griffith diabetes group to meet with MLHD over future support options

Wed 20 Aug 2014, 7:11am

The head of the Australian Diabetes Council's Griffith branch says it makes economic sense to reinstate outreach clinics in the city.

For 20 years, Doctor Dennis Yue provided regular clinics in Griffith for people with complex diabetes, but since his retirement last October, there has only been one.

The Council's Griffith branch president, Tom Marriott, has organised a public meeting this afternoon with the Murrumbidgee Local Health District's Doctor Elizabeth Harford to discuss the issue.

Mr Marriott says it is in the state government's interest to provide the support.

I think the clinics as they were under Doctor Yue, I doubt that's going to happen. I think there are other things that might happen. There's e-health, having consultations via Skype is an option, which is very good for people in outlying areas.

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http://blogs.crikey.com.au/croakey/2014/08/19/unhealthy-haste-what-are-the-implications-of-outsourcing-medicare-pbs-claims-and-services/

Unhealthy haste? What are the implications of outsourcing Medicare, PBS claims and services?

Marie McInerney | Aug 19, 2014 7:07PM | EMAIL | PRINT

Less than two weeks ago the Federal Government called for Expressions of Interest (EOI) from the private sector to provide claims and payment services for Medicare (MBS) and the Pharmaceutical Benefits Scheme (PBS), a $29 billion operation currently managed by the Department of Human Services. The EOI closes this Friday, 22 August.

Such a privatisation not only poses major implications for public sector jobs but looks like a major step towards dismantling Medicare as a public system. It has yet to be subject to public discussion.

Health Minister Peter Dutton issued a statement, justifying the move (raised originally by the Commission of Audit) on the grounds of cutting red tape and the need for a substantial upgrade of DHS IT systems.

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http://www.theaustralian.com.au/technology/draft-paper-to-address-nbn-spectrum-gaps/story-e6frgakx-1227031749093

Draft paper to address NBN spectrum gaps

• The Australian
• August 21, 2014 11:01AM

Stuart Kennedy

Editor, Technology Sydney

THE Coalition has moved a step closer to building out more fixed wireless NBN connections for people on city fringes to fill in a “spectrum gap” created by an NBN Co capacity underestimation.

Communications Minister Malcolm Turnbull has released an exposure draft for public consultation on a potential directive to the Australian Communications and Media Authority to enable NBN Co to acquire 3.5GHz spectrum for fixed wireless in metro areas.

NBN Co uses fixed wireless broadband mainly in regional areas where it is too expensive to roll out either fibre to the home or fibre to the node.

The draft direction relates back to a review of the NBN’s satellite and fixed wireless rollout released in May. This review found that NBN Co had underestimated, by about 200,000 premises, the number of connections needed in the NBN’s non fixed-line footprint that includes satellite and wireless.

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http://www.news.com.au/national/new-sensor-technology-to-prevent-future-falls/story-e6frfkp9-1227034278894

New sensor technology to prevent future falls

• August 23, 2014 8:00PM
• Amanda Bennett
• Herald Sun

FALLS among the elderly could become a thing of the past, with the development of a new Melbourne-based technology aimed at preventing future falls.

Phil Goebel and his team at Quanticare Technologies are testing a sensor system, which attaches to walking frames, that tracks how well an older person is walking and monitoring any changes.

The senior’s caregivers and healthcare providers can view the data recorded by the system to predict and then prevent the incidence of falls.

Mr Goebel began developing the idea last November after graduating from a doctor of physiotherapy at the University of Melbourne, before forming Quanticare Technologies in April.

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http://ehealthspace.org/news/indigenous-health-pioneers-shared-services

Indigenous health pioneers shared services

Posted Tue, 19/08/2014 - 17:26 by Josh Gliddon

Galambila Aboriginal Health Service covers are large geographical area between Coffs Harbour and Forster on the NSW North Coast. Officially it’s made up of four regional health services covering eight clinics, as well as an aged care service and child welfare officers, but the way it operates from a technological perspective is unique.

Instead of each of the four services operating its own IT set up, they have combined into a single shared-service solution, says Jon Rolph, Galambila’s IT manager.

“This allows us to do things other services can’t do,” he says. “For example, we’re able to look at monthly comparative health data across the eight clinics, rather than just a single clinic.”

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http://www.businessinsider.com.au/malcolm-turnbulls-happy-with-this-fttn-speed-test-on-the-new-nbn-2014-8

Malcolm Turnbull's Happy With This FTTN Speed Test On The 'New' NBN

Peter Terlato Aug 22, 2014, 10:32 AM

The National Broadband Network (NBN) has connected the first fibre-to-the-node (FTTN) users and Minister for Communications Malcolm Turnbull has expressed his satisfaction with pilot program’s initial results.

A handful of Umina homes have participated in the first tests of the new network, Yahoo!7 reports.

Turnbull posted a screenshot on Twitter which displays the upload/download speeds of a computer connected to the NBN FTTN network in Umina, on NSW’s Central Coast. It’s getting 95 Mbps down the pipe – that’s fast. A standard ADSL2+ connection has a theoretical maximum speed of about 20Mbps.

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http://www.zdnet.com/microsoft-to-deliver-windows-threshold-tech-preview-around-late-september-7000032668/

Microsoft to deliver Windows 'Threshold' tech preview around late September

Summary: Microsoft is aiming to make available a technology preview of Windows Threshold around late September or early October.

By Mary Jo Foley for All About Microsoft | August 15, 2014 -- 14:10 GMT (00:10 AEST)

Microsoft is aiming to deliver a "technology preview" of its Windows "Threshold" operating system by late September or early October, according to multiple sources of mine who asked not to be named. 

And in a move that signals where Microsoft is heading on the "servicability" front, those who install the tech preview will need to agree to have subsequent monthly updates to it pushed to them automatically, sources added.

Threshold is the next major version of Windows that is expected to be christened "Windows 9" when it is made available in the spring of 2015. Threshold is expected to include a number of new features that are aimed at continuing to improve Windows' usability on non-touch devices and by those using mice and keyboards alongside touch.

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http://www.smh.com.au/technology/sci-tech/toothless-dragon-pterosaurs-once-ruled-the-skies-20140820-1068g8.html

Toothless 'dragon' pterosaurs once ruled the skies

Date August 20, 2014 - 2:52PM

Amina Khan

Ancient winged reptiles called pterosaurs were so successful they ruled earth's skies for tens of millions of years, according to a study published in the journal ZooKeys.

The fearsome flyers, part of a family of pterosaurs named Azhdarchidae, get their name from azdarha, the Persian word for "dragon".

Unlike earlier pterosaurs, they had no teeth, and they dominated from late in the Cretaceous period (about 90 million years ago) until the extinction event that also killed off the dinosaurs about 66 million years ago.

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Enjoy!

David.

Some Interesting Reactions To NEHTA’s Legal Letter And NEHTA’ s Overall Position.

First I had this e-mail.  Quoted with permission but not attributed .

The e-mail is referring to the poll that is running on the blog from 24 August, 2014.

“With respect to your latest Poll, the BCG Papers and EHealth Strategy (2004) unfortunately midwifed NEHTA into existence.  Based on their constituted 2yr review, it doesn't take too much super sleuthing to localise where the Governance issues are to the appalling lack of ehealth progress tragically observed to be missing over the past decade.

The past 10-year direct cost to the Taxpayer consumed by NEHTA is distasteful enough let alone the unfathomable "opportunity cost" their unabated incompetence has been on the healthcare system and ehealth sector of Australia.

And They Don't Care!

Deloitte in 2008 and now the PCEHR Review (2013) both recommended dissolving/winding down NEHTA and yet somehow miraculously they still keep on trucking and consuming Tax Dollars.  If you look at the names on NEHTA's Board and its surrounding alphabet soup of committees, advisory bodies and panels pretending to "Govern" eHealth in Australia, you will find over the past 10 years a common cast of characters that has gladly taken plenty and given nothing as far as positive contributions to Australia's eHealth, with this fish very much stinking and rotting from its very mindless head!

If at minimum nothing else changed but the ceasing of wasted taxpayer dollars thrown at NEHTA and its surrounding constellation of parasitic panels, sycophants and free riders, that alone would make Australia better off in returning these funds back to the taxpayer just as a responsible corporation would return unused or underused funds back to its shareholders for potentially better use and hopefully greater investment returns elsewhere.”

If you want to read these various reports supporting this view go here:

http://ozhealthithistory.wikispaces.com/Key+National+Strategy+Files

(There is a good collection of strategy files found here. If you have others that would be of interest to others please e-mail them to me and I will put them up. We probably needs a State Strategy page and an evaluation of e-Health Page)

It is always good have such a well-articulated view highlighting just what I also happen to believe has gone wrong. To me, NEHTA has a lot of competent staff who are being badly betrayed by the leadership and the Governance framework NEHTA exists under. We all know change is desperately needed but for some reason it doesn’t. Theories welcome!

This point has been emphasised to me by a number of people who know NEHTA very well indeed.

From a legal aspect the advice has been pretty consistent and helpful (nice to have partners in major firms help pro-bono - there are still some good guys around.)

1. NEHTA seems to have rather over-reacted - an e-mail would have worked!

2. It is sensible to remove the posts.

3. Treat the letter as confidential.

4. Keep an eye out and do not allow posting person specific comments that are negative.

Thanks to all for the supportive comments and do vote on the current poll!

David.

AusHealthIT Poll Number 232 – Results – 24th August, 2014.

Here are the results of the poll.

Do You Believe The Present Leadership Of NEHTA and DoHA E-Health Initiatives Will Be Able To Deliver A Successful PCEHR?

For Sure 15% (41)

Probably 4% (10)

Neutral 2% (4)

Probably Not 14% (36)

No Way 65% (172)

I Have No Idea 1% (2)

Total votes: 265

What an extraordinary poll! 3 days ago the outcome of the 80 or so votes was a clear no way. Two days ago it reversed and I wrote a blog pointing out what was going on.

See here:

http://aushealthit.blogspot.com.au/2014/08/the-blog-really-stirs-up-nehta.html

Then there was a sudden reverse as every man and his dog voted No Way. The view of the readership is clear cut. Presently we do not seem to have much of a chance of success.

Again, many, many thanks to all those that voted! A really fun saga!

David.